Does anyone know the answer to this question? Re perimenopause and progesterone

[Spiderplantseverywhere]

Why do doctors happily prescribe progesterone only synthetic pills for issues in perimenopause but won't allow a body identical progesterone tablets to be prescribed without an accompanying oestrogen?

I'm 52 and sadly for me I still have a regular cycle.

I don't bleed though due to a uterine ablation I had in 2022. That proved to be a huge mistake for me. I'd spent decades with periods so heavy that I ended up needing iron infusions and then opted for the ablation to avoid synthetic hormones as I'm convinced I have always been oestrogen dominant and my mother has breast cancer so wanted to avoid putting those into my body potentially making issues worse.
However, I was still bleeding post-ablation. Gynae said to give it 6 months and for the scar tissue build up and this will stop the bleeding. And it did, yay! However that yay was short lived because I simply swopped painless heavy and flooding periods for bleed free yet excruciatingly painful ones. I put up with it for a year. Had a MRI late 2023 which found previously undiagnosed endometriosis and now diffuse adenomyosis. Gynae diagnosed post ablation failure.

So I'm now under a endo specialist and on a waiting list for a hysterectomy (really didn't want this and the whole point of the ablation was to avoid big surgery so now I'm terrified).

Anyhow, I've tried hrt but it made the pain worse. I've been offered the progesterone only pill but I didn't want anything synthetic. I've asked if they are happy to prescribe progesterone only synthetic why can they not prescribe body identical progesterone only for me. Everyone I've spoken to says they can not do this, yet are happy to prescribe it alone as the mini pill or a mirena (I can't have that as my cervix is now sealed from the ablation scarring).

I know I could just accept the hrt in both forms and simply use the progesterone only but I'm worried about doing that if it's not recommended but I still can't see why women in my position can't take it alone. without oestrogen. I understand oestrogen only when you have a uterus can be dangerous but I can not see any evidence that progesterone on its own is as bad.

Can someone enlighten me? My brain is fried from a myriad of peri symptoms, pain from this ablation disaster, an exacerbation from my decades long IBS journey (daily nausea and upset tummy) and caring for my elderly mum who has advanced Alzheimer's.

Life is pretty shit atm and I just want something to take the edge off even if it's just a little bit, it's got to be better than what I am going through right now?

@Spiderplantseverywhere I am so sorry to hear what you are going through, it sounds horrendous and I can to some degree identify having (and still) quite a few debilitating menopausal symptoms.....I don't understand why they can't prescribe Utrogestan? this is a pill but bioidentical is this the type you mean? or am I understanding it wrong. Sorry if you have already tried this...and I would ask for a referral to a menopause clinic to speak to a specialist (put your foot down) there are some good NHS ones, although I know pot luck....there needs to be more and more highly trained specialists for womens health...sigh....Good luck wish you all the best, but finally push on....you will come through this it might not feel like it today, tomorrow or the next but push to be seen and heard you deserve to heard and you will come through it....

@Spiderplantseverywhere I think the real question is if micronised progesterone would sort out your problems. It's sometimes not as effective as some of the older synthetic types used in HRT or for contraception. It can also cause low mood and many other side effects but these are reduced if it's used vaginally. At 52 you're likely to be post meno pretty soon.

The other thing- sorry to contradict what you've said- is there is no such thing as being estrogen - dominant. As far as I know, was a phrase some US drs invented years ago in order to try to flog progesterone cream as a treatment for all kinds of things.

It's not HRT estrogen that causes breast cancer because women who have had a hysterectomy have less BC than women not on HRT at all. It's the type of progesterone used with it that seems to be the potential issue.

You're right that micronised progesterone is not licensed just on its own for menopause. However, if you were to see a private specialist they might help you out. Just be sure of what you want to achieve- is it an end to the bleeding?

Has anyone suggested removing your ovaries which would stop your hormonal cycles but not be as big an op as a hysterectomy?