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[walking the dog]

Hi been on 200 mg utrogestran 6/7 weeks now every day. After 4  ish weeks I got terrible pmt really irritable crying shouting etc which just isn't me , then  I got a bleed and I felt ok. Two weeks later Thursday Friday just gone exactly the same thing happened I could feel the tension across my face and I blew up like a geyser my poor husband got it all, then I was crying and I felt like a mad woman. However I know this isn't normal behaviour for me so was sure it was related to the progesterone in this huge amount , I'm not at menopause clinic til October but no way I could carry on feeling like this til then so I saw my gp who went through a,few things then said she thought the utrogestran was severely affecting my mood and to stop taking it but to go back to days 1/14 a month taking it until I see specialist in Oct. I managed to tolerate 14 days of it fine in the past had no problems its just since I'm on this continuous regime its driving me loopy . Well haven't had any since Thursday and the tension has subsided.
Does this sound like I'm progesterone intolerant?
I'm not sure what my options are now regarding the reason I'm on that amount in first place to thin 8mm womb lining etc .should I carry on 200mg 14 days or should I ring menopause clinic and explain what I'm doing ? I'm a bit confused with myself and my hrt now ! Not had a bleed but imagine may get one now stopped it ?

[Dancinggirl]

walking the dog
I can't remember where you are in your meno journey and what meno symptoms you are trying to control. It does sound as though your PMT is bad with Utrogestan and whilst it is clearly clearing out your womb lining it is giving you quite nasty side effects. 
Whilst many hail Utrogeston as the best progesterone, and it is wonderful for many women, my experiences with this type of progesterone has not been that positive.  When I took 200mg on a sequi basis I was really sedated and felt debilitated but when on 100mg continuously I felt slightly high, spaced out and only slightly sedated but I can well imagine this having a depressing effect for some women.  The fluctuations you are experiencing may well be because your own hormones are kicking in or is simply your body adjusting to this regime - erratic bleeds often happen for the first few weeks or months when taking any progesterone continuously.  When I got problematic bleeding with the Oestrogel and Utro combo, I simply stopped all the hormones for 2 weeks (including the oestrogel) which resulted in a good bleed for 7-9 days which cleared things out.
I think those that use Utrogestan vaginally do get a much better outcome and maintain a thinner womb lining but I found I couldn't use it vaginally (got irritation, itching and burning) but I have VA and my ‘lady bit's' are very sensitive.
If I were you I would try perhaps try using 100mg Utro vaginally for a couple of weeks to see how you feel and if you feel better using this lower dose( it seems to be more effective on the womb lining used vaginally ) you could then do a sequi regime of 14 days of just the gel and then add in Utro vaginally for 12-14 days each month to see if that works - you might then get a proper bleed each month which keeps the lining thinner. Many find they need to stick with sequi regime to avoid using any progesterone continuously due to side effects.
Alternatively, you could take a complete break from all the HRT to actually see how you feel and reassess after that.  The other alternative is to have a Mirena fitted as this will keep you lining thin (minimal absorbed systemically so fewer side effects) and allows you to use as little or as much oestrogen as you need to control flushes etc.  DG x 

[walking the dog]

Thank you dancing girl I have no idea where I am in menopause i was peri six years ago age 44  but meno specialist thinks I'm probably post menopausal now. My symptoms were severe hot flushes as in i was a constant hot flush they just didn't stop and dripping wet night sweats no sleep because of it etc estradoit 50mcg patch cured that and I was fine on the 14 days utrogestran .consultant put me on continous to try thin womb lining.
Have low mood anyway but its been stable since march in fact since I came of AD s my moods improved!
I really dont fancy mirena as I'm terrified I will feel bad on  it and also gynaecology said she wouldn't like to fit it as I have an odd shaped uterus and she said for someone who hasn't given birth naturally it would be very painful. I have tried the utrogestran vaginally but like yourself I reacted to it itching like mad got thrush etc so cant take it that way.
I think I'm left with the only option of taking the utrogestran 14 days at 100 or 200 mg and waiting til October to see specialist, she's doing a transvaginal scan and possibly biopsies then .
Thanks for your advice I do feel reassured its the progesterone causing the pmt feelings and not my mood going. It's a fine balancing act isn't it xx

[walking the dog]

Can anyone tell me how long progesterone stays in your body after stopping it ?
Started a bleed this morning so assume its out of my body now and i will hopefully be rid of the awful pmt symptoms?

