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[MidsummerRose]

Hello everyone, Newbie,here! I'm 36 and on oestrogel and utrogestan for severe PMS

..I know this is a menopause forum but I think I will soon hit that stage as I have been plagued by all sorts of weird,vague symptoms for a couple of years now. I've been using the oestrogel a bit intermittently for the past three months (although I was told to use 2 pumps daily and to keep going). I've stopped the treatment for a week at at a time on a few occasions pending clarification from the gynaecologist about a particular side effect I felt I was experiencing due to it.

I have noticed an improvement in my mood on the oestrogel (although I've still had some bad days). I made a start on the utrogestan 100mg capsules earlier this month. The gynaecologist I saw asked me to take utrogestan for 7 days the first of each calendar month. So far the oestrogel hasn't suppressed my own cycle as I still have my own regular normal bleed. Is it absolutely necessary to take the utrogestan if l still have my own regular cycle? Also, I feel that if you're taking utrogestan for the first seven days of each month,couldn't you have a situation where you end up taking it just as your menstruation might be starting?

I'm asking this because the gynaecologist I saw really didn't seem to listen to me and prescribed what I feel might have been a one size fits all treatment.

[Hurdity]

Hi MidsummerRose

If your cycle is very regular eg 28 days then it seems to me to be sensible to tie the timing of the progesterone in with this rather than take the progesterone monthly, but I presume this has been set as your cycle should be suppressed and therefore you can decide on the length (ie calendar monthly) if the oestrogen dose is high enough.

You should always take the progesterone you have been prescribed - it is to help protect the uterus. I know you say you are having normal periods but if the gynae has prescribed this then s/he must think it's necessary. I realise women who have regular periods do produce their own progesterone at ovulation which may enable adequate shedding of the lining but it's best not to avoid this if the doc has prescribed it.

There has been discussion on here about the 7 day regime - and if your cycle has been suppressed I presume the gynae expects there to be little thickening of the lining?  This is far less than the licensed dose both in dose and duration (100 mg x 7 days) especially if you are taking it orally but I presume there is a reason for this (progesterone intolerance?) and you are being medically supervised? Sounds like you need a gynae who does listen to you - that's so crucial at this time! Maybe see someone different if you can, and if you are not happy?

Hurdity x

[MidsummerRose]

Many thanks for your reply,Hurdity.

The oestrogel hasn't so far suppressed my cycle(by which I mean I still get my own monthly bleed and do still ovulate,I think). I had initially been prescribed 3 pumps daily by the gynaecologist, back in July,but after about a week was finding the side effects too unpleasant and so called up the gynaecologist who told me to go down to the 2 pumps. Certainly, I'm feeling a bit better even on the 2 pumps. Tbh, because I've stopped and started so often because of this or that side effect, I've noticed that whenever I restart the oestrogel(with a view to using it daily as per the gynaecologist's request) even if it's during a point in my cycle when I normally feel pretty low I do find my mood improves a couple of hours after application.

It seems to me a better idea to begin the utrogestan around day 17 or so of my cycle. The only concern I have is that at the moment I am on day 3 of my cycle. I feel that although I haven't really been using the oestrogel continuously since July a d have stopped the treatment for a week or so at a time I really should have taken more progesterone than I have done. I've taken progesterone for just 3 days(that was from the 28th September) since I started the treatment and feel like if I wait it out til day 17 it will be to long to be on the oestrogel unopposed. I had fully intended to see the utrogestan through til day 7 but started a short course of antibiotics.

I am going to see a new private gynaecologist next week. I would have started the utrogestan sooner but have received a lot of conflicting advice. My gp, for example, who wasn't happy about me going to see a gynaecologist off my own bat had scared me into stopping the treatment. I asked her whether it would bve sensible to take the utrogestan to be on the safe side and she'd said, "I wouldn't be taking any of it. This is hrt and you are premenopausal." She then went on to say that a woman only needs four periods per year. I then consulted with the gynaecologist I saw who told me to stick with the treatment and to start the utrogestan the following month. I felt like since he didn't know whereabouts I am in my cycle it wouldn't hurt to start the utrogestan a couple of days early as,if I was to gt a bleed from it, I would rather it happened before my actual period.

Or is bit the utrogestan which suppresses your cycle?

[Hurdity]

Hi again - no it's the high dose oestrogen which suppresses the cycle. High doses of progestogen can also do this I think like in the POP, but not guaranteed. From what I understand high oestrogen suppresses Follicle Stimulating Hormones so no eggs can develop and mature.

Good luck with your appointment and hope you manage to settle on the right treatment and dose to help with your pms. Have you considered the CCP or is there a reason why you don't want to take this?

Hurdity x

[MidsummerRose]

Hi Hurdity,

Thanks once again for your reply.

I do wonder whether the 2 pumps by would be enough to suppress my cycle.

Initially, I was going to give the CCP a go and did try out loestrin. I found that even after just a couple of day's use I was becoming cranky and irritable and decided to give up. At the time, I had been doing a bit of reading on progesterone intolerance and thought my reaction to it was due to an intolerance. 

My GP then prescribed femodene which I was all set to give it a go to until I started reading about the increased DVT risk with the newer pills. Additionally, after starting on the initial three pumps of oestrogel I experienced various unpleasant side effects. On learning that the estradiol content of the CCP is a lot higher than that contained in the oestrogel, I felt that I wouldn't be able to cope with ccp's oestrogen content.

I am starting to wonder,though, whether I've got it wro g and whether the mode of action in the two products is different and whether I should just give it a go.

My own feeling is that I can't cope with utrogestan, either, as even after a couple of day's use I found I had far worse premenstrual symptoms this month than I had in my previous cycle.