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[jasper]

Hi again, as per my other posts I was put on Evorel to try to stabilise
Migraines. I am 47 with regular periods but it was agreed initially I could try estrogen only to see how I reacted as I have a lot problems (chronic Lyme). Recommendation was to use mirena as well but I am very wary.

What is confusing me is that I am still having normal periods on 50-75 patch despite apparently low progesterone levels for last few years. Most recently day 21/7 dpo was 28 but I have been down to 14.
Is it normal to carry on with regular periods when on estrogen and with lowish progesterone?
Ideally consultant wants my natural cycle suppressed hence mirena/patch suggestion. I am going to have to speak to her as I am suffering badly still from migraines during and after period but am insure of what approach to take - would I be best asking for a lower level of continuous utrogestan? While thing not helped by worse joint pain as I raise Evorel dose.

Thanks for any help.

[dangermouse]

I can't help with the Utrogestan q but low progesterone can cause bleeding (hence why you bleed after stopping prog or when it naturally falls at end of cycle), so this sounds in line with your experience.

Progesterone keeps the lining from building up from the over stimulation of oestrogen.

[jasper]

ok thanks dangermouse, so you don't need decent levels of progesterone to still have a normal bleed even when adding estrogen?

Is there anyone here in peri who uses daily utrogestan instead of 7-14 days - kind of in the way that you would with the contraceptive pill?

[Hurdity]

Just to clarify and elaborate on what dangermouse has said - low progesterone per se does not cause bleeding as such. Progesterone changes the structure of the endometrium from "proliferative" (growing) - which it does with oestrogen - to "secretory" to prepare for implantation of the fertilised egg and pregnancy. If the progesterone level then falls - this signals to the brain  (through the endocrine system) that fertilisation has not taken place, and so the changed lining is shed.

I'm not sure why your progesterone levels are being measured - by whom and what for? If you have been having regular periods with normal bleeding then mostly you can assume you are ovulating. From what I understand anovulatory bleeds would be different - both in timing and in nature - because they would consist of sporadic shedding of an over-thickened endometrium and often without "normal" hormonal pre-menstrual symptoms.

If your bleeds were anovulatory then you would need extra progesterone. From what I gather some consultants will give extra oestrogen before peri-menopause proper starts ie when a women is still having regular periods because it wold be assumed that, following ovulation, the corpus luteum would be producing sufficient progesterone to convert all the oestrogen stimulated lining (from her own oestrogen + the added extra from HRT) to secretory - which would then all be shed when the corpeus luteum dies (as it does each unfertilised cycle) and progesterone production ceases??

I would imagine any woman who is under a consultant and being thus treated, would need their lining checked regularly because as peri-menopause begins and ovulation becomes sporadic - progesterone would need to be added externally to prevent an overthickened lining. Why would you want to take progesterone every day in terms of your lining? It doesn't really act like the Mirena which is a very strong synthetic progestogen that specifically targets the uterus ( because it is delivered directly to it).

Hurdity x