200mg utrogestan continuously in peri?

[101trees]

I've been on cyclical HRT since April this year (50 evorel patches + 200 utrogestan for 12 days).

Felt great for the first 3-months, then went off a cliff, so upped to Evorel 75, went became slightly psychotic for a couple of weeks and levelled out again to feel much better.

I get menstrual migraine which has dramatically improved since starting HRT.

The week before my period has dramatically improved with cyclical HRT, but I now seem to drop off a cliff when I stop the utrogestan. It seems to be the starting and stopping which is a problem, particularly for migraine and mood.

I'd like to try continuous utrogestan, but I think I'll probably get breakthrough bleeding as I have regular cycles in-spite of the utrogestan (they start every 24 days, even if I'm still taking utrogestan when they start).

Would doubling the standard continuous utrogestan dose to 200 prevent breakthrough bleeding?

I'm only 40, but my Mum had her last period at 40, and her mum at 42. Prior to starting my cycles were shorter (21 days down from 28) and very light (they have got heavier). I was having 15 migraines a month, now down to 2 (hooray!).

I wasn't sure if starting continuous would eliminate the fluctuations, or throw everything off completely.

Anyone have any experience of continuous utrogestan whilst still having regular periods?

I'm no expert but I'm on continuous and still in peri. I have semi regular cycles still - the utrogestan isn't enough to stop periods. So it can be done. But I was prescribed this way of taking it by a consultant and the thickness my womb lining gets checked every couple of years or so. I wouldn't recommend switching without consulting a doctor. Also I think there is some guidance out there that if you reach a certain age (54?) And you've been on HRT for several years its also ok to switch, with a doctor's advice.

Edited to add: I switched because of a womb issue, but yes, I feel more level and that things don't fluctuate as much generally.

Would doubling the standard continuous utrogestan dose to 200 prevent breakthrough bleeding?

Probably not. But you'd have to try. You might get side effects from using that amount daily - like lethargy, low mood etc.

The guidance is to use continuous after 12 months with no period, or over age 54, if you want to. It's not mandatory.

Would you think about a mirena coil? Or the Pill? Some women your age use the CCP (ones with more natural estrogen in them) rather than HRT.

I saw a menopause specialist talking recently and she mentioned that women who suffer hormonal migraines really shouldn't be on cyclical progesterone as it can cause issues. Wish I'd known that sooner! I switched to Mirena for this reason - to just give me a more steady dose.

Thanks for all the replies.

I don't do well with synthetic progesterone unfortunately. I tried the mirena twice (5 years, then a break for a few years, then again for 18 months), had the same effect from mini-pill and COC. I got really awful side effects even from all of them, mainly horrific mood and migraines. The worst part about the mirena was that I didn't realise until it stopped that's what was causing it all, I just felt my life was awful.

Other than the starting and stopping, the Utrogestan has basically been fine. I was actually shocked as every other progesterone has been so awful in the past. But I am a bit worried about how it works when it builds up over time.

Do you get increased side effects if taken continuously? It's the low mood I actually fear the most. But I'm a bit of a raging psychopath with my mood swings when start/stopping the Utrogestan, so that's not great either.

I seem to feel quite good when it's stabilised in the middle, just when I change it each month I get massive mood swings and migraines.

Thanks for this.

Yes I'm under a menopause specialist so would speak to her first. My GP was actually really keen for me to start with continuous because she thought I wouldn't get a period, but I think she's wrong, when I had the mirena I bled continously for 5 years, I don't want that again.

Can I ask if you feel the continuous affected your periods? Or did they remain largely the same.

Other than getting a bit heavier since starting estrogen (I had an MRI a year go so I know I had a thin lining anyway, so they were very light periods, more like spotting), my period timing is not affected at all by utrogestan at the moment. It still shows up on the same day, even if I'm still taking the utrogestan. I'm wondering if that might happen if I tried continuous too...

For me it has more than halved the blood loss but the cycle is still there. The only time my period stopped altogether was when there was a nationwide shortage of Utrogestan and the dr gave me Provera instead. Might be worth a try? I would have stayed on it but it made my hair fall out!

