When did you move from sequential to continuous progesterone?

[GlomOfNit]

I'm 51, have had perimenopause symptoms since I was about 45/46. I've been on HRT for about two and 2/3 years now. I take 1.5 mg Sandrena gel daily and 200mg Utrogestan from day 1-12 of my 'cycle'.

Recently, I've found my withdrawal bleeds/periods are really scanty. They've started getting a bit more unpredictable in terms of when they come, and sometimes they're barely there at all. I mentioned this a few weeks ago, during my phone appointment with the meno clinic at our local hospital (we were discussing prescribing testogel) and she suggested that I start taking progesterone continually (eg 1x100mg capsule every day). She said general rule of thumb was, if you have three or more consecutive cycles where your period isn't there, or barely there, then go continuous. (and explained that I could expect intermittent bleeds for the first few months but it should settle down after that.) Seeing my GP more recently, she thought this was a good idea as she told me that continuous progesterone is more protective of the uterus lining. I said, I'd give it this cycle to see if I had another scanty period.

I suppose what I'm asking is - is this what other women have done? When I started on HRT I wasn't given any indication of when and how I'd change how I took the progesterone. How have other women managed it? When did you make that call?

(Right now, I'm having some belters of period pains and suspect my 'scanty' period might be a bit more of one this month!)

I'm afraid I can't help with experience of this yet but bumping and placemarking because I have the same question - I'm on a very similar regime and just had my first 'blank' month (other than an early bit of spotting) which led me to wonder 'what happens when...?'

Oh this is interesting as I have gone from femoston 1/10mg to femoston conti 1/5mg on the advice of a gynaecologist I see back in June. This all came about because I had mentioned at a routine appointment that I had spotting on the odd occasion and the doctor arranged a scan of the uterus on the 2 week wait path (which frightened me somewhat)! It was detected the womb lining was thick and I was then sent for a biopsy, things moved fast and if I'm honest I was a little scared by that point. Anyway the gynaecologist I see was clearly far more knowledgeable about HRT and asked questions about my symptoms and bleeding cycles etc. like you mine were almost nonexistent. She switched me over to the conti hrt and thankfully the biopsy was all clear - she'd reassured me everything looked perfectly fine. The femoston conti has been a game changer! No side effects whatsoever and my mood swings which I was having halfway through the month with the other HRT have gone completely. I have more life in me, I'm more sexually charged and it's been a blessing to have met that woman who knew more than any GP I've ever had.

I should add I'm 52 now and I've been on HRT for around 5 years.. tried various different types (patches/gels/tablets) femoston seemed to the best but I did notice a dip in my mood halfway through the packet each month. That's gone now, I'm far more myself if that makes any sense ☺️

I've been on continuous P since I started HRT. I had a Mirena inserted and used transdermal E from day one. Why would you have peri periods if you didn't have to?

To answer your question @GlomOfNit , never.

It's unusual that after so long on HRT your withdrawal bleeds aren't regular which may mean they are your own periods still coming through - called breakthrough bleeding. But you are just 51 and many women aren't post meno by then.

I've been on HRT for over 15 years and never intend to use it continuously. This is through an excellent consultant who explained the different risks, but the choice is mine.

The main reason is the risk of breast cancer is slightly higher (about 1%) so not a lot but it's a consideration.

Many GPs don't mention this. They seem stuck on the endometrial risk, which is tiny and easily treated if it were to happen.

I have a friend aged 72 who's still on sequential.

I also don't feel great on daily Utrogestan. I tried it and it gave me migraines.

A perfect demonstration of how people assess and value risk differently. For me, with no family history of BC, that extra 1-2% risk was not significant enough to influence my decision. Whereas an important aspect of the purpose of HRT was to make my life better, so minimising the misery of peri periods was highly significant. I also felt that I'd rather have 10 more good years than 20 more miserable years.

15y on continuous HRT, no negative consequences and I have not changed my mind.

Watching with interest. I'm 53 and moved from sequential to continuous ( Femoston) as my withdrawal bleed was a day and v light.
I'm on month 3 of continuous and have had a lot of intermittent bleeding.
Don't know whether to persevere or go back to sequential.
I feel better in every other aspect.
Like you OP I don't understand how you know when it's time to switch.
I'm thinking of going private as my GP practice only give you a few minutes of their time and don't seem to know anymore about HRT than I do .

I moved myself to continuous because that period without the progesterone seemed to trigger my endometriosis/adenomyosis to be far worse. Since I've taken it continuously, I've had far fewer days with terrible pain.

@Aparecium It's not solely about risk but how I felt on continuous. As a life long migraine sufferer, the daily 'drop' in progesterone levels before the next day triggered migraine, every day. I never had peri period misery. They just stopped by getting lighter over about 5 months.

