Missed my utrogestan - opinions

[Hamsterfan]

Been on HRT for a few years, mid 50s. Still having periods when I started on Sandrena and utrogestan so take it cyclically day 15 to 26. Our house has been full of cold/covid whatever for weeks. In the midst of all this I have forgotten to take my progesterone this month, day 24 today.

This seems like a perfect opportunity to swap to taking it 1st to the 12th of the month. Does this seem sensible?

Yes.

Since you’re mid 50s and have been on HRT for a few years, now might be a good time to think about moving from sequential to continuous Utrogestan. They recommend you move to continuous after 5 years of use or by age 54 (whichever comes first).

But what very few drs are telling women is that the risk of breast cancer appears to be 1.5% ish higher on continuous, particularly with the older types of progestogen- jury is still out on micronised progesterone.

Source for this?

There is a lot online about this but this is summary here.

https://thebms.org.uk/wp-content/uploads/2025/09/02-BMS-ConsensusStatement-BMS-WHC-2020-Recommendations-on-HRT-in-menopausal-women-SEPT2025-A.pdf

PAGE 15

In absolute numbers, for women taking HRT for five years the increased risk reported in the meta-analysis was as follows:

• For women taking continuous combined HRT for five years from the age of 50, the risk of developing breast cancer between the age of 50 and 69 goes up by 1 extra case in 50 over 20 years from a background risk of 3 out of 50 women to 4 out of 50 women.

• For women taking sequential combined HRT for five years from the age of 50, the risk of developing breast cancer between the age of 50 and 69 goes up by 1 extra case in 70 over 20 years from a background risk of 4 out of 70 women to 5 out of 70 women.

• For women taking estrogen only HRT for five years from the age of 50, the risk of developing breast cancer between the age of 50 and 69 goes up by 1 extra case in 200 over 20 years from a background risk of 13 out of 200 women to 14 out of 200 women.

Be aware this is mainly based on the synthetic types of progesterone as there are few stats for micronised progesterone.

Given that the research is based on mainly synthetic types, and that it’s also the BMS who recommend you move to continuous after 5 years of use or by age 54 (whichever comes first), I think you need to be pragmatic and base any decision on your own circumstances and what works best for those. Otherwise you’ll go completely loopy with all the conflicting advice out there.

So much is based on extrapolation of small populations with very little evidence to support the validity on a larger scale and it tends to end up in whispered scaremongering. Given that being overweight and/or drinking a glass of wine or two every day is a higher risk for breast cancer than HRT (sequential or combined), some pragmatism common sense is required when considering options as even the medical professionals don’t all seem to agree.

I’m high risk for breast cancer due to my family history and have been under the breast cancer family history clinic’s ’supervision’ at Barts for the past 20+ years. I’m also under the menopause clinic there. Quite hard to get the two clinics to talk to each other but even once they did, the decision re HRT and breast cancer risk rested with me. All you can do is decide what is best for you on the information available at the time. I do think the historic (and incorrect) reporting on breast cancer risk and HRT has scared a lot of women particularly those who don’t have any increased risk for breast cancer into avoiding what may the best HRT for them, or indeed HRT full stop.

Thanks both I was aware of the small increase in breast cancer risk with the move to continuous combined having read the NICE guidance. The utrogestan also makes me rather moody and tearful so happy that it is only for part of two weeks rather than more of the month. Hopefully a move to calendar dates will reduce the likelyhood of me forgetting again. I wonder if in part the drive to continuous is the idea that “periods” could not possibly be tolerated for a moment longer than necessary.

Mother nature has a sense of humour doesnt she. Took my first 1st utrogestan last night and woke up to a natural period this morning! Now what carry on as planned with the utrogestan

Would it be a natural period though or just response to forgetting pills?

Feels like a natural period as thinking about it boobs have been sore all week. Withdrawl bleed after stopping my utrogestan normally starts about three days after this is now a couple of weeks after.