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[Caro M]

Hello ladies, this is my first post here, though I've been visiting this great website for the last two years as I've been battling with HRT.

I started two years ago on sequential (Evorel 50, Utrogestan 100 for 12 days of the month). The Evorel patches were fine; however I've struggled with the Utrogestan. It really brought on the old PMT symptoms like bloating, painful breasts and mood swings, plus my period would sometimes arrive within a couple of days of beginning the monthly Utrogestan (and sometimes not) which has made it difficult to regulate my cycle.

My wonderful GP retired earlier this year, and another doctor referred me to Dr Nick Panay's menopause clinic at the Chelsea and Westminster. Result, I thought! Dr Panay recommended I start on continuous combined, with a little added testosterone gel to help with flagging libido and motivation.

So, after about 20 days of 100mg Utrogestan every night, I felt awful. Really moody, bloated, breasts so painful I couldn't bear to even be hugged. Decided to drop the dose to every other day and see what happened. Four days in, I'm having a period. Not just spotting, a full on, painful period. I'm guessing my dose of progesterone wasn't high enough, but I would really welcome some advice. I'm now back on daily Utrogestan and wondering about the way forward. I really don't think I could bear to take Utrogestan every day if I continue to feel like this, but do the symptoms lessen over time? Should I persevere and hope for the best? I'm 53 and was looking forward to no more period after 40 years, but it seems a high price to pay.

My follow up appointment isn't for another four months, and I really feel I could do with some help, if one of you ladies has had a similar experience? I'd love to hear from you, many thanks!

[Hurdity]

Hi Caro M

 

First of all - great that you've been referred to Nick Panay who is one of the best and has published lots of research into hormones and menopause. However if you are one of those who are progesterone intolerant then continuous combined HRT is probably not the way to go.

You havge probably read on here that many of us including several of us in our 60's have opted to continue with a cycle to minimise the time on progesterone.

The problem with utrogestan and progesterone in general - is that a large amount needs to be taken orally and regularly in order for the right amount to get to your uterus, but it is unstable as a compound. It is these large amounts which tend to cause the problems wheres your own ovaries pump out a constant amount which most women tolerate better (apart from a bit of bloating, breast tenderness etc).

You didn't say how far into menopause you were when you started the HRT or what your cycle had been doing up until then. At approx your age (well 54) some gynaes do suggest trying continuous combined HRT because I think 80% of women have reached menopause so theoretically your own hormones will be more stable. However I hadn't reached menopause by this age so my GP started me on sequential HRT and it wasn't until I was 57-58 that she suggested trying conti - which didn't work out for me anyway.

Also some women even though post-menopausal do get random bleeding on 100 mg progesterone due to variable absoprtion - especially when taken orally.

So your bleeding could either be because you are not yet post-menopausal, or because 100 mg conti progesterone is insufficient to keep the lining thin. Having said that also sometimes it takes 6 months for conti HRT to stop random bleeding.

If the side effects don't settle ( you might need to wait several months for the bleeding to settle) then I would go back to a cycle.  Has NP suggested using it vaginally to minimise side effects or maybe you're already doing this? Can he suggest a longer cycle due to the side effects you are experiencing. The great thing is that as he is your gynae, anything you do that is a variation from the norm will be supervised and monitored and he really is an expert!!!

I hope this helps in some way

Hurdity x

[Dancinggirl]

Hi and welcome to MM Caro M
Hurdity has done an excellent response for you but I'd like to add my thoughts.
I have tried Utrogestan as sequential and continuous and had problematic bleeding with both regimes. Though I felt very relaxed when taking Utro I did feel rather sedated and spaced out.  I'm afraid using Utro on alternate days will result in breakthrough bleeding. Some women do very well with Utrogstan but I found it is more powerful in terms of side effects than some of the other progesterones. Many women use Utrogestan vaginally with better success although using vaginally on a continuous basis is probably not a good idea - I got an irritated bladder and vaginal discomfort using Utro vaginally but you could go back to doing a sequential regime and try the vaginal route to see if it controlled the bleeds better.  You say you want to be bleed free so the sequential regime may not be what you want.
Have you tried any other progesterones?  Many women who don't do well with Utro actually do better with Provera (Medroxyprogesterone) - though this is a synthesised progesterone it is one of the kinder versions so is generally tolerated well and usually controls bleeding better.
Your other alternative would be to have a Mirena fitted as this would result in no bleeds at all and you can use as little or as much oestrogen as you need as either patch or gel - some women get a few side effects in the first few weeks but this usually settles quite quickly.  The Mirena is often the best option if erratic or problematic bleeding is an issue.
If I were you I'd try to get a appointment sooner rather that later to discuss your options - are you able to email the clinic for advice?  Dg x

