Nervous to follow doctors suggestion- continuous HRT

[Chattypetey1]

My lovely GP has recently retired and now I have a new lady- She seems to want to shake things up following my medication review and I'm really nervous.

I'm 45 and started Menopause early, still getting periods but with all sorts on meno symptoms so previous GP started me on Oestrogen gel (2 pumps) and progesterone pills daily with a 5 day break every 25 days. It's been about 3 years and I'm still getting periods but lately they have been heavy, painful and my moods have been awful.

New GP suggesting not having a break from the progesterone so that I don't get periods any more but I'm sure my last GP told me this was dangerous and can cause issues with womb lining.
Anyone else have experience of this? Would love to hear others opinions. Thanks.

Would you consider the Mirena coil? It'd give you the continuous progesterone and probably stop your periods for good, too.

I'm on continuous using the Mirena, but I'd finished having periods before starting HRT so not quite the same situation as you. I was on continuous Utrogestan tablets at first but I started postmenopausal bleeding, hence changing over to a Mirena. I knew it worked well for me because my first one, put in when I was going through peri in my mid-40s stopped my periods completely. I know not everyone likes or wants it, but it's worth considering.

I'm using continuous progesterone. I used the BUPA Menopause Plan and the doctor suggested I switch to continuous because the two weeks I was taking progesterone made me feel unwell, plus I had the return of some symptoms.
It's really suited me. I feel fine all the time and it's much easier to remember when to take it!!
For context, I'm 47 and perimenopausal.

Hi @Chattypetey1 You're on a slightly different version of HRT anyway.

It's close to the continuous dose. (The leaflet says 3 days off for continuous but this is now out of date and most women take it daily for continuous.)

Your previous GP seems to have put you on continuous HRT, but only 25 days of progesterone, not every day! Not sure why they did that. The cancer statement doesn't make sense, so maybe he didn't explain it properly

The two options are

1 Sequential
12 or 14 days of 200mgs progesterone each month (this can be every 28 days but many specialists say stretch it to a full month, so that's 12/14 in calendar month.)

2 Combined continuous
Daily progesterone. 100mgs progesterone daily.

Combined continuous is for women post menopause or very late peri (with the occasional period every few months.) OR over age 54, or with no period for 12 months.

If you use continuous combined too soon, while you have your own regular periods, you can get breakthrough bleeds because the progesterone is too little to control the womb lining. This is what you're getting now- heavy monthly bleeds. It's unlikely another 3 days on progesterone in the month will make any difference.

If you want to avoid the withdrawal bleed you can try continuous, but it may not control your own cycle because you're experiencing heavier bleeding already.
Your best option would be to use sequential, 14 days with 2 capsules each of those days and a regular withdrawal bleed.

I was in the same situation as you: started HRT at 43 due to severe peri-menopause symptoms despite still having periods. The GP pointed out that I still needed contraception. So I went straight onto continuous HRT with a Mirena coil and transdermal oestrogen. I have continued with this regime ever since, including post-menopause. I’ve used different forms of transdermal oestrogen, but always had continuous progesterone via a Mirena.

Are you taking 200mg progesterone or 100mg? This seems like an unusual regime to me too.

The danger to the womb lining is from not having progesterone. Continuous oestrogen without progesterone causes the womb lining to thicken too much, which can be dangerous. A break in progesterone causes the lining to be shed - you have a period. Continuous progesterone prevents the womb lining thickening in the first place.

Some women are over-sensitive to progesterone, and a large dose or a sudden change in dose (like a break or restarting after a break) can cause unpleasant symptoms.

Mine is different as I have endo but I’m 42 and take continuous progesterone plus a mirena
without the mirena I still have periods