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[hayjude]

Hi , Just a query re oestrogel and progestersone.

My natural cycle most of my adult life has been longish- 35 days normal for me. as i am in early perimenopause would it be reasonable to try and follow this longer cycle than an unnatural ( for me) 28 day cycle.

What I would like to know is if it would be ok to use the oestrogel for 22 days then add in progesterone for 12 days.

Does anyone do this? Would it be acceptible as one off to avoid a bleed on holiday or special times?

[Hurdity]

Hi hayjude

I think you would need to ask a specialist this. I'm not sure in longer cycles which phase of the menstrual cycle is longer - the follicular phase or the luteal (2nd half). If the latter then your body would have had more progesterone in the cycle, so 12 days may not be enough to keep the lining thin.

Having said that it also depends on the doses of each that you take, and the mode (eg whether vaginal or oral progesterone etc). The bottom line is the progesterone dose must be sufficient to oppose the oestrogen dose that gets into your system and thickens the lining.

I am on a long cycle (doc is happy for me to do this), and I vary the cycle length according to what I'm doing and plan my progesterone year depending on when I know I'm going to be away.  My cycle is never longer than the max the GP knows about ( ie two months). However I am post-menopausal and also my lining has never over-thickened (except before I was due a bleed, which is normal). It would be better to do longer cycle with OK from your gynae/GP.

If you were going to delay one cycle by a week or so then it would be important to take more progesterone depending on how much you delayed the cycle - but I'm reluctant to say what you should do because you need to run it past your doc before you start to play around.....

Apologies if I sound over-cautious, but only you and your doc know your body!

Hurdity x

[hayjude]

Thanks Hurdity.
I am still confused though, I just don't understand how its different to being on the combined pill and having a withdrawal bleed at the end of a pack or sometimes being able to take two packs back to back to avoid a bleed. Does the womb lining not build up in the same way on the pill as on HRT?  What is the real issue ( risk)  with endometrial hyperplasia for any woman or any age on hormones.
I don't think I'm really understanding oestrogen and progesterone in HRT terms yet.
Can  someone explain really simply what each of these hormones does, is it the oestrogen or the progesterone that builds up the womb lining ( I guess Progestrone) how do I attempt to understand this. I have read around this but seem to be getting more and more confused.

 

[Hurdity]

Hi there

CCP works in a different way - very high doses of both hormones as I understand - but really for a couple of months it would be fine I'm sure (delaying the period).

How it works? Oestrogen (from the developing follicle) stimulates the lining to grow (proliferative phase), and progesterone (produced by ruptured follicle after egg is released) then changes the structure of the lining to prepare it for fertilised egg (secretory phase). If there is no implantation of fertilised egg, the empty follicle degenerates, progesterone declines and the lining is shed. There are other hormones involved and complex cellular changes, but that's the basis of it.  The two hormones work in a balanced way such that the more oestrogen that is produced, the more progesterone is needed to change the lining and therefore to shed it. If you have insufficient progesterone the lining will carry on getting thicker.

With HRT, continuous combined HRT works in such a way that, at the right dose of the two hormones, the progesterone interferes with the oestrogen receptors in the uterus lining to stop it thickening.

That's off the top of my head so approximately what goes on.

It's explained in more detail and better here:
http://www.menopausematters.co.uk/article-perils-of-the-perimenopause.php

Hope this helps 

Hurdity x