‘Premenstrual’ symptoms affect up to 20 per cent of women receiving continuous oestrogen and cyclical progestogens. Breast discomfort, depression, nausea, irritability, fluid retention and headaches are noticeably linked to the course of progestogen.
Altering the dose or type of progestogen can give relief, as can switching to the combined oes-trogen/progestogen patches which use much lower doses of hormones. If symptoms are particularly severe, the progestogen course could be taken every three months. Alternatively the duration of the progestogen could be shortened, but reducing the course to less than ten days diminishes the protective effect against cancer of the womb and can provoke irregular bleeding.
Changing to a continuous combined HRT can also improve symptoms because, although the progestogen is taken every day, the dose is usually lower than for cyclical regimens.
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