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[ifcatsruledtheworld]

Sorry in advance for the length of this.
I was looking for some advice. A bit of background.

I'm 50. I haven't had a period since I was 37 (low bmi). FSH test contantly showing that I'm not officially Meno.

Stuff started happening. Bed sweats age 45, painful sex 47, then 47 to 49 increasing fatigue, body ache, itching, hair loss, no sleep. Despite FSH my lovely female understanding doctor said it was fine for me to have HRT. I asked her for Evorel 25 patch and Utrogestan 100, so that I could ‘mess around' and see what does what and what works. I learned quickly that Estradiol patch was a life saver and transformed me from a frail aging wreck back to the previous me. The progesterone on the other hand is VILE. Progesterone - Pregnenolone -GABA - might as well just take benzodiazepines for what it's doing to me.

My question is this. How do others deal with this? Can a woman take Estradiol only and pay for private scans of the endometrium? I realise that you can have endometrial cancer without hyperplasia but at least it's something? My Estradiol was incredibly low according to saliva and serum test so if my 25mcg Evorel patches are getting that back to where I was pre meno but still Amenorrhoeic, could this not be a route?

Those of you on long cycle HRT, how much Progesterone do you take and for how long to force a period.

I would really appreciate any advice from ladies who have found themselves in a situation where the Progesterone is a problem

[CLKD]

 

blood tests are reliably un-reliable re hormone levels, as are saliva tests.

Some ladies find keeping a mood/symptom/food diary useful to chart any patterns that may/not emerge
As oestrogen levels drop the muscles may become lax = aches and pains as well as causing the body to dry: inside and out - nostrils, deep in the ears, throat, eyes, vagina  : do read our threads on the latter!

Many ladies find that progesterone is problematic and I'm sure that they will be along.  In the mean time, browse round. Make notes.

[ifcatsruledtheworld]

I know and those tests cost me £160! But isn't the doctors FSH test totally inconclusive too? So I figured a snap shot might be at least a ‘guide'. I did them on a bad day when I felt as though I was 110 :-)

Menopause matters is such a fantastic thing! I will do as you suggest and have a really good look round. thank you x

[Mindfulmoomins]

Hi,

I have had a break from utrogestan this month to let my oestrogen levels build up as I had awful problems on it the previous month (when I'd only just started Oestrogel).

I am now on Oestrogel 3 pumps and am going to take 10 days of ultragestan 200 mg vaginally for 8 days and then 100 mg vaginally for the following 2 days.

I'd love to hear how others manage too. Apparently if your oestrogen levels are higher that helps. Here's hoping.....

Xxx

[Hurdity]

Hi ifcatsruledtheworld

 

I'm not sure what the position is re blood tests and early menopause brought on by low BMI but if you are not having periods, are now at almost the average age of menopause and are having those symptoms - then forget about the FSH tests (I presume these were blood tests not saliva?). I know if you are post-menopausal they should be raised but your symptoms show otherwise. What have the actual levels (from blood tests) been?.

If you have had low oestrogen for all those years you definitely need to keep taking it and ideally at a higher level if you can ie 50 mcg which would give you better bone protection than 25 mcg.

Have you been taking utrogestan on a cycle or continuously? Has it given you a bleed at all? If you are on a low dose of oestrogen and are post-menopausal then you can probably get away with a long cycle.

As an example I am mid 60s, and have been on HRT for coming up to 11 years. For the last 6.5 of these I have been on a long cycle ranging from 6-8 weeks - and for most of this time I have been using a 50 mcg Estradot patch (although a few months ago increased it to 62.5 because I also use testosterone). I take utrogestan vaginally 200 mg x 12 days. My bleed lasts a few days and is nowhere near as heavy as it was when I was fertile and had my natural menstrual cycle. I could probably go a bit longer between prog cycles or have a slightly higher oestrogen dose but at my age I don't want to push my luck re the endometrium!

This has been with the approval of my doctor (the longer cycle) and scans just after the bleed have showed the thickness is fine ( just under 5 mm the last time it was done).