[Dancinggirl]

There is much debate about this. I believe it's the drop in progesterone that actually triggers the bleed so I assume the progesterone level in the body must fall quite quickly to a low level after 1-3 days of stopping.  My personal experience of Utrogestan leads me to think that the effects of this type of progesterone does linger longer than the synthetic ones - we are all different and will respond to hormones differently.  The PMT type symptoms could be down to many things - when replacing hormones with HRT treatment, I doubt it can ever be the same as what and how we produce hormones naturally through our fertile years - it will always be a compromise.
I would expect your PMT to lift within the next 24-48 hours now the bleed has started. DG x

[walking the dog]

Thank you DG I'm at the end of my tether now I have tried everything and seem to have exhausted every possibility. Back to gp later today I really think six years of up down moods crying etc and erratic bleeding is enough...😐

[Dancinggirl]

walking the dog - Have you tried Provera instead of Utrogestan. If you haven't tried this then it may well be worth trying.  It is a kinder type of synthetic progesterone, will possibly control the erratic bleeding better and many women do move from Utrogestan to Provera when they have problems with Utro and, having read some posts on MM regarding Provera, often seem to do better. 
Here is the link on this site about this option: http://www.menopausematters.co.uk/to_progestogens.php

Dg xxx

[walking the dog]

Saw My GP dancing girl I asked about provera but she doesn't want to interfere with menopause specialist so she's contacting them for me to try and see if I can get an earlier appointment than Oct. So its wait and see. Thank you for all your help DG xx

[Hurdity]

Hi walking the dog

You have been given excellent information and advice already by Dancginggirl.

You may not be progesterone intolerant as such (ie were fine with their own prog) - but many women can't tolerate taking the high doses of oral progesterone needed to keep the lining thin. The reason it has to be at such high doses is that progesterone ( ie the bio-identical one) is very unstable and breaks down quickly in the body, and oral prog has much lower bio-availability than  when used vaginally. Also oral prog as it is digested and goes through the liver - has a greater number of what are known as metabolites (different compounds it breaks down to) some of which cause some of the troublesome side effects. (I've just been reminding myself of all this with a great scientific paper by Kuhl - if anyone wants the info I can post the details but is v technical and involving some unfamiliar biochemistry so somewhat hard going in places!).

Dancinggirl is right about the difficulty in determining how long prog stays in your system! From what I read actually it is eliminated quicker when taken orally but I need to read the paper again (which takes ages!). Also that progesterone like oestrogen acts at two levels - at the cell membranes so external to the cells - and probably responsible for some of the immediate effects as with oestrogen) and intracellular though the nucleus and synthesis of proteins etc. I imagine some of these take a bit longer to reverse.

All the progestogens vary in how long they take to be eliminated and some also differ whether they are taken orally or transdermally/vaginally, not only that there is variation amongst different women in this too so no wonder there cannot be a definitive answer!

I'm sorry I'm probably too late for your doctor's visit - but you don't actually have to take Utrogestan to thin the womb. You could take a short course of a synthetic progestogen every day - one that is more effective - such as norethisterone (which also can have side effects), or Provera as Dancinggirl says. Once your lining is thin you could then go back to Utrogestan for 12 days per month if you preferred.

When you say you were peri 6 years ago - what was your cycle doing and if you had skipped periods, how long had this been going on before you started HRT?

Hope this helps a bit

Hurdity x

[walking the dog]

Thank you for the information Hurdity.
When I was 44 my periods were still like clockwork but became erratic in themselves id have a days heavy bleeding then a few days brown spotting then a normal bleed then heavy all in the same period ! My pmt went off the scale and severe anxiety started along with hot flushes that lasted all day and night sweats . So my gp said it was most likely peri menopause.I started hrt straight away femoston 1/10 didn't help mood or flushes /sweats then femoston 2/10 same thing didn't help then tried premak c which didn't help either I then took premarin as estrogen and utrogestran as progesterone ad still had no relief so in Feb this year was given estradoit 50 patch with utrogestran 14 days a month and in 24 hours sweats flushes were gone. However over the six years I have been on different hrt have had   breakthrough bleeding several vaginal scans biopsies four hysteroscopies no sign of cancer but changes in womb and womb hyperplasia that's why was put on continuous progesterone but as of Thu last week now off it at gp advice and to restart 200mg on 1st month for 14 days.
I feel totally confused and mixed up . I think I do want a hysterectomy I know its a big operation but so far nothing has helped either my pmt/mood or my bleeding and hyperplasia. I really cant imagine another six years like this! 
I tried norethiserone a few years back when the gynaecologist was trying to thin my womb lining but it had me ill very angry and terrible rages, exactly how the continuous utrogestran has made me feel.
I have today asked my gp for a hysterectomy so I don't have to take progesterone she agrees its gone on a long time and will mention this when she contacts menopause specialist but says if they have another plan I may have to try that. Its  wait and see .
Thank you both DG and Hurdity for replying it means  a lot when my heads all over xx

[Mary G]

Walking the dog, I can't add much to what has already been said and agree that everyone is different and we all have different rates of absorption and very different results from the same doses.

