Can I ask to return to daily progesterone on NHS HRT?

[Penelopeandherpitstop]

I moved back to the UK from Canada recently. My GP in Canada had prescribed me 100mg daily progesterone plus two pumps estrogen gel. Initially the GP prescribed cyclical 100mg progesterone for three months before adding in the estrogen.

Before starting HRT my periods had been very irregular - I had about 5 months with no period, then bleeding roughly every two weeks for about two months ish, then no period for a few months then the frequent bleeding again. This was one of the reasons I saw the GP about HRT. When I started 100mg progesterone I didn't have any bleeding/periods for about 5 months, and then did have some irregular bleeding over a approx 2 to 3 months but not as disruptive or frequent as the bleeding prior to progesterone.

The estrogen helped with night sweats and I was generally happy with this HRT regimen.

I get migraines and headaches and found the HRT helped with this to a degree - the migraines didn't increase at least. There are other stressors and triggers for my migraines as well and they didn't necessarily track with menstrual cycles pre HRT.

I am nearly 50 and started the HRT at 48 and had been taking the 100mg progesterone for over 1 year before I moved back to the UK.

When I saw my new GP practice in the UK to request the HRT prescription the doctor told me I had to switch from continuous daily 100mg progesterone plus two pumps estrogen gel to 200mg cyclical progesterone (plus estrogen gel as before - no issues there) because this is NHS prescribing guidelines. This GP didn't seem to know very much about HRT/perimenopause and just said this was what was on the screen for prescribing HRT - it felt very much like a computer says no response.

The first cycle during the progesterone pause for the withdrawal bleed I had a migraine and then on and off headaches that were very disruptive. I also had very high anxiety and low mood - I've never had particularly bad PMS symptoms before so this was very distressing and quite alarming. I'm still in the pause between starting the next progesterone cycle (the prescription says to take for 12 days from day 15 of cycle) and have had much higher anxiety than normal.

My older sister is also on HRT and said she was prescribed 100mg progesterone daily because she also gets migraines, so it seems that NHS prescribing guidelines are not quite so rigid as the GP seemed to think.

I googled about the difference in Canadian vs NHS prescribing and google AI tells me that the 100mg daily is common in Canada and explained the NHS preference for cyclical progesterone until definitely in menopause. AI also tells me that the reason for the migraines and high anxiety is due to the sharp drop off in progesterone in the cycling method and that the daily was providing me with a "steady state". I feel like this suited me much better than the cycling.

I have made a GP appointment to review the prescription - it's with a different GP from the same practice so will hopefully be better/more informed, although who knows.

I really want to return to the daily progesterone. Does anyone have any experience of daily being prescribed due to migraines and high anxiety?

I feel like the fact I was already on it for over a year should have been relevant, as well as the migraine factor, but I'm anxious about GPs here being rigid about prescribing.

You could look up the British Menopause society for the current advice and take that to the GP

Thanks @Nightmanagerfan

The BMS has this document https://thebms.org.uk/wp-content/uploads/2026/04/06-NEW-BMS-TfC-Migraine-and-HRT-APRIL2026-A.pdf

But it's still a bit unclear to me re continuous progesterone while still in perimenopause. It says:

"During late perimenopause/early postmenopause continuous combined hormone replacement can be considered to manage vasomotor symptoms in women with migraine:
— transdermal estradiol (patch/gel/spray) is preferred where possible as it provides more stable levels compared to oral estradiol
— migraine aura does not contraindicate hormone replacement therapy
However, in view of the possibility of irregular bleeding from the natural cycle not
being suppressed, cycle suppression may be more appropriate."

But before that it says "Consider menstrual cycle suppression during early perimenopause using continuous combined hormonal contraception (CHC)"

That reads to me as if they suggest CHC first. I was (and still am) on a bio-identical progesterone. I don't want to switch to a hormonal contraceptive.

I'm interested what experiences women have had requesting continuous progesterone, whether they had info from the BMS or talked to their GP without that.

