HRT query.

[DemonsandMosquitoes]

My GP has today switched me from sequential to continuous HRT. I take 3 pumps of oestrogen per day and she has advised utrogestan 200 every night. I thought the dose of utrogestan was 100 every night on continuous? Only clocked this after I left. Anyone else on 200 daily on continuous?
I’m 54 in January, having in a bleed most months but pretty irregular.

I’m on 200mg each night. This is because I had an episode of postmenopausal bleeding and was referred to a gynaecologist who increased it from 100mg. I think the usual starting dose is 100mg but 200mg isn’t unusual.

I recently increased to 200mg daily on continuous after seeing my menopause consultant (at Barts).

I recently started HRT. I have 2 pumps of the gel and 100mg progesterone at night. I am also on the progesterone only pill.

If you are on 3 pumps of the gel and aren’t taking the mini pill, I can’t see any reason to worry about taking 200mg. I’ve just seen on the NHS website it says this:

”The usual dose of Utrohestan is 2 capsules (200mg) taken once a day, on days 15 to 26 of your 28-day HRT cycle”. It goes on to say some doctors may advise taking it every day if they think it’s in for you not to have a period.

So basically it looks like it’s fine - different irons get different doses for any number of reasons.

I was going to ask the exact same question.
I was on two pumps a day and continuous 100mg per night.
At my annual review, I told them I’d upped it to 3 pumps and they rang me back after my appointment and said when the senior doctor reviewed my notes, because I was on 3 pumps, they were upping me to 200mg continuous.

Oh as an edit, I haven’t had a bleed since 2024. If I can get to January, I reckon I’m official done 🙌🏻

Do you only get put on tablets if you are bleeding ?

@DemonsandMosquitoes The guidance on this from the British Menopause Society is that some women using a higher dose of gel may need to increase the progesterone.

However, it's not mandatory because some women don't need it and don't tolerate a higher dose daily.

The guidance is there for individual prescribing.
Usually, if you use 100mgs a day that is fine.
But if you found you had spotting or any irregular bleeds, you could increase to 200mgs a day.

This is in all the BMS guidance, available online, under endometrial protection/ HRT.

The different doses are for different things @Tillow4ever
Peri meno with some periods and post meno with no periods.

100mgs daily is for women post menopausal- and can be increased to 200mgs a day for women on high doses of estrogen (eg a 100mcg patch or 3-4 pumps of gel IF NEEDED.)

The 200mgs x 12 days is the sequential dose for women in peri or of any age who prefer a cycle, and not daily progesterone.

Thankyou. How do you know if it’s needed though when you haven’t yet changed over? Surprised I wasn’t started on 100 daily and then upped if had bleeding issues, rather than go straight in at 200. My GP has a special interest in menopause so guess I’ll go with it for now and see how I go!

I don’t know - I just added what I found on the NHS website. I haven’t had a period apart from the odd day of bleeding every 6-9 months for years as I’ve been on the mini pill.

Thank you - that makes sense and is worded SO much better than the NHS site!

Okay thank you 🙂

I am on 200mg of utrogestan daily & 100mg patch. I chose over 100mg daily after a long discussion with my menopause specialist because I am younger, only in peri, and wanted to try and prevent breakthrough bleeding / reduce heavy periods (start/stopping utrogestan was making migraines worse).

But my specialist was very clear that it wasn't mandatory just because I am on a high dose of estrogen. In the official guidance, it's only suggested that some women may need it.

I think GPs are just very worried about endometrial hyperplasia and feel out of their depth as they're not experts, but are expected to prescribe and make good decisions.

I don't have an issue with utrogestan, but lots of women do seem to. If you do, you could go back with the guidance in hand.

This is absolutely right.

There was BMS guidance on this a few years ago, partly as a response to women being given very high doses of estrogen (privately.)

However, GPs have now interpreted the guidance as a black and white 'rule' rather than an option.

The BMS report is online (anyone can read it) and it uses words like 'consider' (for higher doses of progesterone) - it's not mandatory.

The 'consider' is for women who may experience heavier withdrawal bleeds or where combined continuous HRT is not controlling the womb lining, resulting in spotting for longer than 6 months.

The growth of the womb lining with estrogen is very individual. On sequential HRT some women get heavy withdrawal bleeds, others almost none, even on the same low-medium dose of estrogen.

Yes. 'The 'consider' is for women who may experience heavier withdrawal bleeds' - this is me.

I initially tried 300mg cyclically to try and reduce the withdrawal bleeds, but this further irritated my menstrual migraine. So now I am on 200mg daily, which so far agrees with me much better. I felt I'd probably get breakthrough bleeding on 100mg daily, so opted for 200mg instead. It was my choice, based on other hormonal complications.

This is the type of scenario that guidance refers to, not just anyone on a high dose of estrogen.

I don’t want to worry you but the NHS guidance says that if you are on continuous HRT and experience bleeding you should speak to
your GP. This happened to me earlier this year and if I hadn’t looked at the NHS website I would have ignored it. I was put on the two week pathway for an ultrasound and then had a hysteroscopy and biopsy. All was fine (as it is for the vast majority of women) but you might want to get it checked out.

@Vlavlg If you're replying to @Tillow4ever , she says she has only recently started HRT. Youre right to ask her but it depends how long she's been on it.

With combined continuous HRT bleeding is expected/ normal for the first 6 months while the womb lining gradually thins.

I started HRT 2 weeks ago. I did say in my first comment I’d only just started. As a separate thing, I’ve literally only just had some tests (in the last 3 weeks) checking for potential cancer - one of my symptoms was an unexpected bleed with a very purpley-pink blood. I had other symptoms too that combined could have been some sort of cancer it turned out - but all my results came back as within normal range fortunately. Still no idea what caused it all, but getting onto HRT was advised so we could work out which symptoms were peri and which we needed to investigate!

Thank you though - it’s useful to know that as the doctor didn’t tell me that. I’m sure other women will read it and that could save someone’s life!