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[br350]

I prefer cyclical to mimic what the body does in its natural state as closely as possible.  I would not use continuous HRT, just my opinion.  To address the original posters question, the 'advantage' to cyclical is less exposure to progesterone (whether synthetic or natural), as progesterone causes untoward side effects for many women.

[Peacegirl]

I prefer cyclical to mimic what the body does in its natural state as closely as possible.  I would not use continuous HRT, just my opinion.  To address the original posters question, the 'advantage' to cyclical is less exposure to progesterone (whether synthetic or natural), as progesterone causes untoward side effects for many women.

Thanks TovahFell. What's confusing me is this: say I was getting some thickening of the womb lining (due to my reduced utrogestan use) and I stopped the utrogestan thereby inducing a bleed, would this not clear the thickening?  I'm probably being really dumb here 🙄

[br350]

peacegirl, I've read before that estrogen is like fertlizer in the womb (growing lining) and progesterone is the lawn mower, cleaning it up.  Because the estrogen part of HRT is continuous, the progesterone - once withdrawn, as in cyclic HRT - will shed whatever lining has built up.  I can't speak to whether it would all be shed out, but a bleed should suffice I would think. 

Do you have any reason to think you're lining is thickening?  If you are on continuous HRT and still having some erratic spotting/bleeding it may be because you're skipping days of the Utrogestan.  If you are only taking 100mg every other day, that might be why.  It's probably best to take it every day, whether it's for the full month (continuous) or for a cyclic regimen where it might be 10-14 days/month.

One would probably only be concerned about over thickening if on high dose estradiol and very low dose progesterone.  The progesterone dose level needs to be adequate for the level of estradiol being taken. Provided you are not on higher dose estradiol, you are probably fine.  For instance, I'm on a 0.037 patch - quite low dose.  I take progesteron (utrogestan) 10 days per month.  I barely have any bleed.  Mostly just some pinkish brown and very, very light.   The estradiol is not enough to build up much of anything in my lining.

[Katia]

Peacegirl, I wondered about that.  Taking it for 10-14 days at 100mg and then not taking it for the rest of the month.  I had no trouble with
norgestimate, drospirenone and gestedene, but i don't think they are available as hrt.

[MicheleMaBelle]

if you take utrogestan at the recommended dose on a cyclical basis, it's 200mg for the 12-14 days.
If you take it on a continuous basis, it's 100mg for 25-28 days so it's roughly equivalent. This would be the same with other preparations- if you take it daily, it's a smaller dose spread over a longer period of time.

For those that are truly intolerant of progesterone, smaller amounts can be take under medical supervision for shorter periods of time. The risk of endometrial cancer increases so I'm not convinced that cyclical bleeding would insure against this happening thus the need for annual scans. You need to make your own mind up- there is a vocal school of thought that it's automatically ok to take smaller doses of progesterone as some eminent doctors say it's ok. It may be ok- it may not. The risk is yours and yours alone and even if I thought this regime was the best thing since sliced bread, I certainly wouldn't be advocating that it's the answer for everyone. Tovahfell is correct- too much oestrogen and too little progesterone is potentially an ill advised combination.

Maybe another progestin would work for you? I've tried utrogestan cyclically, sequentially, every alternate day - I've decided to come off as I'm not comfortable taking it for 7 days a month- I'll give it a go if I need to but the stuff makes me feel awful and I don't need the worry of having to go for annual scans.

You need to make your own mind up but please do seek medical opinion from a consultant if in doubt. X

[Mbrown001]

Not sure I agree with this


"I prefer cyclical to mimic what the body does in its natural state as closely as possible."

When we go through menopause then bleeds stop so how does replicating what our body does before meno become natural.

Sorry if I have miss read this.

Mrs Brown

[br350]

michelemabelle, great points. I feel the same way.  The only reason I am/was comfortable taking it 10 days/mo is I'm on such a low-dose patch.  You bring up great points.  And trying another progestin might be the best idea.  I've heard of some women not tolerating Utrogestan but tolerating a synthetic better.  It's trial and error.  Peacegirl, can't remember what you said you were on prior to the Utrogestan - was it a synthetic?

As for the progesterone itself, I feel the same way.  Other than it helping greatly with sleep, I wish I never had to touch it.  I would love to use a transdermal progesterone cream (compounded by a pharmacy) but they are not covered by insurance here in the U.S. and the potency cannot be guaranteed.  More trouble than it's worth. 

How have you been doing michelemabelle? 

[br350]

No you didn't misread it.   Yes, of course meno means no bleeds but it also means severely reduced hormones which are the only reason we aren't still bleeding.  If we're going to add back exogenous hormones, it seems it might be best to mimic what our bodies were doing prior to menopause - or at least some facsimile thereof.  Our bodies would never be producing a steady state of progesterone all month long (nor of estradiol for that matter).  It's all essentially a science experiment we are doing and one just has to be comfortable with the individual choices. 

