Yay some clarity from the British Menopause Society online advisor service - sounds like a plan - I'll let you know how I get on!
Email from
https://www.womens-health-concern.org advisor below...
"Thank you for your email. Sorry to hear it has felt a challenge to get good advice, and I am glad to hear that you are finding your perimenopause symptoms have improved since starting HRT.
It sounds as though you were doing well with no bleeding while taking the Cerelle, before starting the HRT. In my opinion the best way to add HRT into this situation is to start it with a continuous progesterone. So as you have suggested, this would mean taking 1 x 100mg micronised progesterone daily (at night).
This can be a confusing situation and I understand why your GP has suggested the “cyclical” regime. The usual advice is that a cyclical regime is usually best before the menopause (the end of your natural periods) during the perimenopausal phase. However you are in a different situation - although we think you are still in the perimenopause, your Cerelle means that you do not bleed. This means we do not need to try to induce bleeds with a cyclical regime - but it is usually fine to start a continuous regime alongside the Cerelle. I hope that makes sense to you.
I think you will notice an improvement in many of the side effects if you switch to a continuous regime, and I hope that you are able to discuss this advice with your Doctor to change your current prescription.
However if your side effects do not settle you would need to discuss changing the dose or type of hormone to see if they can be improved.
It is worth saying that any change in the way you take hormones can trigger some initial breakthrough bleeding, that usually settles - so even if you did change to continuous, don’t be surprised if things take a little time to settle (usually up to a few weeks).
You have asked about reducing the dose of Oestrogen - 2 pumps is usually a very reasonable starting point for someone at your age with perimenopause symptoms, so I would not initially recommend reducing. But if changing your regime does not help, that may be a sensible thing to try."