There is some evidence to suggest that when progestogen is given for ten to fourteen days per cycle to women prior to menopause, it should be taken in phase with the existing menstrual cycle if it is still apparent. This helps to reduce the occurrence of breakthrough bleeding. The experience of Josie, who developed severe hot flushes at the age of forty-five while stiD menstruating regularly, illustrates the point. Her cycle length had always fluctuated around twenty-one days, and when she took progestogen for the first twelve days of each month she experienced repeated breakthrough bleeding that required investigation.
At first her doctor tried manipulating the dose and type of oestrogen and progestogen, but this did not help. Finally, her doctor twigged to the possibility that the bleeding problems could be due to the fact that the hormones her ovaries were still producing intermittently were not synchronising with the hormones she was taking on HRT. Josie was advised to take the last progestogen tablet on the day before the start of the next menstrual bleed she was expecting. Thus, with a twenty-one-day menstrual cycle, she took the progestogen from day nine to day twenty. This simple alteration resulted in much less breakthrough bleeding.
*42\38\8*