[MicheleMaBelle]

Hi Tovahfell- I'm a bit up and down to be honest. Joint / muscle pains are back and so are night sweats but I feel more like me than I have in a long time , although I can barely remember what me feels like.I'm going to persevere and see how I get on. Damned if you do, damned if you don't!
I've previously tried 3 different HRT's all containing norethisterone- sent me loopy. The utrogestan/ estrogel combo gave me even worse side effects when I was on the utrogestan part but I didn't get on with the oestrogel either. I feel very strongly that if less progesterone is taken, it must be done under medical supervision and not based just on what you read on here and other people's experiences of what has worked for them. There is no right or wrong answers but overall I think we owe it to our fellow sisters to be as balanced as possible when voicing our opinions...

[br350]

I agree michelemabelle.  I think it has to be whatever each person works out with their own doctor or provider.  Some providers are fine with using a lower dose/less time, some are not.  A great deal depends on how high the level of estradiol is that one is using.   I was not suggesting that someone should use less.  Only speaking regarding my own personal experiences/thoughts.  I think the caveat is always (or should be) understood that we each have to work with our provider on determining what is best for each of us.  We can only speak to our own experiences with our providers.  I find it incredibly helpful hearing about so many varied experiences that others have.

There are different regimens for different levels of HRT, for sure.  My first go around with HRT my provider was fine with me using the progesterone 10 days/month and had experienced no negatives with his patients on this routine.  But he also prescribes mostly low dose.  Definitely no right or wrong.    It may be different depending on where you live (what country) but in the U.S. continuous is not necessarily the 'standard'.  Most practitioners are pretty flexible and it can be cont/sequential depending on the individual patient, their circumstances, and the practitioner.

I'm sorry your pains and flashes are back.   I have them too.  I try to just get on with my day and make the best of it and I find keeping busy and occupied (don't have much choice with my job! LOL!) to be a good distraction and a good way of refocusing my mind.  I hope you continue on and things start to level out.  Good that you are feeling more like yourself though! 

[MicheleMaBelle]

Thank you- hope you get to feel better soon x

[br350]

 

[Peacegirl]

peacegirl, I've read before that estrogen is like fertlizer in the womb (growing lining) and progesterone is the lawn mower, cleaning it up.  Because the estrogen part of HRT is continuous, the progesterone - once withdrawn, as in cyclic HRT - will shed whatever lining has built up.  I can't speak to whether it would all be shed out, but a bleed should suffice I would think. 

Do you have any reason to think you're lining is thickening?  If you are on continuous HRT and still having some erratic spotting/bleeding it may be because you're skipping days of the Utrogestan.  If you are only taking 100mg every other day, that might be why.  It's probably best to take it every day, whether it's for the full month (continuous) or for a cyclic regimen where it might be 10-14 days/month.

One would probably only be concerned about over thickening if on high dose estradiol and very low dose progesterone.  The progesterone dose level needs to be adequate for the level of estradiol being taken. Provided you are not on higher dose estradiol, you are probably fine.  For instance, I'm on a 0.037 patch - quite low dose.  I take progesteron (utrogestan) 10 days per month.  I barely have any bleed.  Mostly just some pinkish brown and very, very light.   The estradiol is not enough to build up much of anything in my lining.

Thanks tovahfell. I tried taking utrogestan every day but felt wretched, couldn't speak to anyone about it until my next appointment so weighed up lots of pros and cons and decided to try alternate days. If I'd listened to so-called experts I wouldn't be on hrt at all, so for me it's now a weighing up of all the information. I.e others experiences, (which like you I think are really valuable) my experience, research papers and 'experts' and balancing thst with quality of life which has mostly been so poor these last two years I'd almost risk anything to have it better.  I just picked up a provera prescription, so fingers x'd 🤞🏼 Hope you get some relief soon too. I had to give up my super-amazing demanding job but it is what it is. We have to play the hand were dealt to some extent. Sounds like that what you're doing! 👍🏼

[Peacegirl]

No you didn't misread it.   Yes, of course meno means no bleeds but it also means severely reduced hormones which are the only reason we aren't still bleeding.  If we're going to add back exogenous hormones, it seems it might be best to mimic what our bodies were doing prior to menopause - or at least some facsimile thereof.  Our bodies would never be producing a steady state of progesterone all month long (nor of estradiol for that matter).  It's all essentially a science experiment we are doing and one just has to be comfortable with the individual choices.

Very good and useful points.

[br350]

peacegirl, you're right, we have to do whatever is necessary to feel better and have quality of life!  I'm sorry you had to give up your job.  I feel horribly that it has been that bad for you to reach that point. (hug)  I hope that you find the Provera works for you.  Fingers crossed for you!