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[Wanderlust]

Hi,

I'm not sure if this has been covered but I have searched the forum and can't seem to find a thread that focuses on what I would like to talk about

Basically, since I was 18 my periods were irregular, about twice a year until my late twenties and then I didn't have a period for four years. Now it's been two years since I last had my period and after much persuasion from many gynos, I was put on continuous HRT 2 pumps of Oestrogel and 100mg Utrogestan nightly about 5 months ago. I had the option to chose cyclically but didn't see the point.


About 2 months ago, my breast size started to increase and I am now nearly 11/2 cup size bigger, 30FF was a 30D/E. They tend to be painful and I had a scan to see why they got lumpy at times, it's due to swelling. I have a tiny frame and this size increase is uncomfortable and I have lost my confidence. I am a runner, so it doesn't make it easy. One of my questions is, does HRT make breasts size increase and will it go back to normal once my body adjusts (It's been five months so far). I'm not sure if I should use one pump of Oestrogel to reduce the size of my breasts.

On HRT, I tend to get various PMS symptoms, I am bloated, I have water retention which is the actual weight gain -I'm naturally skinny - 43kg but have gained 3kg (I'm not underweight, I'm petite with a small skeletal frame). I've had some bad anxiety and depressive moments, but those aren't so intense now. Plus, I tend to get bad PMS exhaustion.

My second question is if I am on continuous HRT, will I constantly experience various PMS symptoms and larger tender breasts? Or if I go cyclical, will I experience those PMS symptoms and large tender breasts only when I take the Utrogestan?

I'm really not sure if I should stay on HRT, but, I have more energy, I sleep better, I have less illnesses, moods are better when I'm not PMS or worried about my breasts and weight! Libido is only a little better compared to being non-existent. But, I honestly can't handle larger breasts, it's really getting me down in a bad way.

Any information and advice will be apprecaited.
Thank you

[Dancinggirl]

Wanderlust  - welcome to M
You've had a tough time.  Not sure how old you are now? but it's good you are on HRT - you need HRT, if you are oestrogen deficient, to protect your heart a bones for the longer term.
HRT does bring side effects (particularly from progesterone) and the symptoms you are getting are more pronounced when using progesterone on a continuous basis.  Utrogestan, whilst the most natural type of progesterone, can sometimes bring more side effects, particularly low mood and sedation.
It would be well worth trying your current HRT combo in the sequential regime - this would involve using 200mg Utrogeston for 10-12 days each month or maybe on a slightly longer cycle (maybe every 5-6 weeks) and though you would have a withdrawal bleed after the Utro phase it may well reduce some of the side effects you are experiencing.
An alternative option to consider might be to have a Mirena fitted, as this often brings fewer progesterone side effects (less progesterone is absorbed around the body), will usually be bleed free and you can then use as much oestrogen you like alongside.
Here is the info about the Mirena:
Mirena is a levonorgestrel (type of progestogen) releasing system which sits inside the womb, gradually releasing the progestogen into the womb. It is licensed in the UK and Ireland as a contraceptive agent, for treatment of heavy periods and, from August 2004, also for the progestogen component of HRT. It can be used in both the perimenopause and postmenopause and it is particularly useful for:

Persistent progestogenic side effects from systemic HRT despite changes in type and route of progestogen.
When contraception is required along with HRT in the perimenopause.
When withdrawal bleeds on sequential HRT are heavy, after investigation if indicated. (see WHEN TO BE REFERRED )
With Mirena in place, systemic estrogen alone can be taken as the Mirena provides adequate protection of the womb lining and the estrogen dose and route can be tailored to meet the individual's needs.

Progestogenic absorption throughout the body is minimal so reducing progestogenic side effects. The effect of Mirena on the womb lining can significantly reduce bleeding and when used as part of an HRT regimen, in time, 30 to 60% of women have no bleeding at all. Although Mirena used for contraception is licensed for 5 years, the license for use for the progestogen part of HRT is currently 4 years.
Price: £88.00

There are other progesterones you could try as well - you might do better with Provera.  Have a look under the TREATMENTS section at the top of this page to see all your options.
Keep us posted - we're here to help.  DG x

[Wanderlust]

