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[Victoria]

Hi all, I am 47 & peri menopausal, and have been for a few years. My periods have been "wavering" over the last 5 years. They have never been heavy/a problem.
Blood test shows FSH 46.

I have just come to the end of a 3 month trial of oestrogen patches (everol/estradot 75mg) and Utrogestan 200mg.

Oestrogen patches brilliant as hot flushes and night sweats stopped after 24 hours! Initially tried taking Utrogestan orally from day 15-25 but sent me nuts. This last month I have taken Utrogestan vaginally for 10 days. I felt extremely tired for those 10 days then had the most horrendous pmt/anxiety for about 4 days before a period arrived. I felt desperate during that time. Today i feel absolutely NORMAL for the first time in ages after a period has arrived.  I cannot put myself/husband & young family through this every month so have decided to stop everything. Oestrogen = good; progeterone = bad.  Can anyone please advise? I have everything intact x

[Cassie]

Same thing with me, the 200mg was horrendous, I switched to 100mg for 12 days per month, made a big difference, will your Dr prescribe 100mg for you to try for a month or 2 maybe, before giving up altogether on it?

[Victoria]

Thanks Cassie, I will ask my GP for 100 mgs Utrogestan as a last ditch attempt before giving up completely.  I was under the impression that I needed a higher dose though due to high (75mg) patch of oestrogen, or maybe I can lower this too?

The only reason I went on high dose oestrogen patch in the first place was because I was following Dr Studd's theory about pmt & oestrogen deficiency but I actually think this dose may be too high for me. I could never tolerate the Pill so guess I am asking too much from hrt and maybe it's not for me either.

Vic x

[andius]

Vic:

In perimenopause you would not need as much estrogen as someone in menopause or someone who has had a hysterectomy.  You are STILL making estrogen from your ovaries if you have not been without periods for at least 12 mo. and it takes some time for the estrogen to fall to your new baseline level after that (if you are not on HRT).  When did you have your last period before starting the patch?

I suggest that you ask your doctor if you can try half (37.5) a 75 patch with 100mg of progesterone for a couple of months.  Estrogen can  cause anxiety when you have too much, not progesterone.....the latter is "supposed" to be calming.  If you don't use as much estrogen, you won't need to use as much progesterone and may get along fine.  Let us know if you feel better after you stop the hormones for a week or so and if your doctor agrees to try to decrease the doses some.

[Dana]

I can commiserate Victoria. I too any starting to ponder the advantages and disadvantages of HRT. I have a lot of issues using even 100mg of Utrogestan. I really don't want to stop using estradiol, but I really have to consider the side effects of the progesterone.

I'm probably around 4 years post meno, so at the moment I am starting to experiment with reducing my 50mcg est patch, because I'm starting to consider the possibility I might be getting too much estradiol. My hope is that I might be able to get my dose down lower, so I won't have to use the Utro as often. I'm also considering trying some of the synthetics instead of the Utro. It's a long time since I've used them, and I honestly have no idea how well I will get on with them. I could be worse off, but at least I can take the minimum amount possible instead of having to use the 100mg of Utro.

[Sarah2]

The other option is long cycle HRT. This is where you only take the progestogen every 11-12 weeks. Not all drs know about this or are happy about it if they do, because there is a slightly higher risk of your lining building up and hyperplasia developing. However, I've been on long cycle HRT for 5 years under my specialist and it seems to be ok (I do have regular scans.)
I've now reduced my cycle to 6 weeks not 10-11 because I was having bad period pains each bleed, but I wonder if a slightly longer cycle might make it more acceptable for you?

I've been using Utrogestan for a few cycles now- the 100mgs gave me breakthrough bleeding from day 9 of the cycle right through to when i stopped it after 15 days, so I am now going back to 200mgs for 10 days, as my gynae suggested. I am now 6 days in and feel fine and am sleeping better.

[Victoria]

Thanks for your replies ladies.

Andious, I didn't realise too much oestrogen can cause anxiety. This is probably where I a going wrong. My last period was sept last year.

Dana, good luck & let me know how you get on.

Sarah2 a long cycle hrt may be the answer. Thanks for your advice, I will bear it in mind.

For now though, I am going to give myself a break from everything. I will let you know what I decide to do x

[Hurdity]

Hi Victoria

Just to say that although unlicensed to be used like this, research shows you need less progesterone when it's used vaginally, so using 100 mg vaginally for the same time that you took 200 mg orally should be sufficient.

