I confess that until I reached peri-menopause, I did not have a comprehensive understanding of the role of oestrogen and progesterone in my body. Okay, I had a vague idea of what each hormone did/does but it was not exact enough to then understand the changes I felt when theses hormone levels started to decrease.
I did what I normally do and took a browse on Google to see what I could find out. I discovered a lot of information but also some of this seemed contradictory. While I could start to understand the role that oestrogen and progesterone, there appeared to be so-called experts telling me conflicting information about what reducing levels might cause in the way of symptoms.
One private clinic seemed to suggest that all of the most common symptoms of peri and menopause were caused by a lack of progesterone. In fact, most symptoms are due to reducing levels of oestrogen.
Why do I need progesterone?
The one thing that continued to confuse me was why I needed progesterone, when that hormone is a critical part of becoming pregnant. I am past all that! In medical terms, progesterone prepares the endometrium for the potential of pregnancy after ovulation. It triggers the lining to thicken to accept a fertilised egg.
Yet, every doctor was telling me that if I wanted to take HRT I needed to include both oestrogen and progesterone. Even now that my monthly bleed has been reduced significantly and often doesn’t happen, despite being on HRT, I must continue with the progesterone supplement.
I knew that progesterone had a role in the menstrual cycle and, specifically, the monthly bleed and I was aware that if the lining built up and was not flushed out as a period there is an increase risk of cancer but I was at the stage where I wasn’t even bleeding.
Why should I care, anyway? I could just take the progesterone and that would be that. However, I have come to dread the two weeks of HRT tablets when I am taking mostly progesterone rather than mostly oestrogen. During that time I feel grumpy, bloated, sluggish and anxious. It feels like the PMT of old but multiplied.
The importance of progesterone
To find out more, I asked on the excellent forum of the Menopause Matters website, and I received this answer: “If you have a womb you will always need a progestogen of some sort if you take HRT which contains oestrogen.
“Oestrogen causes the womb lining to thicken and unless you take progesterone it can continue to thicken unchecked, which can lead to breakthrough bleeding and ultimately potentially endometrial cancer.
“You can take the progestogen cyclically or continuously. If you take it cyclically it acts like it does during the menstrual cycle – it converts the endometrium from proliferative (growing) to secretory (changes the structure ready for fertilised egg and pregnancy).
“When you stop the progesterone it signals that fertilisation has not taken place so the lining is not needed and is shed as a bleed.
“When you take continuous combined HRT, ie progestogens all the time, eventually, if the doses are balanced, the progesterone interferes with the capacity of oestrogen to cause the lining to grow so it (should) stay(s) thin, rather within normal limits.
“Whether or not you bleed on HRT depends firstly where you are in menopause and also what type/dose of HRT as well as other factors eg abnormalities such as fibroids or polyps. Not everyone bleeds on cyclical HRT (15% do not according to the stats on the Menopause Matters website).
“If you are not bleeding and are taking cyclically (eg on 28 day cycle) a proprietary combi HRT product that contains a progestogen then you don’t need to worry because it means your lining is not building up. Usually, it is abnormal bleeding that is a signal that something is wrong with the balance and potentially may need investigation, rather than lack of bleeding.”
So there you have it. I have no idea why I chose to be so ignorant about the role of my hormones in my body for so long but at least I am now trying to educate myself. Perhaps, it is only when things go wrong that you start to seek answers.