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[rhinogirl1959]

Hi

I've been prescribed Estraderm MX50 patches and Progesterone micronised 100mg tablets.  All the literature says to take it for 1-25 days out of a 28 day cycle.  My doctor saw no reason to not take it continually.  I'd quite like a second opinion about that, also talking about cycles, as my periods finished about 3 years ago what exactly do they mean by cycle??  I'm 55 in May and was on Kliovance up until December last year. 

[Taz2]

How confusing. You need to take it continuously. This is the info I have found http://www.medicines.org.uk/emc/medicine/24073/SPC. If you were younger and needed a bleed type HRT then you would add the progesterone into the last twelve days of the four week cycle so that when you stopped the progesterone this would initiate a bleed but as you have already been on a conti HRT for a while you need to take both the oestrogen and progesterone continuously. That's how I see it anyway. Someone else will be along soon with more info.

Taz x

[CLKD]

Ask your local Pharmacist - they have private rooms these days 

[Sarah2]

It depends on what you want.

I am almost 59 and prefer to have a cycle ; there is some evidence is may be safer re. breast changes. I am taking Utrogestan so that I have a cycle and will take it for fewer days you are.

You can take it for as few as 7 -10 days per 28 day cycle. There is no 'rule' that you have to have continuous regime after a certain age- the reason is that most women prefer not to have a period, and it may also lessen the chance of overgrowth of the lining.

Rhino- I think you need to see how you get on and whether it gives you side effects. If it does you can safely drop the number of days to 10- you'd have a bleed so if you don't want this then you would need to take it continuously - or on 25/28 days you would be likely to have alight bleed.

[Taz2]

Sorry I thought Rhino meant that she only had to use the patches for some of the cycle!

Taz x

[Hurdity]

Hi rhinogirl

Regarding Progesterone (as in Utrogestan) - I'm not sure why the licensed dose requires a 3 day break from this but I suspect it is to allow shedding of the uterus lining should there be any. However since this is meant to be a continuous combined formulation, it is designed to keep the lining thin. Variability in individual absorption (it is an unstable compound)  might mean that now and again some women get a thickened lining.

You could try the 25/28 days of progesterone for a few months and see if you do get any bleeding. If you don't then take it continuously. Otherwise as your doc suggested - take it continuously from the start.

In terms of cycles - if you chose to have a cycle you would need to be on the higher dose of utrogestan ie 200 mg. The dose you have been given is only suitable for continuous use (to keep the lining thin). There are woman on here who are on various lower doses (including the 7-10 days of progesterone per 28 days that Sarah2 mentioned - this would normally be with the 200 mg dose) - but these are always under the guidance of a specialist gynae.

Any doses lower than recommended really need specialist supervision to ensure there is no thickening of the lining - regular scans would be needed, and these are not available on NHS except in the case of unscheduled bleeding.

I disagree that you should yourself drop the days of progesterone to 10 of the 100 mg dosage without specialist recommendation, and agree that you will want to see how you get on before finally deciding! Some women find that Utrogestan has a sedative effect.

Like Sarah2 I also have a cycle (at age 60) - because I don't want to take progesterone all the time - but many women are fine with it!

Hurdity x

[Sarah2]

It's true that there are many variations on the amount of Utrogestan.

I was just remembering what Studd said on his website which was 7 days x 100mgs if women are intolerant to it. This is the link but yes, he's just one of many gynaes and they all have their own opinions and ways of prescribing! Most drs would prescribe 200mgs for such a short course each month.

http://www.studd.co.uk/bioidentical_hormones.php

[Cassie]

I think that he absolute minimum dosage for 100mg used cyclically should be 12 days per month...with follow up scans annually.

[rhinogirl1959]

Hi, thanks for all your replies.  Its all so confusing.  I don't want a bleed as I came off HRT altogether a few years ago and didn't have a period or problems for around 18 months and then the hot flushes etc came back.  I assume I'm postmenopause now.  When I went back to the doctors he put me on Kliovance which suited me fine.

