The dosing of progestogen for those in surgical menopause with a uterus depends on the dose needed to prevent overgrowth of the uterine lining. There is evidence that all of the progestogens (and associated doses) described above are effective for prevention of uterine overgrowth.

If you still have your uterus, irregular bleeding or spotting can occur during the first 4-6 months of taking continuous combined estrogen and progestogen, and is not a cause for alarm.

However, you should consult your doctor if you get heavy (rather than light) bleeding, if it continues for more than six months, or if bleeding starts suddenly after some time without bleeding. Irregular bleeding may sometimes be improved by changing the type or route of progestogen.

​Visit www.iapmd.org/surgery for lots of evidence-based information and resources for those considering, going through or recovering from surgery for PMDD/PME.

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