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[Jo24]

My mood seems to be improving on an increased dose of Femseven Conti 50mcg/7mcg as advised by
telephone consult with my Meno Consultant ('try a patch and a bit') and see me in 8weeks.
She agrees that I seem to require continuous Prog along with the Oest for my mood after experiencing increased anxiety and the return of insomnia on Sequi patches.
Some forum members seem to be very 'anti' towards the use of continuous Prog systemically, and advise the Mirena coil?
I do not think this would be of benefit ito me personally, and suggest it is important to recognise that some ladies 'need' systemic Prog - it is not the Big Bad Wolf for us all...

[Dancinggirl]

Some women do actually feel better on progesterone all the time because the fluctuations of a sequi regime don't suit them. The Mirena is good because it gives a continuous dose of progesterone with less systemic absorbtion generally, (usually less negative progesterone side effects) so reduces the fluctuations.
If you feel better in a conti HRT patch, then that's great. We are all different so it's about finding an HRT with the most benefits and the least side effects. Keep us posted about your progress - sounds as though you have a good doctor. DG x

[Jo24]

The Meno Consultant is at the Sheffield clinic - she is very on the ball 👍🏼
Yes, I think I am best suited to continuous Prog; I did not cope with the 'yo-yo' effect of Sequi, my anxiety was worse, and sleep disrupted.
Regarding the Mirena, I am dubious as to whether it would give me enough of a systemic effect.
I did forget to ask her how high I could go with my patch tweak; she suggested 1 + 1/3 to start with, but I have gone for bust today with 1 + 1/2 to see if that further improves my mood.
I do feel less emotional on the 1/3 increase, but still feel a low grade nervousness at times.
Oh, hoping 🙏
Thanks for your support x

[Dotty]

Hi Jo24.  Can I ask which clinic you went to in Sheffield? Is it NHS or private? Thanks

[Jo24]

Dr Stilwell is at the Sheffield Meno clinic, Jessops Wing, part of the Sheffield Teaching Hospital Trust, an NHS facility; she is excellent. About an 8 week's wait, but well worth it.
She does not do private work.
I found my GP lacked true expertise.
If you are in this area, and struggling, I highly suggest a referral .... x

[Dotty]

Thanks for the info Jo24.

[Dancinggirl]

Jo24 - it's not a good idea to constantly change the amount of oestrogen you use.  Ideally you should increase a small amount and stick with this dose for 4 weeks at least to really gage whether this is right or not - if you need more you can then up it a little again. 
As for the Mirena - it won't be the amount of progesterone absorbed but the consistancy that will probably make the difference for you.  Too much progesterone might well undo the benefits of the oestrogen.  If you find you need to increase your oestrogen significantly, then the amount of progesterone you use would also have to increase to protect your uterus and this might well have a negative effect on your mood. What you experienced with sequi HRT was a more extreme response to the withdrawal of progesterone ( some women do get this), so this doesn't mean you would do better on a continuous ‘high' dose of progesterone.  The Mirena allows you to use as little or as much oestrogen as you need (which is great) and may well give you the constant amount of progesterone that would stop the fluctuations. 

If anxiety and low mood are you main meno symptoms, when this is very difficult to control. Many believe that higher doses of hormones are the answer but hormones alone will not solve everything. There will be a point where your flushes and night sweats are under control and you generally feel O, most of the time but it is unreasonable to expect to feel good all day, every day. I assume you are utilising other strategies to help e.g. good diet, exercise and relaxation techniques? HRT can only do so much - it is a range of strategies that will give the best outcome.   DG x

[Jo24]

I have been on the 1+1/3 for over a month now, hence the upwards tweak today ...
Yes, I am 'doing all the right things'; I walk 5 miles a day (we have 2 dogs), am having counselling, and practice mindfulness ... 👍🏼

[Dancinggirl]

Jo24 - that all sounds good - you'll get there.  DG x

[Jo24]

Thank you 😊

[dangermouse]

Some women (and men) produce less progesterone than others, even post meno via the adrenals, which is why when younger you have the choice of oestrogen or progesterone dominant pills.

Adding progesterone can suppress our own and cause withdrawal problems for a few days until our own kicks in again (it causes me severe gastric migraines) but once you get the amount spot on and take continuously, you feel balanced in the same way that women with oestrogen deficiency rebalance themselves.

Progesterone has many therapeutic benefits including building new bones, relaxation, clearer mind, reduces tachycardia, improves sleep, lowers blood sugar etc. I also feel more sociable on it, hence why posting more here! When mine is too low I just want to hide under the bed.

[Jo24]

Thanks Dangermouse- we both seem to 'need' that systemic Prog; I see lots of posts which suggest it is undesirable, and should be minimised, but I personally find it therapeutic.
It is used in Vet medicine for it's sedating, calming effect, so clearly has an effect on mood ... 👍🏼
Good to hear I am not the only one in the Prog Camp- I was beginning to wonder if I was imagining its benefit to me ... 😉

[NinaH]

I use utrogestan continuously because I hated the up and down of sequi. I was an emotional wreck!

Much calmer now 😂

[Jo24]

Mamachunk - 👍🏼

[Hurdity]

My mood seems to be improving on an increased dose of Femseven Conti 50mcg/7mcg as advised by
telephone consult with my Meno Consultant ('try a patch and a bit') and see me in 8weeks.
She agrees that I seem to require continuous Prog along with the Oest for my mood after experiencing increased anxiety and the return of insomnia on Sequi patches.
Some forum members seem to be very 'anti' towards the use of continuous Prog systemically, and advise the Mirena coil?
I do not think this would be of benefit ito me personally, and suggest it is important to recognise that some ladies 'need' systemic Prog - it is not the Big Bad Wolf for us all...

Those women who are OK with progesterone or progestogens in general may get on better with continuous progestogen preparations because they avoid the fluctuations of  cyclical preparations - as it is often these fluctuations that many women are sensitive to - just as in peri-menopause, and the menstrual cycle. It may well be not because of the need for continuous progesterone to give beneficial effects, but the absence of adverse effects (due to having consistent amounts of both hormones) if you see what I mean?  Mamachunk - sounds like this is you!

Some women find all synethic progestogens give unwelcome side effects amd seemingly become more sensitive at menopause eg women on here reporting that they have been OK on the CCP in younger years yet not with the same progestgoen as part of HRT. The Mirena coil does give systemic progestogen - just not as much as the same progestogen when given in the mini-pill -  hence its publicity for women as better for contraception. As HRT though I worked out that it gave approx the same order of magnitude of systemic prog as a Femseven patch - but can't remember at what point in the 4-5 years cycle of the Mirena this was for!

Yes progesterone particularly has a sedative effect which some women welcome - but it has to be taken in very large doses orally as HRT because it is unstable and much is lost through digestion and metabolism through the liver - and it is the large concentrations that give the unwelcome side effects to many women - ie going beyond a calming effect - into fatigue, headaches, lethargy, foggy head etc.

Re blood sugar - there is an interesting article about what happens throughout the menstrual cycle and the different effects of the two hormones - although unfortunately there are no sources for further reading...
https://www.myhormonology.com/female-hormone-cycle/

Synthetic progestogens appear to be more risky in terms of breast cancer - but probably not progesterone itself.

Hurdity x