Wanderlust  - welcome to M
You've had a tough time.  Not sure how old you are now? but it's good you are on HRT - you need HRT, if you are oestrogen deficient, to protect your heart a bones for the longer term.
HRT does bring side effects (particularly from progesterone) and the symptoms you are getting are more pronounced when using progesterone on a continuous basis.  Utrogestan, whilst the most natural type of progesterone, can sometimes bring more side effects, particularly low mood and sedation.
It would be well worth trying your current HRT combo in the sequential regime - this would involve using 200mg Utrogeston for 10-12 days each month or maybe on a slightly longer cycle (maybe every 5-6 weeks) and though you would have a withdrawal bleed after the Utro phase it may well reduce some of the side effects you are experiencing.
An alternative option to consider might be to have a Mirena fitted, as this often brings fewer progesterone side effects (less progesterone is absorbed around the body), will usually be bleed free and you can then use as much oestrogen you like alongside.
Here is the info about the Mirena:
Mirena is a levonorgestrel (type of progestogen) releasing system which sits inside the womb, gradually releasing the progestogen into the womb. It is licensed in the UK and Ireland as a contraceptive agent, for treatment of heavy periods and, from August 2004, also for the progestogen component of HRT. It can be used in both the perimenopause and postmenopause and it is particularly useful for:

Persistent progestogenic side effects from systemic HRT despite changes in type and route of progestogen.
When contraception is required along with HRT in the perimenopause.
When withdrawal bleeds on sequential HRT are heavy, after investigation if indicated. (see WHEN TO BE REFERRED )
With Mirena in place, systemic estrogen alone can be taken as the Mirena provides adequate protection of the womb lining and the estrogen dose and route can be tailored to meet the individual's needs.

Progestogenic absorption throughout the body is minimal so reducing progestogenic side effects. The effect of Mirena on the womb lining can significantly reduce bleeding and when used as part of an HRT regimen, in time, 30 to 60% of women have no bleeding at all. Although Mirena used for contraception is licensed for 5 years, the license for use for the progestogen part of HRT is currently 4 years.
Price: £88.00

There are other progesterones you could try as well - you might do better with Provera.  Have a look under the TREATMENTS section at the top of this page to see all your options.
Keep us posted - we're here to help.  DG x

Dancinggirl, thank you so much for responding with helpful information. Apologies for the delay but I was doing more research and more reading on this forum

I'm 34 years old and my hormones started playing up when I was 17. I have never experienced the typical menopause symptoms, only non-existent libido, tiredness and low bone mass this is why I was able to get away without HRT for 16 years.

It's really difficult to find out information because everyone is different. My GP has very little knowledge and the Gyno who prescribed my the HRT is not reachable and was seeing me for a different procedure. Once I am discharged, I will not be able to see her. so it's difficult to get answers and such. I have so many questions and so many doubts, it's quite scary!

I like the idea of going cyclically every 6 weeks, which should give my body enough time for the Utrogestan to leave and restore back to its normal size- my main and only issues are weight gain/water retention/ bloating and tender/painful/enlarged breasts- too big for my frame. I am exercising so much and eating less, I should be underweight by now. Progesterone, is essnentially the cause of the weight gain, enlarged painful breast issues?

If I go sequentially every 6 weeks and reduce my Oestrogen to 1 pump a day, I should be able to take 100mg or Utrogestan for 10 ten days? Moreover, will I not develop oestrogen dominance and suffer the same symptoms? Secondly, will I have worse PMS symptoms during the Utrogestan phases, due to a build up of lining and the fact that my body has to accustom to the progesterone again?

It's true that it takes six months for most symptoms to settle and I have experienced this over 5 months, but the weight and breast issue doesn't seem to be subsiding much at all. Today, my breasts seem only slightly smaller, not sure if that is because I'm going through the non-PMS phase or because I have reduced my Oestrogel to 1 pump these last three days. (I was PMS free for the most part of 12 years - had a period twice a year up to my late twenties)

I read about the coil and there are been reports of weight gain and migraines ( suffer from migraines by HRT hasn't caused me any problems). I don't like the idea that's inside and the dosage can't be adjusted. I like the medication I'm on, I'm just struggling with some side effects as mentioned above.

Thank you for your help, Dancinggirl x

[Dancinggirl]

Just to add: don't do this long cycle with such a low dose of Utrogestan (100mg for 10 days) without the OK from the specialist.  Doing a long cycle can result in breakthrough or erratic bleeding as the lining can build up - regular womb scans are a good idea if doing this regime. Some women get away with doing this longer cycle, with low dose of Utro, if they use the Utrogestan vaginally.  If you do a long cycle then it should be 200mg of Utro orally per day for 10 days. Using Utro vaginally isn't licensed in the UK but is popular in France and elsewhere.
Oestrogen dominance is a bit of a myth spread by alternative remedy practitioners - it's used to describe what many women experience in the peri meno stage when there isn't enough progesterone to control the build up of the womb lining and results in more problems with bleeding etc. You may get some PMT but this should be short lived and often strikes once you finish the Utro phase - PMT is usually to do with the progesterone highs and lows. A longer cycle may give a heavier and possibly more painful bleed - if this happens then perhaps reduce the time between bleeds.
Another point - one pump per day of oestrogen may not be enough to protect your bones - I would ask for a blood test to see if your oestrogen levels are high enough for bone protection - the usual dosage is 2 pumps per day. As you are quite small with a slight frame you may get away with one pump per day.
Don't rule out the Mirena as it can be an easy, no hassle solution. The Mirena is a favourite with many gynaes as it works so well for many women for many reasons. DG x

