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[Mary G]

DEETLE, the final decision is up to you but I would not advise you to take 100mg of Utrogestan everyday because it takes away a lot of the positive effects of the oestrogen. 

You have private health insurance so I would recommend you keep the Utrogestan to a minimum and take 100mg for 7 days each month and have a scan every year to check the lining.  If you take more than that, you might find it gives you a low mood and other side effects (I couldn't even consider taking any more) but as I said it is up to you to decide whether to start higher than 7 days and see how you get on. 

I wouldn't worry about the peanut oil, if you were allergic to it, you would know about it by now. 

[DEETLE]

I have something called a g6pd.  and peanuts are a known allergy for this.  so i am assuming that peanut oil would be from peanuts?   although.... my pharmacist just told me she could put the same progesterone with acidophilus in a capsule and I could use that?  does that sound right??   sorry it sounds like mine is not straight forward, but I still want to get it correct (bioidentical) and definitely not synthetic..   would that be ok?  or any other suggestions?

[Lizab]

Mary G, she may not have private insurance, depending on her age and economic situation she could be on Medicaid/medicare/some other state program, and even with private insurance,  it could be difficult to get them to honor a claim for annual ultrasounds. It's simply not the norm, and insurance would likely argue it.

As for how you take the progesterone, I've never heard of doing that, but I think the main thing is that you get the progesterone in some form, any form, to protect your uterus from the effects of the estrogen. You should not go on estrogen alone if you have a uterus.

I understand your confusion from what your doctors have said, but I think that once you get started on it, you'll quickly understand how it all works. As one of the other ladies said, don't get too tied up in the details. It's not something that has to be perfect the first time. If something seems wrong, come back and ask about it. You can always make changes.

[Hurdity]

Hi DEETLE

I've come somewhat belatedly to this thread.

What an awful confusing time you've had with the various doctors! It makes me so glad I live in UK with our NHS! OK we do have some GPs that need educating but there are strict guidelines and protocols and basically we can get any of what has been talked about free (or at minimal cost) without having to go privately,. Sometimes we have to make a bit of a fuss but it is possible.

The first thing is to clear up the issues of compounded creams. Lizab is right that they are not popular here. To be correct they are simply not on the radar because they are not approved by NHS nor by most private gynaes. They are simply not used - except by a few compounding pharmacies but most women haven't heard of them. Progesterone creams are not approved because they are not standardised and so the amount of progesterone is inconsistent. The same is the case in US. They are not approved by FDA.

In terms of equivalent to prof studd in us - I'm sure there are many practitioners but the one who is well known is Dr Elizabeth Vliet who has written amongst others a book about menopause called "Screaming to be Heard". She also talks about bio-identical hormones and the con-trick by all the practitioners that make women think they have to shell out a fortune privately to get these when the FDA approved drugs provide esatrdiool gels ( which you have) patches, and micronised progesterone in the form of Prometrium http://www.webmd.com/drugs/2/drug-8042/prometrium-oral/details which should be available from your regular local doctor or whoever you go to for general health/gynae stuff.

Here is her Youtube talk about bioidentical hormones (just ignore the weird hairstyle!)
https://www.youtube.com/watch?v=9XfpAATJkC8

You might like also to see the N American Menopause Society which is the equivalent of our British menopause Society in US http://www.menopause.org/ . There is a find a specialist section http://www.menopause.org/for-women/find-a-menopause-practitioner

They've got a whole page with links about bio-identical hormone therapy and the confusion between compounded ones the body-identical hormones that I have talked about above and are generally available.
http://www.menopause.org/publications/clinical-practice-materials/bioidentical-hormone-therapy

If anyone tries to tell you Prometrium is not available then they are trying to make money out of you. On the NAMS website the approved products are listed here:
http://www.menopause.org/publications/clinical-practice-materials/government-approved-drugs-for-menopause

Actual list: http://www.menopause.org/docs/default-source/professional/nams-ht-tables.pdf

In terms of what you need I can't find anywhere in the thread (but I might have missed it!) where you say where you are in menopause ie what have your periods been doing re cycle etc over the past year - and how this relates to your symptoms that have worsened in the past 4 months? Also if you have only just started trying the gel you mention - and how long you have been trying out HRT? This is quite important to know how best to treat you.

