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[keancy]

Good evening Ladies,

I have only just registered here all though I have been reading and learning a lot from you all over the last 12 months. I am beginning to get desperate now.

I realized I was in Peri in December 2016, I tried for 5 months to go down the natural road, i.e supplements , diet ect. This didn't work for me and in May last year I went onto Evorel Squi. This worked absolutely brilliantly for 2.5 months at which point I was sinking deeper and deeper into depression and suicidal moods every time I hit the Progesterone phase (Conti) By the middle of September I was so bad I went back to my GP and said if you don't help me I will jump of a cliff!!!! She immediately advised me to stop the Conti phase and suggested Mirena for the progesterone. I had, had Mirena previously until 2008 before getting my Tubes tied so I agreed. However, having this fitted in early October it soon transpired by early November that Mirena and Evorel 50 alone were not working and I was climbing the walls with Anxiety and Tension. After some debates with the GP they agreed to supply me with Utrogestan which I started toward the end of November. I was using this vaginally after reading here a lot that it was a good method and again I felt absolutely fantastic.

Fast forward to the second week in January 2018, 6 weeks in and I got what I assumed a UTI, another visit to the GP after a week of trying to shift this irritant with over the counter meds and I end up with a course of Antibiotics. Culture was sent away and after a week of Antibiotics, no better off, I was told by the GP no infection actually got found. I am now desperately running to the Toilet every 15 minutes barely trickling Urine and the most horrendous burning below. Another Trip to the GP and I am referred to have a whole abdomen scan aswell as Bladder scan and a medication to slow Urine incontinence and Vagifem for dryness below. (I had to stop the Urine meds because the side effects were horrendous) Coinciding with that after more reading here I decide to stop the Utro as a trial..............3 days without Utro and the Bladder issue has almost cleared completely so I decide to try it orally instead, same problem resurfaces and I am forced to admit defeat taking Utro. This was last week, I am now back to square one and just on Mirena and Evorel 50 (and Vagifem 2 x a week), but again I am shaky, dizzy, anxious, uptight and cannot function.

What else can I do/take at this point to balance the progesterone which I so clearly still need desperately. Any suggestions will be gratefully received.

[Mary G]

keancy, sorry to hear you have had such a difficult time.

Have I got this right, you have a Mirena coil and you have also been using Utrogestan, why is that?  You don't need to do both.

I tried patches with a Mirena coil and they were completely useless because they didn't supply anything like enough oestrogen.  You would be far better off using Oestrogel (you rub it on your skin) because it absorbs better and gives you maximum flexibility and control over your oestrogen levels.  If you have a Mirena coil you need to balance it out with oestrogen otherwise the progesterone is far too dominant - although most of the progesterone is confined to the womb enough of it gets into your system to cause side effects.  Dizziness is a sign of low oestrogen and this is clearly why you are feeling so bad. 

Once further point, when I had a Mirena coil and was not getting enough oestrogen via the patches I had horrendous problems with constant vaginal burning, frequent urination and overthinning of the womb lining.

[Hurdity]

Hi keancy



Heavens if you had a Mirena and utrogestan that is far too much progesterone!!

If you like patches but are still getting menopausal symptoms ( flushes and sweats?) then you could increase the patch dose to 75 mcg or even 100 mcg. I use Estradot (for 11 years!) which are much smaller so you can increase dose and the patch is still small - there have been supply problems recently though.

Some women do find vaginal utrogestan irritates the bladder. When I am on this phase (I still maintain a cycle) I always empty bladder more frequently and always wake in the night once whereas recently, when on oestrogen only, I sleep so deeply I don't need to get up in the night. As I am on a long cycle I can cope with this for 12 days in 8 weeks!

Just a point that women vary in how much they absorb from patches or gel - some are better with one method, others with the other - and also it is a matter of preference.

If you are feeling shaky dizzy and anxious - this could well be the large doses of synthetic progestogen in your system and hopefully this will settle after a few weeks and it might be especially helpful to increase your patch dose too ( or change to gel if this is what you would prefer).

Just one thing - you say you were peri in Dec 2016 - presumably you had started skipping periods and having irregular sometimes longer cycles? You also haven't said how old you are?

