'Ask An Expert: Q&A' is a place for health professionals to ask our team of experts about cases seen in work and/or clinical practice.
Questions can cover a wide range of women’s health topics and will be answered by an expert in the multidisciplinary Jean Hailes health professional team. Read more about this series or learn how to ask a question here.
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Answering your questions for this edition of 'Ask an Expert: Q&A' is Dr Sonia Davison, endocrinologist.
In women who cannot have the COCP but have started MHT, and also need contraception - how do we manage the oral progesterone (if Mirena is not used). Can POP be the progesterone component?
From Jean Hailes endocrinologist Dr Sonia Davison (pictured)
There is no data to support the use of progesterone only pills (POP) in combination with MHT oestrogen. Hence other contraceptive measures should be used (tubal ligation / vasectomy / barrier methods etc).
The Australasian Menopause Society MHT equivalents webpage states as a disclaimer:
How do you deal with bleeding side effects of MHT?
From Jean Hailes endocrinologist Dr Sonia Davison
If women are perimenopausal with erratic periods, then a sequential regimen of MHT should ensure that they have a regular scheduled withdrawal bleed. Reassure women that any bothersome bleeding after initiation of MHT should settle in the first few months. If bleeding is still bothersome at this point then if on continuous MHT a trial of sequential MHT may be necessary, or investigation via transvaginal ultrasound to see if any pathology is evident e.g. a polyp. Some progestogens are better at controlling bleeding compared with others. Mirena may be a good option.