Re the blood tests. The oestrogen will be in pg/ml as you are in US and that reading is normal yes, but also it depends on where in your cycle that test was taken as it varies so much so doesn't really tell you anything. As Stellajane says - she hasn't had a blood tests but her docs go on symptoms. At your age, cycle and symptoms should be enough to decide that you are menopausal and to issue standard (bio-identical - but not compounded) HRT to treat your symptoms, if this is what you want.

Depending on what you say you could start at the standard dose and then work upwards.

As Mary G says it is best to start on cyclical HRT anyway - at least to see how you feel with the extra oestrogen and then add in the progesterone. If you are post-menopausal ( ie no natural period for 12 months) then taking it every day is fine if you feel well on it - but many of us on here don't.

Please clarify about your cycle - and then take it from there.

Absolutely as Lizab says - don't accept the weird stuff your pharmacy is suggesting - you need Prometrium (the same as our Utrogestan) which is bio-identical.

I hope this is helpful - it's a bit long - and hasn't confused you further DEETLE!

Hurdity x

[DEETLE]

thanks Hurdity and Lizab....   I am currently at the pharmacist lab, hopefully someone can answer this soon..   I am HIGHLY allergic to the peanut oil in Prometrium..   He is reading to me all the other fillers in Prometrium which I am also allergic to the sterate..  so this is not a progesterone I can take.  but he is telling me that he can make a capsule with progesterone (plant based only) with acidophilous ONLY... no other fillers or products??   OR he can mix the plant based progesterone with cocoa butter ONLY... no other fillers..    both of which can be used vaginally.   wouldn't these be ok??  apparently it is the exact same progesterone in the Prometrium (only without the peanut oil)

Thank you all

[Lizab]

That's kind of a special situation. I'm not a doctor, but if my pharmacist recommended that as a workaround, I'd certainly be open to running it by my doctor. If you can't have Prometrium it seems that is your only alternative unless you're willing to take synthetic progestin. I personally would give the synthetic a go before I went to experimenting, but if your pharmacist and doctor are in agreement that it would work, and you absolutely can't tolerate the synthetic, I don't see why it couldn't work.

[Cassie]

The only way you going to know is by trying it, if you use it cyclically 100mg for 12 days and get a bleed and future ultrasounds show a uterus lining thats say under 5mm then you know its doing its job. I would not think the filler would be too important be it peanut oil or something else, the main thing is the progesterone itself.

[Hurdity]

DEETLE - Utrogestan no longer contains peanut oil, but sunflower oil instead and as far as I can make out some formulations of Prometrium do not either but it;s difficult to track down the latest product info. I am sure it will have been phased out due to peanut allergies.

Here are the ingredients that I can find:
http://www.medbroadcast.com/drug/getdrug/Prometrium

Each capsule contains micronized progesterone 100 mg. Nonmedicinal ingredients: sunflower oil, gelatin, glycerin, soya lecithin, and titanium dioxide.

Can't see anything about sterate ('stearate)

The point about custom making stuff is you can't guarantee the absorption but as Lizab says if your doctor thinks it's OK then that's fine. The compounding pharmacies are not regulated as you will see from the links I gave you.

Hurdity x

[DEETLE]

I cannot thank you all enough for helping me.            I have a new question not sure if I'm suppose to start a new topic but I have done two pumps of estrogel yesterday and one so far today and feel completely wired. Like on overdrive. It's extremely uncomfortable. Should I start lower to avoid this?