Ah well I have enough hair for 3 people, so I don't mind losing a bit!

Never heard of Provera before, I just looked it up and found it interesting.

Did you find they were regular periods just lighter? Or loads of spotting at random times?

My experience of contraceptives in the past has been loads light of irregular bleeding and spotting, which isn't the end of the world, but it's also been accompanied by PMS symptoms which I've had enough of. I really don't want to be continually bleeding a bit.

I don't mind having a period once a month, especially if it's lighter, I just don't want to be randomly bleeding with random mood swings due to random PMS - which is how I was on the Mirena.

Couldn't someone just find a perfect solution for each individual woman already !?

I just don't think GPs know much about HRT or migraine. And they're the ones prescribing it most of the time. Even my menopause specialist paused when I first mentioned cyclical being a problem for migraine - she's used to treating hormonal symptoms, not migraines.

But I think it's quite individual with migraines. I've been under neurology for years, tried Botox, CGRP, every medicaiton under the sun.

The only thing which has ever improved them is HRT. My neurologist actually said you just can't tell how someone will react, you just have to try them and see.

When I started peri, migraines increased to 15 a month, it was completely unmanageable. My hormones were just going nuts.

I'm really grateful for the improvement in migraine, I just can't cope with the mood swings and remaining migraines from start-stopping. But I fear messing with my hormones so much.

Thanks for sharing your experience, it's so helpful to hear from others.

I'm on continuous utrogestan because of endometriosis. 2 balls a night to balance 100 estradot. Works well for me.
I thought it would stop my periods but it hasn't. They are generally light be quite erratic. Helps reduce my migraines too, but still get them a little before my periods, when presumably my hormones naturally fluctuate. It's not like the drugs cancel out your natural cycle entirely.

I’m on a continuous progesterone and have been since day one as I had surgery for endometriosis at 45 I’m 50 now and have been on HRT for 2 years, the stopping and starting wasn’t even a consideration for me I get massive anxiety around my periods and this has been my life line and only thing that’s given me a break from agony.

it’s also advised that women with endometriosis using HRT will be better continuous and a lower patch, to avoid any flare ups in later life.

I feel like I can “feel” my cycle under my pill, I do get odd pulling pains like ovulation I have mood changes around what I think would be my period but no bleeding or cramps etc.

Soeak to your menopause clinic but I know a few others that don’t do the breaks more so as it’s so bloody confusing! And it’s essentially the same as having the coil just orally.

Can I also just add migraines are also linked to low iron, which women are prone to, so get that checked as well, that can be a simple fix.

Thanks, that's interesting. Is it used that way to try and stop ovulation altogether? Or just try to balance the estrogen?

The idea of balance in that way always confused me because I think - well isn't the point that we're trying to top up estrogen ? Why do we then try to balance it with more utrogestan so we're back where we started ?

@100Bees the progesterone part if to protect the womb lining, it would build up otherwise and can cause issues.

@101trees As PP has said, progesterone is only given to protect the womb lining. Using estrogen makes it grow. When you're not ovulating (post meno) it will grow and grow without progesterone to control the growth. This can lead to some cells in the lining growing irregularly= cancerous.

Progesterone changes the lining from growing to becoming 'stable' and when you stop it each month the lining sheds, like a period.

If you don't want this, using a low dose of it every day controls the growth of the lining.

It's not used to 'balance' estrogen.

If you had a hysterectomy you don't need progesterone with HRT.

Oh that makes lots of sense. I hadn't thought about the folks who have estrogen only. Thanks to you both for explaining.

My Dr said something about 'getting the balance right' with estrogen and progesterone in relation to mood issues.

But when you put it like that it makes complete sense.

I have to say my periods have only got heavier with HRT. They were almost non-existant, but still very regular, for a few years before starting HRT (bar the immediate 7 months after I had a baby when they were insane).

Does the bleeding lessen and settle down the longer you are on cyclical HRT? Or is that just continuous?