A good rule of thumb is - the higher the oestrogen dose you have, the more progesterone you need for a longer period of time, and the less likely a long cycle is to work. Vaginal progresterone allows more to get to where it is needed than when taken orally.

It is definitley inadvisable to take oestrogen only even if you are very progesterone intolerant.

There are LOTS of posts about this on this website and a while thread devoted to Utrogestan and estrogel where you will find some nuggets of info and experiences from other women

Hurdity x

[Mary G]

ifcatsruledtheworld, I agree, progesterone is vile!  This comes up on here all the time and unfortunately the progesterone part of HRT is the downside for many of us.

If you react badly to progesterone and it is ruining your HRT regime then yes, you can use less of it and have uterine scans to check your lining is clearing properly on the lower dose.  This is what I have been doing successfully for years. 

Many of us on here take 100mg Utrogestan vaginally for 7 days each month and have regular scans.  If you feel terrible during the progesterone phase, it is also a good idea to increase your oestrogen dose during that time.  You might find that switching from patches to Oestrogel (you rub it on your skin) would give you more control and flexibility over your regime and help to minimum the side effects of the progesterone. 

I'm considering having a uterine ablation so that I can switch to a very long 3 month cycle and avoid the ensuing bleed. 

[CLKD]

   Girls.


love the name by the way ..........  you mean your cats *don't* rule the world   

[ifcatsruledtheworld]

It's so good to hear from ladies in the same boat and you all sound so sensible and logical.

Mindfulmoomins. 10 days! I might be able to do that but after 5 days I couldn't drive. I was like a zombie. Useful to know though. I have the 100mg dose though not 200.

Hurdity, me thinks you know about these things. :-) I will look up test results and post them, they are in my work case. Yes Fsh was a blood test through the doctor. I didn't make a note of results but remember they were about mid range for a non meno lady. My doctor is happy for me to go to evorel 50 and I have tried doubling up but it makes me depressed (never got on with the pill for the same reason). Hurdity I've been terrible with the Utrogestan, on it, off it. It makes driving actually dangerous for me after a few days and I drive an hour to work.  I honestly don't think I could manage 200mg for 12 days. Do you get on better taking it vaginally? I take it you have the same as me but choose not to take them orally? The pregnenolone is still a by product of it from what I've read (acts like a benzo gaba receptors) and hence I hadn't tried it? Does it help? Interesting that the near location may help but does using it vaginally alter absorption or delivery cuvre? problem with pregnenolone is that it may be ‘cumulative' like benzodiazepines.

Mary G. I reckon I could just do 7 so I'm going to give this my best shot. Starting Monday. And I may try it vaginally like hurdity. How often would you have to have uterine ablation? nhs? ‘hey doc that progesterone is vile, can have endo ablation please'? I just can't imagine it being terribly simple? Is this something that you have to sort out yourself and ask your doctor for (and I'm thinking my doctor may say privately only).

CLKD!!! Thank you. Yes my meezers do!! I am waiting for them to make cat human marriage legal

Strikes me I still have a lot to learn about all this. Will find saliva serum results

[Mary G]

Give the 100mg Utrogestan for 7 days a try and make sure you place the capsule next to your cervix.  I've always used it vaginally and I think most women do because it works better at lining clearance and has fewer side effects.

You would have to be referred for an ablation but you should be able to swing it on the NHS if you are severely progesterone intolerant.   If the procedure is carried out properly you only need it done once.

[ifcatsruledtheworld]

Thank you Mary. I'm going to start tonight

[Hurdity]

Ifcatsruledtheworld

I have only ever used it vaginally and there are definitely fewer metabolites - I'd have to spend time looking it up but I'm not sure you get pregnenolone as a by product when used vaginally - or if you do then it would be a minute amount. I have never taken it orally as I've always been a nilbynouth gal when it comes to HRT - it being the most natural way to get the stuff into your system.  I have a feeling the GABA receptors are only affected through oral use but must admit I am hazy on the details as haven't read up on it for a while so might be wrong there!

