Hi tootsieroll
![welcomemm :welcomemm:](https://www.menopausematters.co.uk/forum/Smileys/extended/welcomemm.gif)
I'm not sure whether you are referring to what's happening in your body naturally or as a result of HRT? I am assuming the former.
A really good article is here which tells you what happens to the body during peri-menopause
https://www.menopausematters.co.uk/article-perils-of-the-perimenopause.php. This will tell you about the role of oestrogen and progesterone better than I can as well as some of the bleeding problems and how to treat them.
There is also some information about heavy bleeding here:
https://www.menopausematters.co.uk/heavyperiods.phpIn terms of the ratio - I don't know if there is a ratio of oestrogen to progesterone that is necessary to ensure the lining is shed fully but the main point is that once the ovaries start to pack up and you don't ovulate some months but oestrogen is produced, which thickens the lining, then heavy bleeding is bound to result eventually. The ratio is not important in terms of a numerical value - just as a broad principle.
There is no need to reduce oestrogen - but increased progestogen can help with the bleeding eg through a Mirena coil, though the reason for the prolonged bleeding may need to be established through consultation with you GP?
Too much progesterone rarely causes bleeding but eg too much progestogen such as Mirena coil, in late perimenopause, in the absence of added oestrogen, can cause the endometrium to become too thin, called atrophic, and sometimes ulcerated which can lead to spotting/bleeding. Probably not heavy like bleeding from the thickened lining being shed.
If you are under 50 and want to regulate your cycle then one of the birth control pills designed for peri-menopause may help and they give replacement oestrogen in the form of as type of estradiol - the same as our bodies produce.
We can help you further if you need it!
Hope this helps
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Hurdity x