During the fertile years progesterone is produced within the ovaries as a result of ovulation. It dampens down oestrogen’s effect on the growth and thickening of the endometrium, the lining of the uterus. When the levels of oestrogen and progesterone decline towards the end of the menstrual cycle, the endometrium is shed as a menstrual bleed. The term progestogen is used to describe any manufactured substance that has similar chemical effects on the body to those of progesterone.

PROGESTOGENS USED IN HRT Although all the progestogens used in HRT have properties similar to those of progesterone, the body breaks them down in rather different ways. They are all more powerful than progesterone too, having more pronounced effects when given at doses comparable to the levels of progesterone found in the body. (For a detailed description of the varieties of progestogen used in HRT see page 176.) The main reason for including progestogen in HRT is to protect the endometrium, the lining of the uterus. If the endometrium is exposed to constant oestrogen without progestogen, the endometrium may become

too thick. This condition is known as hyperplasia, which occasionally develops into cancer.

It follows that, if you have had a hysterectomy, endometrial hyperplasia is not something for you to be concerned about. The way is clear for you to use an oestrogen-only form of HRT. This seems to be an option with few side effects or risks, but you must be carefully monitored.

Some women cannot tolerate the progestogen component of HRT as it can produce unwanted results such as breast tenderness, increased blood pressure, mood swings, depression, acne, backache, bloating and abdominal cramps. These symptoms resemble those of premenstrual syndrome. ‘I hate progestogen,’ said thirty-year-old Mardi, whose diseased ovaries were removed two years ago. She has since tried various combinations of oestrogen and progestogen, partly because of her mood changes. ‘The progestogen makes me snappy and irrational and I get fed up with it. Some months I’m a bit naughty: I don’t take the progestogen at all.’

At those times when Mardi has both progestogen and oestrogen she has regular withdrawal bleeds, that is, bleeding for a few days at a predictable time of the month. Withdrawal bleeds are usually indistinguishable from short menstrual bleeds (they tend to be two to four days long) but, of course, they come about in different ways, being induced by hormone therapy. If you are taking progestogen you may also experience unpredictable bleeding, which is known as breakthrough bleeding. Understandably, such withdrawal bleeds and breakthrough bleeds deter some women from embarking on HRT or persevering with it, since an advantage of menopause for many women is an end to the bother of tampons and pads. A number of women appear to be happy to continue having withdrawal bleeds. The particular combination and timing of oestrogen and progestogen in HRT have a major influence on whether and when women experience bleeding.

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Related Posts:

• INTERMEDIATE SYMPTOMS OF THE MENOPAUSE
• HRT QUESTION: WHEN SHOULD PREVENTION OF OSTEOPOROSIS START?
• HOW TO IMPROVE SEX DURING AND AFTER MENOAUSE: HORMONE THERAPY
• HORMONES USED FOR OSTEOPOROSIS