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[Lizab]

I switched from cyclical to a lower dose of continuous progesterone 11 days ago. I started bleeding yesterday. When on the 200 cyclical, I would typically begin bleeding on day 9 of the progesterone and took it for 10 days per month. It had been seven weeks since starting my last course of cyclical, so I'm not surprised by the bleed now even though it's only the 100 dose of progesterone. My question is, should I withdraw for a few days and then try taking it continually, or should I carry on? My body doesn't seem to care whether or not I stop the progesterone, 10 days in I start a period regardless. I have mistakenly cycled on 3 weeks before and still brought on a normal period. I'm thinking I should stay with it, but since it had been 7 weeks I may have a better chance at success if I allow a complete bleed before going completely continuous, if that makes sense. I'm not sure what to do or if it makes a bit of difference either way.

[Hurdity]

Hi Lizab

At what point in your cycle did you change to 100 mg? It is always advisable to have a withdrawal bleed before starting conti HRT as you need to shed the cyclical lining that has built up and then your lining will start the continuous at its lowest. This is especially important if you take progesterone as this is less efficient than the synthetic progestogens in keeping the lining thin. Can't remember if you are still perimenopausal? If so your own hormones will play a part. You will only thin your lining properly ie have a complete bleed with sufficient progesterone - either of your own or from utrogestan, so after 7 weeks of oestrogen only - you will have built up some lining (I think you are on 37.5 or 50 mcg?) so need to take the full course. I always do 12 days vag utro x 200 mg after this length of time.

Hurdity x

[Lizab]

I had been 5 and a half weeks on estrogen only. I'm on 50 mcg. I don't think my own progesterone plays a part. I don't seem to get any bleed on my own without adding progesterone, regardless of cycle length. So given that I'm 11 days in on the lower dose of progesterone, should I withdraw now? Or take it for a few more days then withdraw? Up the dose back to 200 for a few days?

[Hurdity]

In your position I would up the dose to 200 mg for a few days - then withdraw say for 5-7 days and then start the 100 mg. What does doc say about this and are you having scans? Sorry I know we've talked a lot (I remembered patch!) but I'm really busy at the moment and pop in so don't have time to remind myself of everyone's complete story! (Am I right you are quite young and have two or more fairly young children?)

Hurdity x

[Lizab]

I haven't had a scan since, I can't remember when, 2 years ago? I had a scan when I was bleeding almost continuously months at a time then skipping for months then bleeding again, before hrt. I was never notified of results and when I called the receptionist said they had been signed off so everything was fine. I no longer visit that office.

Yes, that's me. Now 40 and two young kids. The only thing keeping me from tossing the whole lot is my age. I had, before the hrt, had some bouts of dryness and stress incontinence, which I thought nothing of at the time, but now having learned more I'm terrified of the effects of not having the extra estrogen. Aside from that and the melting hot flushes, I'm no better off than I was before hrt, maybe worse, emotionally. I did get a few months of feeling almost 100 percent before it all fell apart again in December. I felt the decline in November but hoped it was just a small hurdle and I would get past it, but I have continued to feel worse. The doctor allowed this change in January at my request, hoping to reduce the effects of fluctuations.

I am somewhat on my own with this, presenting what I think I know to the doctor and seeking his advice. He's very laid back and so far has followed my suggestions and hasn't presented any new ideas to me. I may have to return to the gynecologist. If I schedule now I could hope to get in by August.