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[SwimyAlice]

Hi I am a healthy perimenopausal 47 yr old on the POP Cerelle and 10 weeks into 2 pumps of oestrogen daily and 2 capsules of progesterone for 12 days of my cycle.
My problem is I have started to get breakthrough bleeds and period ache & sore boobs - most annoying - is this gonna settle do you know as I loved not having periods on my POP before but had to do something about the menopausal symptoms.

I am only petite and wonder if 2 pumps of gel and 2 progesterone tablets is too much for my 8.5 stone weight?
Should I up or down either the gel or progesterone tablets or just wait and see if it improves?

My Doctors are really hard to get hold of and seem to know less than I do - I had to tell them what I wanted and only got a crappy phone call with an uncertain, hard to understand Dr last time 

Any advice welcome as you lot all seem to know what you're talking about!
PS I have searched on the forum but not found about perimonpausal bleeds on POPs (sorry if I have missed a similar thread!!).
Thanks ladies Alice xx

[CLKD]

What's a POP  ?

Weight doesn't affect HReplacementT.  Which medication have you been prescribed?  MayB put the product names into the search box which might take you directly to info that you are looking for.

[Dotty]

If you weren’t having bleeds on POP then I believe you can talk one capsule of Utrogestan on a continuous basis …. 1 every day

[Booroo]

I take double dose mini pill with 1mg sandrena gel at mo I bled for 5 weeks it did stop have 3 months reviews next week

[SwimyAlice]

CLKD - POP is the progesterone only pill - I'm on oestrogel x2 pumps and urtrogestan x2 tabs

Thanks Dotty I will take a note of that and see if the Dr agrees when I have my 3 month check (I wasn't having bleeds on the POP alone)

That's interesting Booroo - I did wonder if the POP plus just one Urtogestan might be enough progesterone - 2 plus POP seems like a lot but then I guess they might be acting differently

Not sure what triggers the bleeds - too much or too little progesterone or oestrogen.

[Claire MM]

If you are taking progesterone cyclically then the drop in progesterone should trigger a bleed, is that when the bleed happens? It may be possible to go straight onto continuous?

[Booroo]

CLKD - POP is the progesterone only pill - I'm on oestrogel x2 pumps and urtrogestan x2 tabs

Thanks Dotty I will take a note of that and see if the Dr agrees when I have my 3 month check (I wasn't having bleeds on the POP alone)

That's interesting Booroo - I did wonder if the POP plus just one Urtogestan might be enough progesterone - 2 plus POP seems like a lot but then I guess they might be acting differently

I’m not taking utro just 2 mini pill plus gel

Not sure what triggers the bleeds - too much or too little progesterone or oestrogen.

[SwimyAlice]

If you are taking progesterone cyclically then the drop in progesterone should trigger a bleed, is that when the bleed happens? It may be possible to go straight onto continuous?

thanks Claire, bizarrely I seem to bleed when I go onto the progesterone or just before it. I would love to take continuously to avoid this and will discuss with my nurse/Dr at my next call!

[Dotty]

You can take 2 x desogestrol POP for the progesterone part of HRT. It is off licence but is mentioned in an article by the BMS.

Page 7 of this document

https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

[SwimyAlice]

Oh thanks DOTTY that's a really good read 

[SwimyAlice]

OK, so I spoke to a nurse who said give it another month and if it's still a problem they may do ultrasound. Sounds a bit dramatic to me as I've only had the bleeding since being on HRT - my contraceptive POP stopped my periods nicely before I needed HRT.

I am finding I'm bleeding this month 3 weeks out of the 4 so getting a bit boring now!

I've read around a bit and seen many ladies are starting out on the average dose or HRT rather than a low one that can be increased if necessary.

I am now wondering if I should have been started on a lower does of oestrogen and progesterone - maybe 1 pump rather than 2 of oestrogel daily and and 1 urtrogestan rather than 2 (and my contraceptive POP) at night time?
Anyone else know of this lower dosing working?

thanks again!!
Alice

[SwimyAlice]

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."