Hurdity x

[Optimist]

Hi Keancy,
Sorry to hear you've been having problems, I've had the same with progesterone so I've had Mirena fitted (last Wednesday). I'm using oestrogel and I'm currently up to 4 pumps as I think it takes a bit of time to get in your system effectively. (That's what I'm hoping). You would have been having a full whack of progesterone on both the Mirena and utrogestan, no wonder you felt awful on it. Advise like Mary G to trial
Mirena with oestrogel.
Just about to ask Mary G a question that you may find relevant also. I'll start a new post if Mary G doesn't see this.
Mary G can I ask how much
 oestrogel you used with
Mirena initially and now as a
week in using 2 pumps in morning 1 at night, urine frequency and volume increased (using vagifem also), also joint pain thumbs, elbows, back etc plus some dizziness,  so today used 3 pumps morning & 1 tonight. (4 in total). Is this okay and will I eventually be able to titrate down do you think? Did you do this at all or similar? Appreciate a response if you see this.
Keancy good luck xx

[Mary G]

Optimist, unfortunately I didn't get that far with the Mirena coil.  I used patches which were completely useless and didn't give me any relief at all and I had the Mirena coil removed.  With the benefit of hindsight, I wish I had tried the Mirena coil with Oestrogel because it works so much better and it is much easier to attain the high levels of oestrogen needed to counter the side effects of the progesterone in the coil.  I worked my way up to a 100mcg patch eventually and I still wasn't absorbing it properly - this was confirmed with blood tests.

At a guess I would say you would need 3-4 pumps of gel to get good results with a Mirena coil - that's the beauty of Oestrogel, you have so much more control over the dosage.  You are doing the right thing by splitting the dose to get an even spread of oestrogen and hopefully you will feel the positive effects very soon.  You might be able to reduce the gel dose as the effects of the coil wear off (I think the progesterone in the coil reduces year on year) but I wouldn't rush to do it if you find a level that works for you. 

I hope that helps!

 

[keancy]

OK, so I am confused .

I assumed now I dropped the Utro if it were the case I had to much Progesterone I should start feeling better with just the Mirena, Evorel 50 and Vagifem, however apart from my Bladder improving I feel worse after the lack of extra Progesterone. Utro made me feel so so much better in combination with Evorel50.

How is it possible to feel worse now?? I almost feel as if I am Estrogen overload rather then the other way.

Hurdity, sorry I am 47 (48 in August) I was still having periods however very irregular and after starting Evorel Sqeui quite heavy and prolonged along side the suicidal feelings, hence Mirena.

Also, I have neither Flushes or Sweats my symptoms are:

Extreme Dizzyness, constant fatigue, Palpatations, Anxiety, racing Heartbeats. All of which I had before Utro and now again after stopping Utro.

Mary G., I was getting Utro because the Mirena, even though it releases Progesterone, only releases small amounts into the Womb. It does not however release progesterone into your body to level out Estrogen and help with wellbeing. I felt 100% better with Utro until the Bladder issue surfaced.

I am so, so confused. Am I Estrogen dominant or am I deficiant. I am scared to add even more Estrogen now seeing I am on the 50 patch aswell as Vagifem now. I really, really appreciate the replies Ladies, but I am confused to hell. Should I perhaps try adding another half patch of my Evorel50 to see if it makes things better or worse?

Add: I wasn't on any weekly/monthly routine with Utro either, it was daily!!!!!

[Mary G]

keancy, if you are perimenopause and need oestrogen and progesterone then you might be better off using the contraceptive pill. 

The symptoms you describe sound like oestrogen deficiency.  The bladder symptoms you talk about are the same that I had with the Mirena coil when I didn't have enough oestrogen.  You said you tried taking Utrogestan orally and you still had the bladder problem so I doubt that is the cause.

You need to work out what is causing you to feel like this and I would start a process of elimination before making any drastic changes.  Why not start by increasing your patch dose to see if you feel better?  If not, you could try using the Mirena with Oestrogel to see if that makes a difference - it is easier to control the dose and it absorbs well.  If all else fails, you could then try the contraceptive pill and if that works, you could stay on that and have the coil removed, you don't need both.

I think you probably need to try a few experiments. 

[keancy]

Mary, think I have to eat humble pie here and you're Spot on. I called the surgery today and the blood results have returned.

Verdict: low estrogen!!!

So, my patch is due for replacement tomorrow and I will apply one Evorel 50 and a half of the same and see how I go with that over the next couple of weeks. If it improves my symptoms I will ask the GP for a higher dose patch.

Thank you for.the reply, appreciated

[Mary G]

That would explain a lot!   It's good that you know your oestrogen levels are low but I would urge you to try Oestrogel because it is far easier to attain higher levels of oestrogen and it is very dose flexible meaning you have far more control over your HRT regime.   I had the same symptoms as you when I had a Mirena with inadequate oestrogen and I eventually worked up to a 100 mcg patch and it still wasn't absorbing properly. 

Try the extra patch first and see if you feel a difference and please let us know how you get on.