[Wanderlust]

Just to add: don't do this long cycle with such a low dose of Utrogestan (100mg for 10 days) without the OK from the specialist.  Doing a long cycle can result in breakthrough or erratic bleeding as the lining can build up - regular womb scans are a good idea if doing this regime. Some women get away with doing this longer cycle, with low dose of Utro, if they use the Utrogestan vaginally.  If you do a long cycle then it should be 200mg of Utro orally per day for 10 days. Using Utro vaginally isn't licensed in the UK but is popular in France and elsewhere.
Oestrogen dominance is a bit of a myth spread by alternative remedy practitioners - it's used to describe what many women experience in the peri meno stage when there isn't enough progesterone to control the build up of the womb lining and results in more problems with bleeding etc. You may get some PMT but this should be short lived and often strikes once you finish the Utro phase - PMT is usually to do with the progesterone highs and lows. A longer cycle may give a heavier and possibly more painful bleed - if this happens then perhaps reduce the time between bleeds.
Another point - one pump per day of oestrogen may not be enough to protect your bones - I would ask for a blood test to see if your oestrogen levels are high enough for bone protection - the usual dosage is 2 pumps per day. As you are quite small with a slight frame you may get away with one pump per day.
Don't rule out the Mirena as it can be an easy, no hassle solution. The Mirena is a favourite with many gynaes as it works so well for many women for many reasons. DG x

Thank you Dancinggirl I really appreciate your advice. Again, I've been doing loads more research, in fact, I'm exhausted from it! I just don't feel I have access to proper medical help, i.e. I don't actually have a gyno and my GP was against me using HRT though very supportive- he is an amazing doctor nonetheless. As you know, most GP have basic knowledge and he was like if you want to use one pump, then use 1 pump - do what's best for you. After doing research, I realised that wasn't good advice, for the reasons you have mentioned above.

I have a few more questions I'd like to ask and would you mind answering them? Of course, I understand if not and anyone is welcomed to add their thoughts and advice

[Dancinggirl]

Wanderlust - I am not an expert but happy to try and answer your questions.  I hope others will offer help as well.
With your history of hormonal problems your GP should have referred you for specialist advice really - maybe you need to ask for a referral to a gynae or menopause clinic where they will be able to give you the professional help and advice you need.
On this forum we are here to support those who struggle with the meno - we simply share our experiences and hope this will inform and help others.  DG x

[Wanderlust]

Hello Dancinggirl,

Thank you for your response and apologies for the delayed response. I decide to take a break from reading so much information about HRT, that it was making me feel anxious. Instead, I decided to ride it out a bit longer.

What I can say, since reducing the dose to 1 pump, most of my symptoms have disappeared. My breasts aren't as big, most of the PMS symptoms happen cyclically and not so bad- I get different symptoms.The crazy hunger has disappeared, instead, during the PMS phases, I'm a bit more hungry than usual but not starving to the point I can binge eat! I'd still like my breasts to go back to the size they were pre-HRT but I can tolerate the size they are now. The only two side effects I'm dealing with is acne and bloating/air. Water retention isn't too bad either.

The gyno who prescribed these to me said the progesterone could be causing the bloat and suggested I go cyclically, 100mg for 14 days every two weeks. She also suggested this mostly because I still have my period every two weeks on the continuous regime, even after being on it for 7 months.

I'm quite nervous about the side effects (anxiety, depression, mood swings, drowsiness, swollen brests-if prog caused) returning when I start taking Utrogestan after the 14-day break. Will the side effects that have worn off, return? Will I have oestrogen side effects during the days I'm not taking Utrogestan?

The questions are for anyone to answer not just Dancinggirl-not pressuring you into answering!

[Hurdity]

You shouldn't get oestrogen side effects returning when you are just taking oestrogen. Yes when you take cyclical HRT you do still get the expect cyclical changes just like when you had a natural menstrual cycle and you may get some bloating or breast pain on the progesterone phase. However - I agree with Stellajane - just go for it and don't worry too much about what's causing what. Most important is to make sure you feel better overall taking it than not - which is what we all aim for ( as well as long term health benefits if we can).

Hurdity x

[Cassie]

Because you are so young, it may be better to use the Utrogestan 100mg cyclically so instead of daily use it for the 1st 12 days of each mth, am sure its the progesterone that is causing the water retention etc, it certainly does for me. Using it this way you will obviously get a bleed but you wont have that constant progesterone bloated feeling and just generally blergh....

