Has anyone gone back to cyclical progesterone after not getting on with continuous

[hrthrt]

Wondering if anyone can help with this? I am 50 and was on cyclical hrt for about three years (oestrogel and utrogestan). At my last doctor's appointment she suggested that I might like to try continuous progesterone so that I wouldn't have periods any more. I am about six months in and have had a lot of bleeding since starting the continuous regime (utrogestan 200 every day). Also I think maybe some lowering of libido.

Although I know that the bleeding can take 3-6 months to settle I am feeling that I would like to think about going back to cyclical. Has anyone done that? I'm worried I will have some sort of mega period and that I should stick it out now I've started. Would be v grateful if anyone has experience.

Hopeful bump...

Maybe not enough info for you but I am still on cyclical after 16 years on HRT, starting in my early 50s.

I had around a month on continuous at one point and hated it- daily migraine.

Cyclical or combined continuous is a choice.
A lot of GPs try to push cyclical saying it reduces the risk of endometrial cancer, but rarely explain it also raises (slightly) the risk of breast cancer compared to cyclical.

Ah - that's really interesting, thank you! My doctor was definitely enthusiastic about the idea, although it was the 'no periods' bit that sold me at the time. With apologies if this is intrusive (or just a daft question), if you carry on having cyclical does that mean that you carry on having a monthly bleed even when you would otherwise be post-menopausal? Also, do you recall whether going back to cyclical caused any problems? Appreciate that it may not have done because you did it for a relatively short time.

Same experience as you. Doctor suggested at a medication review that I moved from cyclical to continuous which I did. Bled constantly for six months, it didn't settle at all. GP suggested I move back to cyclical which I did and all good since, a monthly bleed just as before but not the endless bleeding. No mega periods, it was all pretty seamless. I'm 49.

With apologies if this is intrusive (or just a daft question), if you carry on having cyclical does that mean that you carry on having a monthly bleed even when you would otherwise be post-menopausal?

I'm afraid it does. But the bleed lasts only for about 4 days with 2 heavy-ish days. I don't like that at all but I feel it's the easier option.

My HRT is through a private consultant. I'm allowed to extend the cycle a little so it's not every 4 weeks. The cycle is considered off-licence. I have a pelvic scan usually annually to check everything.

Going back to cyclical didn't cause an issue but I was only off it for a very short time.

Thank you both so much @JinglingSpringbells and @martinflannigam . That is incredibly helpful - I have struggled to find anything online about this despite the wealth of info about hrt generally.

It is interesting that continuous progesterone doesn't agree with everyone - the doctor didn't mention that possibility. I find it difficult to weigh up the pros and cons, but I think dealing with carrying on having some level of periods would be better than feeling like I do now. I guess in the end it is only the same thing as the last 37 years or so (pregnancies aside)!

Typo? "A lot of GPs try to push cyclical saying it reduces the risk of endometrial cancer, but rarely explain it also raises (slightly) the risk of breast cancer compared to cyclical." Did you mean continuous? Apologies, if I'm being extra dozy tonight — brain seems constantly fried these days.

Sorry- yes typo! They push continuous @DozeeMare@hrthrt

I didn't even notice it - so am clearly also in the brain fried camp! I have been thinking for the past couple of days about whether I may have had some mood effects from the progesterone as well. It is so difficult to identify impact on mood, particularly given that I am still taking it, but I think maybe it has had a slightly depressive effect.

I wonder if there should be a bit more discussion of pros and cons before suggesting continuous. Also, @JinglingSpringbells I have been thinking quite a lot about the approach of just carrying on with the cyclical, which I had been fine with, even after I would definitely be out of menopause. If only on a 'it isn't broke, so why fix it' basis.

I have a friend coming up to 72 who is still on sequential HRT as she can't tolerate continuous. Her GP 'allows' her to extend the cycle a little.

Ah, thank you for clarifying; that makes perfect sense (almost!). I thought it might be continuous.

I was upped to 200mg of progesterone daily as the oestrogen patches were increased to 100mcg — but when the HRT specialist at the GPs discovered (I pressed for my levels to be checked) my very low oestrogen levels (Serum 17b oestradiol). Obviously, I was not absorbing enough from HRT patches, so rather than increase them or change brand, they put me on Lenzetto and... back come the hot flushes. Oh dear.

Be aware that taking blood when on patches is very inaccurate- I posted a long extract from a dr at a menopause clinic on this a few days ago.

Ideally, blood needs to be taken over 24 hours which is impossible. The info said that the blood (when on patches) is best done when the patch has run out.

That is interesting, I seem to remember from memory (but then ... !) that I was at the 'needs to be replaced patch' day. Still, at Serum 17b oestradiol it's alarmingly low? And the mood swings, hot flushes seem to be agreeing...