[Hurdity]

Just to recap - I did suggest a couple of days ago you could increase your patch to 75 mcg or 100 mcg and best to change to estradot as they are small. Your dizzy feelings sounds like excess progestogen. I can't think who or where would prescribed utrogestan as well as Mirena! You are getting progestogen in your body with the Mirena (it really is absorbed systemically roughly similar to a Femseven patch) and synthetic progestogens are not associated with well-being!  If you were taking utrogetsan orally then this acts as a sedative so it was just zonking you out - acting as a depressant so you maybe didn't notice what else was happening. Too much prog of different types is defo not the way to go!

By the way if you are peri-menopausal the measuring oestrogen levels doesn't tell you very much because it is it varies a great deal and depdnds when in your cycle the bloods were taken. Do you know when it was and also do you have the actual reading? Even so I would still increase your patch as I suggested.

If you are one of the women who like progestogens then there are two contraceptive pills that contain the same oestrogen as HRT and are good for women in your position - they are called Qlaira and Zoely. Qlaira only has two tablet free days. You would want to get the Mirena removed before starting this.

Hurdity x

[keancy]

Thanks again Ladies. I added the extra half a patch along side my normal switch tonight. I will see how this goes over the next couple of weeks or so. If no use I will revisit my GP and suggest what you have both said about above.

Thanks again, will keep you posted

[keancy]

Hi Ladies,

So adding the extra bit of the Patch seems to be helping as far as I can tell, I am adjusting to not having the Utro and am slightly calmer now. However since I stopped Utro a while back I seem to be spotting daily, not a lot, and the stuff coming out is more dark brown then red so old blood at a guess (sorry for the TMI)

I am curious though, I use the Vagifem twwice a week now but on a daily basis I am getting weird kinda gritty looking discharge. Is this the resolving bits of the Vagifem tablet?? Bit gross

Thanks again for the help so far

[Optimist]

Hi ladies, glad to hear the extra half patch is helping Keancy!
It really is a trial for some getting the right hrt regime.
I'm on 4 pumps oestrogel and just into 4th week of Mirena and I'm feeling so flat it's awful and I'm so fed up with it all now. I've got a check up with gp in another 2 weeks so will ask for blood tests to see if I'm absorbing the oestrogel as I thought the higher dose would counteract the progesterone side affects. I'm not sure if this feeling low and flat will wear off  and just be a side effect, feeling irritable also and have developed an intense dislike for other half which I'm sure after the rollercoaster 18 months I've had on hrt will eventually finish us as I don't feel he'll be able to put up with “me” whoever that is... for much longer.
MaryG thanks for your response earlier, is this how you felt on Mirena?
Any suggestions/reassurances ladies would be very welcome. X

[Mary G]

Optimist, my experience with the Mirena coil is complicated because I had it fitted for contraception originally.  When I had the first one fitted in 1998, I asked the gynaecologist at the FPC if it would give me breast pain and she said 'no' but I'm afraid it did.  Apart from that, I don't remember any significant problems but I was not menopausal then and had the protection of my own oestrogen.  My problems started several years later when I hit the menopause and stopped producing enough oestrogen and the progesterone in the coil became too dominant.  I had constant vaginal itching, burning, overthinning of the womb lining and last but not least, silent migraines but I don't remember any significant mood problems.  I started using patches but couldn't get enough oestrogen out of them so I had the coil removed but as I've said before, I really do wish I had tried the coil with Oestrogel because I know I can achieve much higher oestrogen levels with the gel and it might have worked.  I would not want to risk it now because I've had too many problems with progesterone and it might set my silent migraines off again. 

In your case I think you probably need to keep going with the higher dose of gel to try and counter these side effects.  The good news is the coil starts to run out of steam after a while and hopefully the higher dose of gel will work soon.  It is definitely a good idea to have blood tests to see if you are absorbing the gel, I found that my oestrogen levels were extremely low when using the Mirena with the patch. 

[Optimist]

Thanks MaryG and apologies for “hijacking” your thread
Keancy.
Will definately ask for oestrogen blood test. Strangely enough I only used 2 pumps of oestrogel yesterday morning (I just thought I'd trial as I remember getting irritable on oestrogen before) and I haven't felt irritable and mood seems to have lifted, so maybe 4 pumps is too much,  however peeing like an elephant again yesterday, so it's a fine balance to overcome progesterone side effects v low/high enough oestrogen. I shall persevere and update. Like you've said MaryG the beauty of the gel is that you can adjust the dosage!
Keancy I hope you're finding the extra half patch helpful? Re the vagifem I had the gritty discharge on the 2 week loading dose and now and again I still have it (I use it every 2-3 days dependant on symptoms) but I wouldn't worry about it too much as the benefits far outweigh that.
X