The 3 Day Break
If you’ve been prescribed Utrogestan (body identical progesterone) as part of your HRT regime, you may have been prescribed the continuous dose as you are considered to be post menopausal (no periods for 12 months or more)
There are lots of approaches to prescribing progesterone which is not the topic of this blog but is covered in our private facebook group.
I am just going to briefly cover the question of the 3 day break regime which is a bit confusing as continuous means continuous right?!.. so here’s a summary of the response given directly from the manufacturers of the product (Besins)
I will give you my take on it all too!
Summary of Reasoning
The Sequential Regime
The recommended dose of Utrogestan is: 200mg (2 tablets) taken orally at bedtime, for 12 days from days 15 to day 26 of your cycle (day 1 is the first day of taking estrogen)
A withdrawal bleed is to be expected during the following week.
NOTE: I prefer to recommend the 14 days from days 15-28 on this regime as it’s perfectly safe and easier to manage 2 weeks on and 2 weeks off the tablets.
OR
The Continuous Regime
The recommended dose is 100mg (1 tablet) taken orally at bedtime, from days 1 to 26 of your cycle; followed by a 3 day break.
It is stated that the continuous regime will cause a lesser withdrawal bleed.
The 3 day break in the cycle for Utrogestan is mostly based on:
The effect of the progesterone on the endometrium (the uterus lining that we are protecting from cancer) and the suppression of the oestrogen receptors within the endometrium
The break would aid the oestrogen and progesterone receptors being recovered (like a reset) so helps avoid excessive bleeding or unexplained breakthrough bleeding.
Studies have shown that the 1-25 day regime offers sufficient protection for the endometrium whilst reducing bleeding.
My Thoughts On It
In my experience of working with women who have numerous questions about their HRT doses, timings and challenges; there is a very simple approach to continuous progesterone.
It seems that the manufacturers of Utrogestan are happy for women to have small withdrawal bleeds for an unspecified amount of time, which I do not view as necessary; bearing in mind that women start a continuous regime of progesterone (the contraceptive pill, the mirena coil or another progesterone such as Utrogestan), for a wide variety of reasons including:
Being post menopausal
Having very heavy bleeds
Endometriosis
If we have the 3 day break, it can be very confusing for our body. When the progesterone is removed, our body assumes we are ready to have a period and therefore even that 3 day break often initiates a period that we don’t need to be having.
There are always exceptions to this as we’re all individuals with very temperamental hormones but that’s the general rule.
So.. the more usual approach by menopause experts is to just advise that we take 100mg every day of every month alongside our estrogen and this is certainly my approach.
This offers consistency and stability to our hormones so that there is no question that a period is not required!
Can I Take Continuous Progesterone?
Is it harmful to be on a continuous regime of progesterone if you haven’t been period free for 12 months?
NO! it is not harmful and you don’t need to bleed as the progesterone is keeping your uterus lining thin; although you do need to have a good reason to be taking your progesterone this way.
For example, some women really struggle with the mood fluctuations of peri menopause (or with PMT) so that level progesterone dose is vital.
Many young women are not having a bleed as they are on the pill or mirena coil and nobody tells them they ‘need to have a bleed’
Please do check with your specialist before moving to continuous progesterone
Jane Pangbourne is an HRT Educator, accredited nutritionist & women’s health practitioner.
When you need more help with your hormones, your symptoms, or your HRT choice, you can book a consultation via the services page HERE
