Constant bleeding on continuous progesterone

[QueenMabby]

I've been on hrt for just over three years. Was on the cyclical regime so 4 pumps oestrogel daily and then 2x 100 progesterone pills on days 15-27 of my cycle.

In the summer my gp said that I needed to move to the continuous progesterone regime with 1 pill every night. I did this but I was just bleeding all the time. Not always red blood but often dark brown. Over the first three months I only had about 14 days where I wasn't bleeding. The gp referred me for an ultrasound which was normal with a normal uterine lining etc so was discharged back to the gp. She recommended I double the progesterone to 200 a night which I've been doing for six weeks now but I'm still just bleeding all the time but now heavier. I just don't know what other options I have.

I'm really reluctant to try a mirena as I had one years ago as contraceptive and had to take it out early as I was just bleeding all the time on that.

Other than the bleeding I feel fine - I actually feel better on the continuous than the cyclical. The constant bleeding can't be right though.

Before I go back to my gp AGAIN has anyone else had this issue and what (if anything) resolved it?

Thank you.

It's very annoying for you I can see that.

Medical advice is that any change in dose needs 3 months before reassessing.

And, with combined continuous they say it can take 6 months for the lining to be thin enough not to shed. (So your scan at 3 months wasn't really necessary.)

You're on the highest licensed dose of estrogen. Have you been able to use less at any time?

That's probably the only way to reduce the bleeding in the short term or wait for another 6 months to see if it settles.

If not, you could try combined continuous patches which have Norethisterone and is usually more powerful than Utrogestan.

I’m currently in a similar situation. I started on continuous (provera and oestrogel) 3 months ago. I was doing really well with it until I started spotting earlier this month and I’ve had a heavy period for 2.5 weeks. I saw my GP last week and she said to just keep going with it and go back if it hasn’t settled by the end of Feb (so after 6 months).

When I went on to continous I was bleeding at least half of each month for about 3 months. I was so fed up I stopped taking it entirely. After about 4 months of not taking it the hot flushes and aches and pains came back with a vengeance so I decided to give it another go. I had no bleeding whilst stopped. Two pumps each morning and one tablet each night. I had one bleed then nothing, that was probably about 6 months ago - I've lost track. I feel absolutely fine now and happy to keep on taking the hrt. I think my hormones couldn't handle the switch from cyclical to continous without having a break in between to settle down.

Interesting. I was initially put on 2 pumps of oestrogel but symptoms which had improved suddenly came back after about 6 months so my gp doubled the dose. I've never tried changing it - mainly because I don't understand the interactions between the two hormones and how one affects the other.

Have a read about what progesterone does in HRT- it's to stop the womb lining getting too thick. (Women with no womb don't need it in HRT.)
The more estrogen you use, the more progesterone is usually needed. Or a different type.