When I went back to the doctors after 12 months she suggested I started to think about coming off HRT so she just gave me another 3 months worth.  I went back and saw a different doctor when they ran out and she told me it was entirely my decision whether to come off it or not, when I said I'd rather stay on it for now she suggested the progesterone micronised 100mg tablets and estraderm mx50 patches continuously.  I'm now having a bleed after being on them for 3 months (I have forgotten my progesterone for a couple of days though) - hate it as I've had nothing for over 3 years

Its all so confusing, tempted to come off it altogether and see how I go.

[Sarah2]

Your dr sounds quite good- the bioidentical progesterone is being recognised more and more as being perhaps safer to take if anyone is on HRT long-ish term. You are in fact lucky your GP knows about it because it tends to be prescribed only by consultants or on patient-request.

However, one drawback is that it is absorbed poorly by some women. This means you might get break through bleeding even if you take it all the time-  and as you are only taking 100mgs, if you miss a dose for 2 days then that is why you have had a bleed. Can you get into a routine taking it? It's better taken at night so maybe take it after you've cleaned your teeth etc?

You shouldn't bleed if you take it for 25 days. But you have to remember to take it!

If you prefer Kliovance then why not ask to go back on it?

[rhinogirl1959]

Thanks Sarah2, its so difficult to know what advice to follow (I've even got colleagues at work horrified that I'm even taking HRT). I think I might have to get one of those boxes with the days of the week on and dispense them into it.  I've always taken it on a morning but might just switch to evenings.

Was also considering asking about the patch that has both hormones in so I don't have to take anything orally.

[Sarah2]

I put all my HRT in the bathroom and apply it/ take it after a shower or bath as part of my getting-ready routine. Shower, teeth clean, make up, HRT!  If I didn't then I might forget.


How old are you and how long were you on HRT before?

I have chosen to go down the bioidentical route with Utrogestan because I've had my 5 years on synthetic progestogens and I want to try something safer.

If this is not something that worries you then you could carry on with what you took before.

I think you need to consider what you are trying to achieve and what your main concerns are. If it's a no bleed prep you want primarily then you might have to accept that Utrogestan is less reliable for some women, and it does need to be taken regularly. That means you might have to go back to what you used before but accept that it may not be quite as  safe re. breast cancer long term.

If you find you can't remember to take pills then you need to be on a patch , or set your phone or something to remind you to take the pills.


Not sure why your colleagues are freaking out about you taking HRT- more prejudice... as discussed on a thread earlier this week! None of their business anyway.

[rhinogirl1959]

Hi Sarah2, I'm 55 this year.  I was on hrt for 2-3 years up to being 50 due to heavy flooding periods and flushes mainly.  The doctor suggested I came of just after my 50th birthday, really to see if my periods had finished.  I had a break of around 18 months where I didn't have a period but couldn't cope with the hot flushes.  I was under the impression that I could only be on hrt for a total of 5 years, then my doctor said no, its recommended not to take it for more than 5 years after the age of 50, then I've heard other people take it for years and years.

My doctor also said that the health benefits of hrt outweigh the risks but its a decision only I can really make.  Think its that that bothers me, just weighing up the pros and cons and making that decision.  I'm tempted to try coming off it and see how I go but I'll speak to my doctor about that I think.

[Sarah2]

Compared to some posts here your dr sounds quite enlightened!
Makes a real change!

The latest advice is that women can stay on HRT long term if they benefit from it and are informed of the risks. You have only taken it prior to being 50- those years do not count as you are only replacing what you should have had. so you have not in fact had 3 years in terms of risk- you have had zero plus the few months recently.

Look at the green menu on the left here and go to all the info on HRT and the 'scales' show the risks and benefits at various ages.

[rhinogirl1959]

Thanks Sarah2 I'll have to have a look