It does seem to be prescribed as a one-size fits all though so perhaps more (Prog) might be needed with a higer dose of oestrogen.

I am on a long cycle as well - but most GPs will not sanction this. I am on Estradot patches 50 mcg, and take 12 days of utrogestan vaginally every 6-8 weeks. Before I start each cycle I make sure I use lots of Vagifem/local oestrogen pessaries to plump everything up and this minimises absorption.

There are lots of options for variation of dose (of progesterone), route and cycle length but needs to be done in consultation with doc to make sure the dose is right and to minimise the chance of endometrial hyperplasia.

I agree with andius that if you are still peri and were having regular periods, then you are still making your own oestrogen and you would probably be OK with 50 mcg at the moment. As you are still young you don't want your oestrogen levels to fall too much. You need to find the right dose to make you feel good! Then increase later if necessary.

Are you under a menopause clinic or gynae consultant - as they may be more likely to prescribe variations from the norm and especially taking into account progesterone intolerance? There was discussion recently about Prof Studd and Taz posted this link which mentions the prog intolerance:
http://www.studd.co.uk/hrt_current_thoughts.php

Hope this helps

Hurdity x

[Victoria]

Thanks Hurdity for your response.

My GP is very good, I have to say - a young male - but he did admit he knows nothing about HRT.  He referred me to the 'Menopause Clinic' back in December (which turned out to be the Gynae Clinic at my local hospital).  The Consultant told me I needed a Mirena Coil despite me telling him I didn't cope with one I had in the past.  He told me to 'trust him' so I had it fitted and he discharged me back to my GP.

I ended up having the Mirena removed a few weeks later as felt I was going nuts and it ruined my Christmas.

So, I don't feel I can ask my GP to refer me back to the 'Menopause Clinic' and, to be quite honest, I don't want to be referred back there. When I mentioned Utrogestan to the Gynae instead of the Mirena, he shook his head and said "it hasn't been proven to be effective".

I am going to go without for now.  When my symptoms reappear I will cut my 75mg patch in half and try a longer cycle.  I will get 100mg Utrogestan from my GP. I was not having regular periods - I only had 3 last year.

Thank you all for your support.  I will repost to let you know how I get on, with or without HRT xxx

[Suzyq]

I had problems taking progesterone for only 10-12 days a month but now I am taking every day and am fine. Just as you have side effects with estrogen, there are side,effects with short-term dosing of progesterone. I also had a lot of problems with estrogen and have finally cut my dose in half - feeling better. Too much estrogen is as bad as not enough in my opinion .... Taking a break and then starting over if you need to seems like a reasonable approach - but start slowly and be patient. Hope you feel better soon

[Sarah2]

Victoria- your gynae is wrong about Utrogestan not being effective. It has been used in Europe since the 1980s and there is a very detailed research paper from France written in 1999 which shows it's effective and safe. Clearly, he has not educated himself on this!

I hope your GP is supportive.

[Hurdity]

Hi Victoria

Utrogestan could not be licensed if it wasn't shown to be effective and safe in trials ( albeit often limited) set up to test this!

I am appalled firstly that your gynae consultant is that ignorant - and no wonder women have problems in this area when even specialists are not up to date - perhpas understandable with some GPs! Secondly that he disregarded your view and experience of Mirena and fitted one against your will - or presumably was persuasive that you felt you had to agree.

When I had investigations last year and a hysteroscopy, the gynae suggested fitting a Mirena at the same time so that  I could continue HRT without extra progestgoen - but I declined and he accepted my view. This is how it should be!

Good luck with your prescription and feeling better

Hurdity x

[Hurdity]

I know what you mean Stellajane - it's testing my patience too. Had a 3 day migraine over the weekend, better yesterday, and headache's come back today and I have a meeting to go too tonight  . Still have 3 days to go on the Utrogestan...

All I can say - if I haven't already said it below - I would probably have given up HRT long ago, if it wasn't for having a longer cycle.

Utrogestan is the most natural (licensed) progesterone you can take, but if you are susceptible, does still cause side effects in some women. I grit my teeth and bear it - every 6-8 weeks, and now seriously thinking of extending my cycle to 8 weeks each time, because I am wasting so much time not feeling up to things for some of the time on the Utrogestan.

In case this is putting you off Victoria - I am usually OK for the first 4 days and problems often kick in by Day 5 out of 12.... so I'm making too much of it really!

The main difficulty with this if you are my age (61) and there is a problem (bleeding or something) - it then becomes a fight to stay on HRT at all

Hurdity x