Are you on Utrogestan oral capsules or pessaries? You mentioed 200mcg every day but when used continuously the oral capsules are usually 100mcg daily (as opposed to 2 caps (200mcg total) for 12-14 days on cyclical HRT). Just trying to understand what you are taking.

Am using pessaries as I didn't get on with oral progesterone at all. The doctor suggested 200mg a day, although we didn't discuss the possibility of 100mg every day. I did wonder about going down to that - or even 200mg every other day - but wonder whether that would be the worst of both worlds.

Am very grateful for everyone's thoughts so far and any further thoughts very welcome!

I too thought this was odd.

Unless you're on a high dose of gel (4 pumps a day) the dose of Utrogestan is 100mgs a day for a combined continuous regime.

Some drs will suggest 200mgs a day to prevent breakthrough bleeding for women using high doses of estrogen. That's 4 pumps or possibly 3, but it's not a 'given' - it's all individualised.

Utrogestan as a vaginal pessary only comes in 200mgs (one capsule.)
But many women use 2x100mgs capsules (for cyclical regimes.)

You can use 100mgs capsules vaginally. They are identical apart from size!

Continuous progesterone should be 100 mg only - 200mg means you will still bleed.

Sounds like your GP might be confused about the dosage for continuous no bleed.

you do 3 pumps of gel - I started with 2 but increased to 3 in the morning.

The progesterone must be taken at night 2 hours after food before bed with water.

if you don’t do this you will bleed. If I miss my dose and take it in the morning I can bleed for a few days if I take two by mistakes I can bleed as well. It’s a 100 mg continuously every day. Does that help?

www.nhs.uk/medicines/hormone-replacement-therapy-hrt/continuous-combined-hormone-replacement-therapy-hrt-tablets-capsules-and-patches/how-and-when-to-take-continuous-combined-hrt/#:~:text=Take%20continuous%20combined%20HRT%20tablets%20or%20capsules%20once%20a%20day,to%20take%20it%20with%20food.

It took about 3 months to stop all bleeding and get my dose on continuous hrt but I feel a million times better now

@Lefthanddownnumberone Taking 200mgs doesn't mean OP will bleed- only if it's part of a sequential regime where it's taken for 12 days a month.

Taking more means less bleeding as it opposes estrogen.
That's why it's suggested to increase it to 200mgs for women using a high dose patch or gel.

Also, the only reason to take Utrogestan at night is that it can cause dizziness and drowsiness.

Taking it with food increases its action- doubles it. So it makes bleeds less likely.

The reason they say 'after food' is that as food increases its action, it can also increase side effects in some women.

OP is using it vaginally- not orally.

I’m 57 and still use cyclical HRT as I really cannot tolerate daily progesterone. My GP is happy for me to do a slightly longer cycle and I have a short bleed every six weeks. Life is much easier when I don’t want to stab people every day!

I take it cyclically and don't have periods. I did at first but now it's settled down

I switched from sequential to continuos just over 12 months ago, after 2 yrs on sequential (gel and utro)HRT (I'm 51)
Although I know many people dont like it, personally I much prefer continuous as find I get less mood fluctuation and it suits me well. However, I have continued to have a monthly bleed. I suspect this is simply because I am not post menopausal, and I was not surprised and TBH was not concerned. However, this flagged at my last HRT review in dec as technically all bleeding should have stopped after that long on continuous. My GP was lovely, and very pragmatic about it , but still had to refer me on, which I understand. This then led to a TV scan. My endometrial thickness was 5.8, which would have been fine if I had still been on sequential, but because I am on coninuous it flagged as thickened and then triggered referral for uregnt hysteroscopy - which I am now off to have done today!
So just to say, from my experience bleeding doesn't always settle on coninuous, esp if not post menopausal and this can the trigger further investigations. Its all a bit annoying as I would prefer to stay on continuous, but also dont really want this to happen at every HRT review if I am still bleeding....will wait and see what outcome of today is and then decide on next steps.

I've not long been seen by a meno consultant. I easy taking cyclical utrogestan because I was struggling to tolerate it however the consultant whilst saying I could stay on cyclically really wanted me on continuous. Apparently once your over 50 or at least 5 years on hrt your better to move over to continuous due to reduced cancer risks. I take 100mg daily and have been really surprised how ok I've found it.
Have had days of extreme fatigue and low mood but I think that's just my body adjusting. I've only been on the continuous a month but fingers crossed seem to be over the initial problems and doing quite well on it. It's definitely improved my quality of sleep and anxiety. I take it vaginally every night.

If I didn't get on with it though I would have no problems moving back to cyclical.

Forgot to say as pp I've found my mood much more stable on continuous progesterone. I no longer get pms type symptoms. I was also finding a 'crash' for a few days where I felt really low once my cyclical progesterone stopped. Continuous has kept things on a much more even keel.

I'm 51 and post menopause. Take 2 pumps of estrogen a day.