You are on a low dose of oestrogen ( 25 mcg patch) so less progesterone will be needed but please be aware that the 7 day progesterone x 100 mg per calendar month is way way lower than the licensed dose and most gynaes do not sanction this. You might well be OK but only if your doctor permits this and under medical supervision. You would need to have regular scans to see how your body behaves. Personally I would choose a slightly longer cycle with say 10 days x 100 mg vaginally if you could (still under medical supervision).

By the way the week before I start my utrogestan I make sure my vaginal tissues are well plumped up by doing a week re-load of Vagifem - my theory being that this will produce less systemic absorption but this is based on no research whatsoever - as it might not work like this at all. It does for oestrogen so I am hoping it does for prog. I feel pretty tired and hard to wake up in the morning when I'm on my prog and sometimes I get progessively foggy headed, and sometimes a migraine but nothing I can't cope with - even though I don't like this part of the cycle. I have just done 3 nights of 200 mg for this 8 week cycle and so far so good..... just the usual tiredness.

Re endometrial ablation - there is no way I would want to have an unnecessary surgical procedure unless this was indicated medically and if there was any possibility of finding another solution so I would try other things first!

Do try the vag Utro but I recommend doing the plump up with vagifem first.

Hope this helps.

Hurdity x

[Kwebst]

I had an endometrial ablation years ago due to having very heavy periods. They are never able to remove all the lining and some of it does grow back. It means i still get regular bleeds (very light in comparison to what I had)and need to have sequential Hrt- I'm peri. This is insisted upon. Heavy periods are the only reason they would carry out this procedure.

[Mary G]

All points re uterine ablation are duly noted.  This is only suitable for women like me who are severely progesterone intolerant and have been told they really need a hysterectomy.  Although you still need to take progesterone, at least you can use it every 3 months without much of an ensuing bleed.  It is not a perfect solution but I think it might be worth a try before committing to a hysterectomy.  I need high levels of oestrogen so I can't do a long cycle without getting breakthrough bleeding and this procedure would mean I can manage a 3 month cycle which makes the whole thing more palatable and would make a real difference to me personally.

It's just an idea that I thought was worth putting out there.

[ifcatsruledtheworld]

You know I can't tell you what a relief it is to have a conversation withe people that talk such sense! Must be your (and my) age!

Hurdity - point taken re the low dose and timescale. I'll just give it my best shot and see how long I can go.
I haven't managed more than 5 days on the trot.

On the ablation thing. Estradiol feels like a lifesaver so I am terrified I won't be able to keep taking it because I can't take Utro-benzo-zombie tablets. So personally I would go for it, but my doctor is very frank and will say things like ‘If I can't stand up in a court of law and say.....' So if it's not supposed to be done then I guess she wouldn't do it. Thing is if she stops my estradiol I will go back to being the frail wreck.

Your advice and openess has been honestly lovely
kx

[ifcatsruledtheworld]

Please excuse my lack of forum etiquette if I'm doing this wrong. I don't know if you are meant to open a new ‘question' or go to your old related one.

Well this vaginal Utrogestan is blinking brilliant!!! I can do it! Hurray. And I guess I'm lucky as some of the ladies here were so intolerant of Progesterone that they struggled with it via either route. Goodness ladies thank you so much for the advice.

I have a question though. I have done 10 days and planned to do 4 more and hope like mad a get a period. In your experience, do you get a bleed? Do you think there is a chance that I won't? My doctor said that she really needed to know that I had been able to shed endo lining to put me the safe zone. I wondered if other ladies ever didn't? Or perhaps did but it was more adhoc.

And how long after you stop the Progesterone does it happen.

One more question. Do you get PMT when you stop? I never minded the ‘mechanics' of periods but the horrid depression and paranoia of PMT are distant memories for me (Amenorrhoeic which I liked for exactly that reason even though I knew it wasn't healthy). I will deal with it but forewarned and all that.....

Your thoughts and experience would be really welcome.