Endo - prescribed cyclical, chances of continuous with same GP?

[EndoEndoNoNo]

Sorry this is long. In peri for 4 years but my symptoms were completely manageable until 2 months ago. I still have periods every month but once a year I have missed one. I went to the GP and the conversation included that I had yet to have a mammogram, I am almost 52 and then a referral to the Familial Breast Clinic because of family history so the appointment was taken up with that, plus weight, height and BP.

She would only prescribe cyclical progesterone even though for endo continuous is recommended. This is because unopposed oestrogen feeds the endo and my endo was so debilitating I stopped working 20 years ago. I do not want to make it any worse than it already is, I am on prescription painkillers for my period as well as daily pain and other symptoms from my endo.

I didn’t expect there to be any pushback to the continuous progesterone so I didn’t have evidence to back it up. Came away with a prescription for oestrogen and cyclical progesterone. I understand their reasoning which is breakthrough bleeding can be a symptom of other things which may be ignored. They did offer me the coil and continuous progesterone because the coil would stop my monthly periods. I don’t want the coil.

My GP surgery has a brilliant messaging system where I basically said I am not taking the prescribed HRT and here is the medical evidence for continuous progesterone and cited The British Menopause Society, The Menopause Centre plus consultant gynae surgeon Chris Mann who specialises in endo who spoke with Louise Newsom on her podcast. He agrees with continuous progesterone too. In that podcast he said anecdotally that most women settle after 6 months on continuous combined HRT.

The surgery called me back and booked me for a follow up appointment with the same GP next week. Would a GP change their mind on this? I will print out all the links to medical papers because in medical school they are taught endo calms down after menopause but there are medical papers citing this isn't the case.

Anyone out there with endo on continuous progesterone? Was it a fight to get it?

Of course your GP can and should change their mind.

You can also ask for a 2nd opinion and to be referred to a consultant who knows more than they do.

The use of cyclical v continuous is a matter of individualised treatment- it's not black and white, regardless.

You could also if you want to just use the progesterone every day and make it your own choice if they are being non compliant.

Look up the ESHRE guidelines which also recommends continuous HRT for endo sufferers. It shouldn’t be a particularly contentious request.

I'm on continuous combined and in peri. I take 200mg utrogestan daily because cyclical upstairs my migraines, it wasn't an issue with my GP.

I take 200mg daily instead of 100mg daily because I was having heavy bleeding on cyclical and didn't want breakthrough bleeding on continuous.

You'd want a higher dose continuously to control endo growth I assume? I can't imagine 100mg a day being enough.

My GP does also keep trying to get me to have the mirena too. They all seem obsessed with them and have a hard time accepting they don't work out well for everyone.

In general my GP is fantastic though and really well informed. I have taken in info from the Internet before and she happily it as extra info, there is another GP at the surgery who is the total opposite of this so I think it's a bit of a lotto.

This is all very helpful thank you. She did seem informed about endo, even offered me relugolix but I had put my body through a chemical menopause in my late 20s and the side effects were horrific so much so I was dreading menopause. I became a completely different person and hated myself but my endo was so painful I would have done anything.

My endo symptoms are currently the best they have ever been which I attribute to my falling oestrogen and I don't want to start it back up again with unopposed oestrogen.

I was prescribed Oestrogel pump pack 0.06% and cyclical progesterone at 100mg. She said if I give you continuous you will be all over the place but I am all over the place now with being over emotional and dry hot flushes all the time as well as brain fog, memory issues, disturbed sleep and feeling low.

I have no idea about dosage for endo but will start looking into that too and at ESHRE guidelines. My appointment is Wednesday so I have time. Dh is also coming with me, he is incredible, backs me all the way.

She's being a bit black and white on this.

You're 52- not 42. Your own periods are likely to stop soon (average age is 51) so they are likely to be irregular anyway getting further apart.

If the choice is between some irregular bleeding (and that's not a given, it may never happen) or a reactivation of painful endo, it's a no-brainer.

Stick to your guns.

(By the way the cyclical dose is 2 x 100mgs capsules.)

@JinglingSpringbells thanks. I can't see dosage on the NHS app for the progesterone, just what has been prescribed, but I realise it says 84 tablets so you are correct it is 2 x 100mg.

I am determined and I hope that a quick discussion will see her change her mind on it. Like you say bleeding vs reactivation of endo is a no brainer. I think I will be using that line.

Just an update, she did agree to continuous but begrudgingly and in a way that made me feel I was in the wrong. She did put up a fight with increase breast cancer risk and I said well I can't carry on like this either, I feel dreadful and I wouldn't be here unless I thought HRT would help. She then doubled down and said that it won't be a miracle cure for my symptoms, I thought, wow, you are so cheery. She too is either perir or menopausal and just flat so I let it go as I got what I came in for.

I am on the lowest dose of oestrogel and 100mg progesterone so we will see how that goes for the next 3 months. I slathered oestrogel on when I got back from the GP. Thank you to everyone above.