It's not an extra 1% compared to no HRT but a higher risk than sequential.

I think GPs should give women more information so they can choose. There has been this emphasis lately on using continuous . I do wonder if it's to stop so many (costly) investigations that can sometimes occur using sequential if the bleeds aren't regular.

I'm on an off-licence sequential regimen so the bleeds aren't every month.

Most women aren't using HRT long term (over 15years) but GPs should still give the stats.

Sounds grim. If oral P leaves the body so quickly that its elimination causes such effects, how can it be considered 'continuous'? Part of the reason for having a Mirena inserted was to avoid such consequences. Mirena dose is minute compared to oral dose - and there's no drop effect.

I'm not trying to persuade anybody, BTW.

It's completely individual.

And- it takes up to 6 months to be effective when used continuously which shows it's not working 'overnight' but it is a slow process.

The Mirena gives as much progesterone systemically as a low dose patch. Some women have terrible side effects with is as it's an androgenic, synthetic type and can cause acne and weight gain.

Sure :)

Me neither.

I just think GPs should inform women of the stats so they can decide.

I seem to recall I was offered continuous after a year on sequential?

I declined, because I’ve had some issues with progesterone. I can tolerate the patches (although I do get migraines, @JinglingSpringbells, thank you for mentioning that, I’m going to pay attention to when in my cycle I get them), but I don’t want progesterone all of the time.

Watching with interest as I’ve wondered this too.

I went to continuous patches at 50 to manage my mental health. Sequential patches gave me 2 functional weeks and 2 low weeks where I struggled. Previously utragestan made me feel the world would be a better place without me in it. Currently trialling continuous progesterone and for the first time in 18m im actually functioning well at work!

That’s exactly how I felt on utrogestan. It was awful. It’s scared me off continuous progesterone. I’d be interested to hear more about how you feel on the continuous.

I've been talking to a couple of doctors at my surgery this week and they said I could switch to continuous utrogestan 'as I've been on HRT for three years'. I didn't realise this was a thing. Thought I'd be waiting a few years. I'm 'only' 48 and definitely no signs of scant periods. I might give it a go as I've not had any side effects on sequential.

@lickycat I had similar highs and lows and it became very noticeable which weeks where what. This has massively settled down now I'm on femoston conti and life is far better than it was.

I've been lucky in that Utrogestan hasn't given me any obvious side effects - I know a lot of women really struggle with their progesterone.

Well, as of the last few days, I think I may stay on the sequential regime a little longer, if the protocol the meno clinic doctor told me was to go continuous after 3 consecutive absent or very scanty periods! I've just had a fairly painful period (period pains did come back with HRT which is annoying, not having had an issue with them since giving birth) and for a couple of days absolutely nothing happened - and then I had, for me on HRT, a pretty heavy one. Lots of blood, lots of clots. :-/ In fact enough for my anxiety-prone brain to worry that something's amiss. I think it's easing off now though. So I think I'll stay sequential but keep a diary of bleeds and see if there's a trend.

@GlomOfNit Just wanted to add that my withdrawal bleeds are quite heavy and far more so than normal periods I had.

I don't understand your Dr saying after '3 months of no bleeds go to continuous' .
Continuous HRT is for women with no natural period for 12 month or aged over 54.

If you're already using sequential HRT the withdrawal bleed occurs as long as you're using it.

Blood loss on sequential varies but statistically 75% of women do have a withdrawal bleed.

If the HRT is creating a pattern, you would normally bleed 2 to 3 days after the last Utrogestan capsule. The blood loss is linked to how much estrogen you're using and the dose of Utrogestan alongside it.

If you are not having a regular withdrawal bleed each month, at roughly the same time each month, (and they're happening at odd times) it looks as if your own periods are still there and the HRT hasn't overridden them yet.

I switched to continuous off my own back (then ran it past the menopause specialist later who was fined with it) when I was still having regular bleeds. Flip flopping between two weeks on two weeks off utrogestan was destroying me. As the first 7-10 days of utrogestan I couldn't sleep then I'd finally settle and then the first week of no utrogestan I couldn't sleep. I was broken.

My sleep, mood and other symptoms are much improved on continuous HRT. I have a small amount of spotting approx every 26 days (I was still having regular periods when I start HRT but oestrogen level was 54pmol/l, which is why it took so long to be diagnosed as early menopause despite having all the symptoms and my life spiralling out of control).

I have considered switching my copper coil to a minera but I'm okay as I am, so don't want to rock the boat.

I've reacted badly to microgynon in the past so I know I'm hormone sensitive.

I'm good! No pmt, pretty positive, consistent. Periods are a bit random - but period pants mean they're not too much of a bother.

It's not the way the medication is supposed to be taken. Not sure how many GPs would support it. I may have just got lucky!