I am severely intolerant to all types of synthetic progesterone and also to Utrogestan in high doses.  Therefore, I have absolutely no choice other than to seriously limit its use and have regular womb scans to make sure the lining is thin.  I was never intolerant to my own progesterone and didn't have any problems with PMS or period pre-menopause but for some reason, I just can't tolerant any form of progesterone used in HRT preparations.

I know many women don't have a problem with progesterone but if you do, then the only option is to have a tailor made regime and regular scans.  If you can't take it, you can't take it and there are very few option open to you - if only there was an alternative.

I currently take 100mg Utrogestan vaginally for 7 days every 5 weeks and I can just about live it that - for me, it's either that or a hysterectomy.  You could try something similar under supervision but I think you would have to try and sort out the thickness problem first.  It is very difficult to know how much progesterone each individual needs to get the adequate clearance and you can't guess because there are huge variations i.e. my gynaecologist said there are huge variations amongst her patents and many of them need to take far more progesterone than me in order to get the same results. 

If you can face it, a hysterectomy could be the answer but before you go down that road, it might be worth one last try with a tailor made regime. 

I do hope you find a solution, I know how frustrating it is. 

[walking the dog]

Thank you maryG I will discuss the seven day/ tailor made to suit me regime to the menopause specialist when I see her .
Once again thank you everyone for your replies xx

[Hurdity]

Hi walking the dog

Sounds like you could be post-menopause by now although also that you probably started HRT when you were in the late reproductive stage (just before the peri-menopausal transition) and the latter can last for several years. It may well be that you were going through peri and having anovulatory cycles while taking HRT which meant that excess oestrogen led to the endometrium build up.

If you are now post-menopause, then treatment with a strong progestogen should clear the lining quite quickly. If you can set your mind to coping with the temporary side effects in your position I would personally go with taking a strong progestogen temporarily - knowing it's going to make you feel rough for a few weeks. Make sure you have support. Once the lining is clear as confirmed by a scan following the withdrawal bleed you will get, then you can go back to a normal cyclical regime. Did you say you were fine with utrogestan for 12 days and maybe you could reduce this to 10? However with a history of endometrial hyperplasia then I doubt a 7 day regime would be advisable.

If you are post-menopausal and have no fibroids or polyps then 200 mg orally for 10-12 days should be sufficient - but even so with your history I would want ( and I am sure you would be offered) regular scans.

A hysterectomy is not without its problems so I would definitely want to try to find a solution I could work with that didn't involve this if possible. If you are under a meno clinic - perhaps when your lining is clear you could ask about having a slightly longer cycle eg 5 weeks - with the 12 days of prog - provided you have regular scans? No harm in asking about the 7 days though as Mary G says - after all this regime was intended for women with progesterone intolerance like yourself but only under proper medical supervision.

Such a pity that dydrogesterone (the progestogen in Femoston) is not available on prescription in UK - because this one has very few side effects. Perhaps the meno clinic is able to get hold of it - it used to be available years ago as ?Duphaston (I think) but was withdrawn for commercial reasons.

Good luck!

Hurdity x

[walking the dog]

That makes complete sense Hurdity about the estrogen build up causng the womb lining problems plus the menopause specialist did say she thought I was probably post menopausal now. I think you have hit the nail on the head and having it explained to me it makes sense. I have been on 200 mg for six weeks now so hopefully that will be long enough to thin the lining . I'm starting progesterone again September 1st on 14 days 200 mg which I tolerate fine just a tiny bit pmt ish but nothing like how I have been the past few days . Strangely I kept graphs as I thought the progesterone was causing the anxiety but my anxiety was low when  I was taking it and shot up when stopped it just before the withdrawal bleed. I'm under a meno clinic andi will ask them about the longer cycle and if the other progesterones are possible to access.
Once again thank you for your help and thank you DG and MaryG xx

[Mary G]

WTD, sorry, I forgot to say that from my experience, synthetic progesterone hangs around in my system for a very long time after I take the last tablet - more than 2 weeks with some.  They are deliberately manufactured to have a long half life. 

Utrogestan is slightly less but still quite a while in my case.  I get a bleed 5-6 days after taking the last capsule but still feel strange for a while after that.  I think it is stronger and more effective at lining clearance when used vaginally and has fewer side effects like breast pain for example.  I still don't like it though!