I am following this with interest. I am currently on cyclical progesterone tablets (and oestrogen patches) and have been for 2 years.. Periods have got heavier and more painful over this time. When I first started HRT they were becoming less frequent/severe. I would like to swap to continuous progesterone if possible to hopefully stop periods altogether but not sure if this would be allowed by the GP… I am going to ask but would be good to see others experiences of moving over to continuous

I take 100mg 25 out of 28 days. Periods were sporadic, about every 3mths or so on continuous and haven’t had any bleeding on the 25/28 regime for about 18mths. I’m 48.
I’d just do it OP - My gp is a menopause specialist though, and the advice they gave was very much try and see. I started both P and O gel at the same time, so not sure the 3mth P only is standard either.

Sorry to hear your periods got heavier, it's no fun going from fairly infrequent and light periods to a heavy regular cycle. This is one of the things I want to avoid, as well as the migraines, headaches and major anxiety spikes in the off progesterone days!

I will update once I've had my appointment at the end of next week, and hopefully there are others who can chime in with their experiences in the mean time :)

I have endometriosis so I am meant to be on continuous progesterone to avoid unopposed oestrogen for 2 weeks every month which would potentially feed my endo deposits and make my symptoms worse but my GP wouldn't prescribe it just cyclical. I still have periods so fall outside the usual BMS guidelines.

Armed with all the research I didn't think I would need to take to the GP the first time, I saw the same GP and put my case forward. She was absolutely convinced that this would be a horrific decision for me but did agree to the continuous progesterone. I have been on it for 5 months, no breakthrough bleeding, no emotional all over the place dysregulation that she was convinced I would experience.

I understand her viewpoint but each person is an individual and I said well can I try it for 3 months and see how I get on? She was very willing for me to have the mirena coil which of course would release progesterone daily. I am on the lowest dose of Utrogestan at 1 tablet a day and the lowest Oestrogel dose of 2 pumps.

My period was early and light this month but usually they are pretty much the same and unaffected by the continuous progesterone.

Having had to fight for everything to do with my body for my endo for 30 years I am no stranger to this fight to try to get what you think is best for you, hence me not backing down.

I would go in to the GP and say, I want to try continuous progesterone and let me tell you why. Lay it out for them. I always type it up and put it down on their desk and read from it. That way they can see it as well as hear it. Ask to try it for 3 months with a review after that. Best of luck to you.

That's interesting to hear about the 25 out of 28 days, I don't think I've heard of that cycle/regimen before. Did your menopause specialist GP explain what the reasoning was to switch from continuous?

I'm definitely thinking about just doing it, especially since my sister was prescribed the daily 100mg!

I was on cyclical but gradually had terrible mood swings and random periods not lining up with the right window (ie not happening at the start of the non-progesterone fortnight).

My GP SUGGESTED moving to continuous. I was 52 at the time and had been on cycilcal for 2 years and it had been great at first then gone screwy.

I’m on continuous due to endo AND a mirena! Gynae wrote a letter so when the GP questions it, it’s on record

Thanks and good for you for making your case! I will go armed with my research.

I think one of the things that's bothering me is that I was already taking 100mg progesterone daily without any issues, and this was just disregarded by the first NHS GP I saw, although to be fair she was nice she just didn't seem to know very much.

Watching with interest. I vastly prefer the two weeks i’m on progesterone- I sleep better and am less anxious.

Sorry I made a typo - should have said I had very sporadic bleeding on Cyclical, 2wk regime, not continuous. And periods had pretty much stopped before I started HRT.
Mostly because I told her I wanted to I think, but because my bleeding was sparse and sporadic I think it’s a compromise between 2weeks/continuous. You could have a bleed in the 3 days, but I haven’t. I suspect I’ll swap to continuous next time there’s a review.
I’d just swap if I was you - if it worked for you before and you’re already prescribed the right dosage!

If you’ve already been on the regime that’s common in Canada and you know it suits you, just continue to take it in this way. How is anyone going to know whether you take 100mg progesterone daily for the whole month, or 20mg daily for just part of the month.

Thanks @calflions and @ghostperfume6

It seems like there's a few different reasons women switch to continuous and that hopefully a decent GP will see that it's very individual. I don't have endometriosis, but I know it's horrible for sufferers @ghostperfume6
But the mood swings from stopping daily progesterone have been awful :(

That's true, and I think I probably will even if the GP doesn't want to change it. Initially I thought it might be beneficial even though I wasn't keen on having to have a period, but it definitely hasn't been!