[Wanderlust]

Hi Wanderlust

I am well post menopause but I can definitely say that 2 pumps of gel gave me breast discomfort which has disappeared since reducing to 1 pump. I also developed a benign breast cyst whilst using 2 pumps and although there may not be any connection, it seems rather a coincidence that I never had any cysts before and haven't had any recurrence since.

I'm one of the few who choose to remain on a cycle in my 60s as for several reasons I just don't like taking progesterone every day. I use 100mgs for 10 days (as I'm older) and I've had scans which have shown my endometrium to be normal - also my bone density is normal (which is very good news as I have a lot of osteoporosis in my family).  I can still become spotty and somewhat bloated when I use Utrogestan though - and that's using it vaginally! Not sure if you've thought about using the capsules vaginally - it does reduce side effects.

I'd say you've been put onto an excellent regime.  I'd recommend you stick with it for two or three months before considering making any other changes - and try not to overthink things. This is a trap most of us fall into at some stage I think, and it can indeed cause unnecessary anxiety!

Hello Stellajane

Thank you for your response and sharing your experience

I wouldn't be surprised if the cysts were linked to the 2x dose of gel. Mine felt like hard lump volcanoes! They were so painful, prior to HRT, they were quiet and smaller. Since being on 1x daily, they are quiet again without any lumps and pain! Still a little big but not 2 cups bigger! It's really good to know your bone density (Osteoporosis runs in the family too) is good whilst on 1 pump, my bone density was so low, that I was taking Alendronic. I still am even though I'm now on HRT. I went without HRT for over 15 years - I'm 34 now.

Thank you ))

[Wanderlust]

You shouldn't get oestrogen side effects returning when you are just taking oestrogen. Yes when you take cyclical HRT you do still get the expect cyclical changes just like when you had a natural menstrual cycle and you may get some bloating or breast pain on the progesterone phase. However - I agree with Stellajane - just go for it and don't worry too much about what's causing what. Most important is to make sure you feel better overall taking it than not - which is what we all aim for ( as well as long term health benefits if we can).

Hurdity x

Hello Hurdity,

Thank you for your advice and information This gives me a peaceful mind The one and only side effect I love about the prog is how it helps me sleep at night! I agree with you about the essential reason for taking HRT is to feel better and believe me, I do now on 1x pump I just need to sort the prog side effects as mentioned above.

The scary thing is getting more/emphasised or new side effects when changing regimes but, I'm going to take all your advice and ignore my over-thinking anxious mind and try it. However, I will wait until the beginning of the month to stop taking the Prog. Also, I will try to sync it up with my current bleeds which seem to happen every 23 days, around the 24th of each month! Although, this month's bleed was more like spotting and was super light- lasted 3 days. I guess the continuous mode is now taking effect where my periods ceases to happen. Nonetheless, I'm going cyclically!

Thank you x

[Wanderlust]

Because you are so young, it may be better to use the Utrogestan 100mg cyclically so instead of daily use it for the 1st 12 days of each mth, am sure its the progesterone that is causing the water retention etc, it certainly does for me. Using it this way you will obviously get a bleed but you wont have that constant progesterone bloated feeling and just generally blergh....

Tell me about it! I constantly feel fat around the waist and arms and I always have a muffin top. All my jeans and trousers use to fit me so well and my stomach used to be so flat. It doesn't matter what I eat or how little, it still bloats out. I'm doing more exercise than I ever have, and the weight won't shift. Whereas before, my weight was always low, no matter how much I ate! I know it's bloat and water retention as opposed to fat! I'm so glad you've pointed out those side-effects and sorry to hear you suffered from them too. :/ I remember when I first started taking prog, the first month was tough, I felt like I was injected with a light dose of anaesthetic 24/7! Now, I no longer feel drowsy during the day and love how it helps me sleep!

How long do the side-effects take to wear off once stopping? I'm hoping I get at least three weeks of prog peace!

Thank you )))

[Dancinggirl]

Hi wanderlust
I had awful problems with Utrogestan and I tried it sequentially and continuously - it isn't good for everyone.
I mentioned before about the Mirena and I still think it would worth you trying this as it could give you a more stable effect overall - fewer privesteoneside effects and the plus of little, if any, bleeding after the first few weeks. You are young and you need the oestrogen, so you need to find the least problematic way to protect your womb lining from building up. The Mirena will allow you to use as little or as much oetrogen as you need to protect your bones.
Utrogestan made me sedated, I had a lot of spotting and breakthrough bleeding, period cramps and also developed an itchy rash around my chin and neck. In my experience Utrogestan is far from the perfect progesterone and I'm not alone with these side effects - many women move to Provera and do much better.
I would stick with 2 pumps of the Oestrogel as this will protect your bones. I'm 61 now and only had one pump per day through most if 40s and am now getting real problems with my hips!!!! I think I should have had a higher dose. I've also have vaginal atrophy which might not have developed so early if I'd had a proper dose of oestrogen. DG x