[Caro M]

Hi Hurdity and Dancinggirl,

Many thanks for your quick and informative replies, god bless you both. I suspect that if I wasn't on HRT I would still be getting periods as I tried the three-monthly cycle for a while and every 28 days I had a sort-of period which was quite light but nevertheless a regular bleed. Nick Panay seemed very clear that the continuous method was now the way forward as I have been on HRT for two years, but at this stage I'm not convinced. And I'm very confused, which is why this forum is such a godsend! Your replies have made much more sense of what is going on.

I did initially try to use the Utrogestan vaginally but didn't really like it (bladder irritation as you mentioned) and was still getting the side effects; however once this period has finished I may go back to that method for a while and see what happens. I'll give it another month of sequential (probably with Utro taken orally) and if it doesn't settle, I'll probably try the three-monthly cycle again. In the meantime, I'll have a look at Provera. I only went with Utrogestan as it was bioidentical, and I thought that meant it would be the best-tolerated, so that's interesting to know about.

This is really trial and error isn't it... It's great to be able to see Nick Panay, but his waiting lists on the NHS are very long and none of the GPs at my surgery seem to know much about how I should proceed, so I really am so grateful for this forum. Dr Panay was very complimentary about it also. xx

[Frankie3030]

Hi Caro

I am new here (written a new post as I am confused about my regime).  I am also under the care of Nick Panay, he is meant to be excellent.  He has put me on  Sandrena Gel daily and Utrogestan 100 for 12 days (but his letter says 14 days). Left messages but have yet to hear back regarding how many days I should be on it.  He is quite hard to get hold of, as he is so busy. 

I have done one month of 12 days and it does leave me feeling so tired and quite itchy.  I cant imagine being on it daily.  I do know you should give it at least three months, but if you are feeling like this maybe you should insist on seeing him earlier.

I hope you get this sorted.

Vix

[Hurdity]

Hi again Caro M

Many gynaes do prefer the continuous method for post-menopausal women or those who are nearly so - but I know Nick Panay does recognise the issue of continuous progestogenic side effects that can be experienced with such regimes - since he mentioned these in one of his papers. However he is obviously trying you with this method first, as it protects against endometrial cancer and of course theoretically eliminates bleeding - but I am sure if you experience side effects he would recommend a different regime.

I use utrogestan vaginally - but I still have a cycle (at age 63) because of the side effects from utrogestan - mainly excessive tiredness and gradually foggy headedness the longer I am on it, as well as a migraine sometimes.

I imagine Dr Panay was complimentary about the website - because Menopause Matters is so informative - and Dr Currie who writes and manages it is herself Chair of the British Menopause Society.  However, the forum is just the chat part of it with members being non-medical professionals however well-informed - so I would be surprised if he mentioned it specifically - but you never know!!!

Hurdity x

[Caro M]

Thanks for your reply Vix. I feel great on the oestrogen, but adding the progesterone is a totally different story, and I feel that Hurdity is right when she says the continuous method might not be for me. At this point, a bleed every three months is sounding like the more attractive option! Having said that, I will give the daily Utrogestan another month, and if I really can't take it I'll try the three month regime again. Will report back! Good luck with your HRT, we are very lucky to see Nick Panay but as you say, it's difficult to get hold of him and I don't know if I'll be eligible for another appointment after this follow up one in Nov, so I'm hoping to have stabilised on one regime or another by then. There are so many variables and we are all so different aren't we xx