Yes me too. The one initial advantage to the 200mg progesterone was that it helped me sleep better - 100mg didn't make any difference to my sleep either way. But the 2 weeks without any has been pretty awful.

I’m in Australia, so we have a much better health system than the UK, but even here, I felt as though I was being gaslighted by GPs until I saw one who was recommended as a peri/menopause specialist. If you can find one, make an appointment even if it’s far in the future, then it’s worth it.

Before starting HRT, she organised every conceivable scan - uterine, mammogram etc - to get a baseline.

She is also very supportive of the “try things and see” method! Eg 1/2/3 pumps of estrogel/ trying the patches etc. I sleep so well with 200mg prometrium each night and it’s massively improved my life.

Can I just clarify what you're asking @Penelopeandherpitstop ?

There isn't any absolute rule on this anyway.

(I'm with a very well-regarded private consultant and they are able to tweak the way it's used far more than GPs seem to.) For several years I was on long-cycle HRT in peri- progesterone on a cycle once every 2 to 3 months.

The guidance for GPs is to make the prescribing very simple for them to manage, without having to think about different options for each patient.

The guidance (NOTE- GUIDANCE not mandatory) is that for women in peri, HRT should be sequential to avoid erratic bleeding as 100mgs a day often doesn't control the bleeding.

There are some exceptions, like yourself, if women have hormonal migraine, when daily 100mgs can be tried.

If however you prefer a cycle using 200mgs x 12 days a month, that's also fine. The guidance is to change from cyclical to continuous at 54 or when you've not had a period for 12 months. Again, this can be tweaked according to side effects etc.

Does this answer the questions?

Thanks! That's good to know that it's guidance and not mandatory that for women in peri, HRT should be sequential to avoid erratic bleeding as 100mgs a day often doesn't control the bleeding.

My experience with the first NHS GP I saw was that the prescribing guidance is pretty rigid if not mandatory as such, and this GP didn't seem to have a lot of knowledge about HRT so she was sticking to the guidance regardless of my preexisting 100mg daily regime that was working. So that tracks with your point that the prescribing guidance is simple to make things easier for GPs.

After my negative experience with the first cycle of 200mg I did some research so I'm generally aware of the NHS guidelines (and how these compare to Canadian healthcare). So I'm posting to see what women's experiences are of asking their GP for something different from the NHS prescribing guidance and if the GP agreed to it, particularly if they've ended up with migraines and anxiety from the 200mg cyclical regimen.

I think my specific situation of having already taken continuous progesterone for over a year under a different country's prescribing rules, and then being told it has to change by the NHS despite continuous P working for me is maybe not as common. But it's definitely helpful to hear that there is actually quite a bit of variation in prescribing, and your point that the guidance is not mandatory and is more there to make things simpler for GPs rather than about patient needs or safety is really helpful in preparing for my GP follow up (with a different GP than I saw last time).

I think one other question I have is if the GP will be likely to want me to have blood test, scans etc if I want to go back to 100mg daily? If you or anyone else has experience of this that would be great to hear about. I had mammograms in Canada and all was well, but in general Canadian healthcare is a disaster zone and it's really difficult to get GP appointments, so after I had my follow up and got my continuous HRT regimen finalised I didn't see the GP again and just got repeat prescriptions. So possibly getting tests done again would be helpful anyway.

Thanks again, your post was very helpful :)

It's not usual to have other tests for HRT and in England mammograms are every 3 years unless there is a need to one more often.

This is guidance and the relevant part is bottom of page 3.

https://thebms.org.uk/wp-content/uploads/2026/05/14-NEW-BMS-TfC-Progestogens-and-endometrial-protection-MAY2026-A.pdf?utm_source=news&utm_medium=website

I'm really surprised that you're having to fight for something that is very commonly given! I take 100 mg utrogestan on a 25/28 regime as it works better for me . The two weeks on/ off were causing me all sorts of mood problems. I'm not in full menopause either, but with this method my periods are largely absent.