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[Sunnydays]

Thanks Dana. This certainly confirms how there's no one size that fits all.  As soon as the letter from the gynae reaches the doctor I'm going to bite the bullet and try provera with an oestrogen patch. I think I'll start on the low dose 25 mg patch. I hope progesterone can't take more of the lining than it should 😁!

[Petra]

A discussion on another thread prompted me to search for 'provera' and I did some reading...I guess I remain a bit confused about the progestogen/progesterone side of HRT, though I'm a bit of a newbie, too. Maybe I should start a new topic, but never mind...here goes. I'm on (1) Progynova (estradiol valerate) 1 mg and (2) Provera (medroxyprogesterone acetate) 2.5 mg...daily continuous. Some folks, e.g. Hurdity, have talked about side effects so I guess I had two questions:
1. What kind of side effects do people report with progesterones/protestogens/Provera
2. How do you know how little progesterone you need to be taking to protect the lining...? Or 'How low can you go'?
(It seems the estrogen side of things is a lot less complicated.)

[Dana]

I can only give you my experiences, and what my GP and pharmacist have told me, but hopefully it might be helpful to you.

I'm a little different to you, in that I'm on a medium hrt dose and I'm also on a two-monthly cycle. You are on a low dose and on a continuous routine (ie no periods). I use a 50mcg patch which would be equivalent to double your dose of 1mg of estradiol. 1mg (or 25mcg patch) of estradiol is considered a low dose and 2mg (or 50mcg patch) is considered a medium dose.

I have talked to both my GP and pharmacist about the dose of Provera I am taking with my dose of estradiol, because there just doesn't seem to be any set guidelines about dosages. It is very much an individual thing. Both of them said more or less the same thing - if what you are taking is giving you a "normal" period and you aren't experiencing any spotting or bleeding in between periods, then the dose should be okay. Seeing as I only take the Provera for about 12 days every two months, and I don't get any bleeding in between, I'm certain the lining is being kept thin.

Seeing as you are using a continuous method (ie you are taking the Provera everyday) if you aren't getting any break through bleeding I would think you should be okay. If you are, and if you have been on this routine for a while, (because sometimes it takes a while for the body to adjust to a continuous routine) maybe you might need to consider increasing the Provera dose, or maybe switching to a monthly or two-monthly cycle.

If you want to be really certain about the thickness of the lining, you could have a scan done of your uterus to be sure. However, whenever I've asked my doctor about that, she hasn't been concerned and just said as long as I'm not getting any break through bleeding she can't see any problems.

As for side effects, there really aren't any for me. Every so often I might have some sleep issues for the first few days I take it, but then it subsides, so maybe it's just my body getting used to the sudden increase in progesterone. I do tend to put weight on while I'm taking it, but that also disappears at the end of the course.

How low you can go is very much an individual thing and you can only work that out by trial and error. However, seeing as you are already taking a low dose of Provera (ie 2.5mg) that might be about as low as you can go.

[Petra]

Hi Dana, thanks so much for that. It's super helpful. I think I've gotten my head around what I'm on and why and the various options. I have had a couple of heavy periods, but not in the past few months, so maybe as you said, it took a while to settle down. But if that happens again, I'll tell my doc. (Who, as I said in another thread, is kinda negative about HRT, so I don't particularly enjoy getting into it with her. -- and, who I said in that same thread, I'm going to see tomorrow for another 6-month HRT script renewal. I think I'll leave things as they are, as I am pretty happy with how I'm feeling... Thanks again!

[Dana]

Is there any possibility of you changing doctors, to see if you can find one that is more hrt-friendly?

[dangermouse]

Wouldn't it be the case that a heavy bleed on stopping progesterone suggests it's not doing as good a job rather than the opposite?

The pill, for example, throws out enough progesterone to keep the lining from building up, so when you stop you only have a light bleed as its not built up. Also if you take it back to back (or use the Mirena) nothing builds up - I had a normal light bleed after stopping a Norethisterone combined pill after 6 months without a gap.

I don't see how having a 'good bleed' is a good thing as surely it means the prog has allowed a large lining to build up which it is now shedding on stopping. In the same way that breakthrough bleeding might occur if the withdrawal bleed continues to be heavier and heavier.

[Petra]

That makes sense, Dangermouse. Hmmmm. Since it's been a while since that happened, is there any way of telling if the lining is building up unacceptably without medical intervention? I just got back from the Dr. and didn't think to mention this. I got the usual lecture about slowly cutting down on my hrt. (Skip once a week for a few months, then skip twice a week for a few months etc. etc.)
Though there was this exchange:
Dr.: Because you realise that if, let's say, you stayed on hrt until you were 75, you'd still have all the hot flushes and symptoms when you went off then. So you're just putting it off.
Me: So why can't I just stay on it until I'm dead then?
Dr.: [no response]
(I'm 54...)

[2cats]

Hi there,

Just trying to find out more info about Provera as I don't think 100mg of Utrogestan is agreeing with me (though I will give it a a go vaginally next month to see if I get less nasty side effects).
I used to get on well with the depo-provera injection as a contraceptive (except it turned me barren for 20 months whilst trying to conceive - though I got my 2nd baby in the end!), and I think the meno version is related, so wondering if it might suit me better...
Progesterone is a strange thing....I don't think my own naturally occurring prog agreed with me as some months I suffered with dreadful PMS.  What a cruel trick of nature as it seems to be the case for so many women!
In Utrogestan's favour, I slept like a log from night 1 whilst taking it, and after 3 days, my horrible, continuous shoulder and neck pain, reduced dramatically!  Has anyone else noticed that it does have positive physical side effects?
Thanks,

 

[soniad]

I take a 5mg Provera tablet for 10 days a month and that gives me a reasonable period for a few days, but the periods I got when using Utrogestan were extremely light, leading me to believe it was never completely clearing the lining properly, so I personally wouldn't risk using Utro continuously without taking a progestin every so often to be sure you're getting a good “cleanout”.

Hi Dana, could you explain what you mean by 'extremely light'?

What dosage of Utro were you taking and for how many days?

Also, did you have a scan at any point to check your lining?

I have been using Utro for 3 months and so far my periods have lasted about 4 days with 2 heavy days. So far there has been no breakthrough bleeding. Do you think this is okay?

[Dana]

Hi soniad

I haven't used Utrogestan for probably over 2 years now, so things are a little fuzzy.

I know I was using 100mg vaginally for about 12 days a month, or as long as I could tolerate it. Sometimes it might have only been 7 days.

My periods were very light, meaning I hardly needed more than a panty liner and it only lasted maybe 3 days. I thought this was normal, but when I started using the Provera, and especially in the first couple of months where I got very heavy periods and a lot of cramping, which I don't normally get, I realised that the utrogestan periods probably weren't normal for me at all.

I never had a scan to prove anything one way or the other, just my gut feelings.

As for what's normal or not, I don't feel qualified to say either way. If you are concerned it's probably best to talk to your doctor and maybe have a scan done.

[soniad]

Thanks dana,

It's good to have another person's experience to compare to.