[Lizab]

I'm thinking absolutely not. If you can deal with it, that will likely subside within a day or two. If you're extremely uncomfortable, for peace of mind you could back off for a day or two and then try again, but unless you're getting a severe side effect, like an allergic reaction, you should probably just go with it. That said, I confess that when I first tried estrogen, I developed a headache (pure coincidence) and chickened out. I removed my first patch after 24 hours and didn't try again for a few months. Similarly when I increased my dosage, I felt strange and switched back to the lower dose within 24 hours, and tried again in a few days. Both times I'm sure we're my own over thinking and paranoia, as the second tries were uneventful. The reason I want to say absolutely not to you is because, as I mentioned somewhere earlier on the thread, you need to take a dose and stick with it long enough to see what happens. If you start mixing things up from day 1, you'll probably suffer as much from the fluctuations as you suffer without any hrt.

[DEETLE]

maybe I need to back off then for a day or two, cuz this I feel really revved up.. 

[Cassie]

Why dont you start with less, I have always used less than the prescribed dose, I started on one pump and found it was more than enough to control any symptoms, I pushed it up to one and tiny blob more but def not 2 pumps....try this and use it at night as you get into bed but give it time to settle I would not skip days once you start the gel stay on it or you are likely to get breakthrough bleeding, esp with the oestrogen.

[Hurdity]

If you use it at night DEETLE and share a bed with someone, then do make sure they do not come into contact with the skin area you have applied the gel for at least an hour to prevent transference.

Hurdity x

[Dana]

A few comments I'd like to make, after reading this whole thread –

Seeing as you are already dealing with a healing period from benzo use, I would NOT recommend taking progesterone continuously on a daily basis. This could compound the GABA receptor issues you already have. It really doesn't matter what your doctor wants you to do. As I always said on BB, sometimes you just need to nod your head and politely agree with what your doctor is saying, and then go home and do exactly what you want to do. Let your doctor write whatever prescriptions they want to. You just choose the ones you actually want to fill. You're in charge.

Don't worry too much in the short term about taking any more progesterone. Find out what dose of estrogen works for you and get stable on that. If you've recently had a period, your lining won't build up to a point of being a concern in just a couple of months. When you do take a course of prog, start out with say 7 days and see how you feel. If you feel you've had enough, wait and see what kind of bleed you get. However, if after the 7 days you feel you can cope with a few more days then see if you can get to say 10-12 days. It's all trial and error. You won't get it right straight away. It could take months to get a routine you feel happy with.

I also wouldn't be messing around with a compounding pharmacist. Frankly, it's the compounding industry (particularly in countries like USA, Canada and Australia) that is responsible for this whole “progesterone cream is a cure-all” nonsense. Consequently we have a whole lot of doctors and websites allowing women to overdose on progesterone, or advocating the use of a progesterone cream to oppose estrogen, when it is not proven to be strong enough to oppose estrogen.

If you are allergic to the ingredients of Prometrium, there is nothing wrong with trying a progestin instead. I would personally rather stick with something that is regulated before I would resort to a compounding pharmacist TBH. Sometimes we get a bit hung-up on using “bio-identical” stuff, but basically you will end up using what actually works for you. For some women progestins work just as well as progesterone. A lot of women find medroxyprogesterone (Provera) quite tolerable. Norethisterone seems to be less tolerable by a lot of women, but there are obviously a lot of women who do use it because it's widely available, and is also the only progestin available in patch form.

Everything is going to be trial and error for you. Probably nothing is ever going to be "perfect", like whether you do or don't have periods, or do or don't use a progestin, but you will work out a routine that works for you, including how much estrogen to use, how much, how often and what kind of progesterone/progestin to use. It takes time and patience. Blood tests rarely help very much, so I wouldn't be too concerned with the figures. Most women (and doctors) prefer to go by symptoms. I wouldn't have a clue what my levels are. I've only had one blood test done and that was about 6 years ago. Whenever I've mentioned more tests to my GP she just says, “What's it going to tell us that we don't already know?”.