PCOS or Perimenopause - try cyclical progesterone?

[Clare123]

I'm soon to turn 41.

Had a PCOS diagnosis in 2019 after my periods not returning to a regular cycle after coming off the combined pill after over 20 years for health reasons after a focal migraine.

Am childless, having never tried to conceive. I track my cycles (cervical mucus and basal body temperature) and have not confirmed ovulation since September 2021 but I do have occasional breakthrough bleeding, often enough to not have to worry about hyperplasia.

I don't know whether I'm not ovulating because of either:

PCOS/Insulin resistance
Perimenopause
Stress (lost my Mum just over a year ago to cancer)
Iron/B12/Folate deficiency (which is now being treated I had an iron infusion last week and have started B12 shots and folic acid, and am eager to see if ovulation returns as a result)

I have read Lara's paper on cyclical progesterone therapy for PCOS.

If my ovulation doesn't return soon, assuming the cause is either PCOS or Perimenopause, would cyclical progesterone therapy be beneficial for both scenarios and therefore be worth a go? Is cyclical progesterone HRT with no added estrogen a thing?

Thanks.

[Lara]

Yes, "cyclical progesterone HRT with no added estrogen" is definitely a thing. And yes, it could be a good strategy for the combination situation of PCOS-perimenopause. In fact, my perimenopause book Hormone Repair Manual has a patient story about that. The tricky thing is convincing a doctor to prescribe progesterone alone, but I provide some suggested talking points in the "how to speak with your doctor" sections of Hormone Repair Manual.