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[Honey43]

Hello all, thank you for all you share - I'm learning so much from you. 

I'm in peri and in my first month of Evorel 25 and Utrogestan 200 per day from day 17-28.  Felt okay on the patch only but not really any marked difference to symptoms, apart from ever so slightly less anxious and slightly less low mood.

Decided to take Utrogestan as is often discussed on here - 100mg vaginally instead of 200 orally to try to minimise side effects.  3 days into the Utrogestan I started feeling awful.  I've had a near-constant silent migraine and I don't stop taking it until Sunday (another 5 days to go).

I've tried to contact my hormone Consultant but I can't get a response and I don't see her again for another 2 months.  I've now made an appointment with the GP, but I was referred to the Consultant because the GP admitted she was not knowledgeable about these forms of HRT.

So I see the GP this afternoon and I think, from reading on here, I need to ask for Estrogel, rather than the patches so that I can control the amount more easily.  I'm wondering if my oestrogen is too low for the amount of progesterone at the minute.

Also, my natural cycle pre-HRT had dropped to 24 days from 28 days.  I would have been due on tomorrow and I'm wondering if my own natural PMT part of my cycle has kicked in.

I would really appreciate any advice that I'm on the right lines with this.  I really can't function.  I'm so dizzy, my vision is affected, feel low, anxious, confusion etc, etc.

Thanks so much x

**Update** - Consultant has just phoned.  Said I need to take 200mg Utrogestan orally, stick with the programme for 3 months and definitely not up my oestrogen dosage. 

[dangermouse]

I've not tried the Utrogestan but natural progesterone (unlike synthetic) can take a couple of weeks for your body to get used to it. This is why I think it must be hard for those who have a programme where they have to keep stopping and starting it. That to me is a migraine waiting to happen!

Hope it settles down for you.

[Honey43]

Thanks so much for your reply dangermouse.  I'd not heard that so that's really something to think about.  I started this so positively but gawd it's getting me down!

[Mary G]

Honey43, sorry to hear you are suffering.  You may have read some of my posts, I also suffer with silent migraines but mine are caused by all types of artificial progesterone used in HRT preparations in high doses, nothing else.

Do you have a history of silent migraines and if so, at what part of your cycle did you have them?  Assuming they only started when you introduced the Utrogestan, it is safe to assume that they are triggered by high levels of progesterone in conjunction with low levels of oestrogen which is exactly the same as mine.  That being the case, you very definitely do need to switch to Oestrogel to give yourself maximum flexibility and control over your oestrogen dose and to give yourself the best chance of making this HRT regime work for you.  A 25mcg patch is very low and probably not enough anyway - dizziness is a sign of low oestrogen. 

I can't see why your consultant would suggest you switch to a high oral dose of Utrogestan as opposed to a low vaginal dose which has fewer side effects.  If your migraine trigger is progesterone then that makes no sense.  What was the thinking behind this decision?  Even if your migraine trigger is simply hormone fluctuations, it still doesn't make sense to dose you up to the eyeballs with progesterone and leave your oestrogen levels very low.  Are you paying for this consultant or is it on the NHS? 

Can you describe your silent migraines i.e. do you get shimmering zig zaggy lines for about 25 minutes each time?

When I took norethisterone, a very strong form of oral progesterone, I had 5 attacks of silent migraine in 1 day each lasting for 25 minutes, it was a nightmare.

[Honey43]

Hi Mary G, thanks so much for your reply.  Silent migraines were my very first symptom of perimenopause 3 years ago.  I'd barely even suffered a headache before (apart from wine induced!)  But for 3 years, and with lots of other symptoms starting up, I was told I was too young for these to be caused by hormones.

So now I've been heard and I've started on the HRT mentioned above.  What I'm experiencing are all the symptoms I used to get during the 'migraine hangover' - not the full aura experience with the zigzaggy lines that end up moving off to the side and disappearing.  But the odd bright light here and there, aching all down my left side, tingly face, completely exhasuted, low mood, anxiety, jelly legs.  It used to last for a couple of days, but this has gone on since about 3 days into the Utrogestran - so this is my 5th day.

Consultant just said Utrogestran is not licenced to be used that way and I may not be taking enough.  I would have been due on tomorrow with my natural cycle and she said the low dose of Utro could be allowing my own cycle to break through.

I feel truly awful.  Just hoping I can get to the 12 days and then see for sure if it's been the Utro.

This is an NHS Consultant but also holds private clinics.

What do you take now Mary G?

Thanks again for your reply x

[Mary G]

Utrogestan isn't licensed to be used vaginally in the UK but it is practically everywhere else so there is no reason not to use it that way, it is the same capsule that can be used either orally or vaginally.  The UK should change their guidelines.

I was using Oestrogel but have recently switched to a new product called Lenzetto (you might want to google it) but it is not available in the UK.  I now use 2 pumps of Lenzetto every day (slightly more than 2 pumps of Oestrogel) and a few 100mg Utrogestan capsules vaginally every 5-6 weeks but I do have regular scans via my gynaecologist due to severe progesterone intolerance - it's either that or a hysterectomy.  If it turns out that you are severely progesterone intolerant, you might be able to have regular scans on the NHS and take a low dose of progesterone.  I find that if I use this very low dose of Utrogestan, I get good lining clearance and no side effects from it so it works quite well. 

My silent migraines started in perimenopause too and I had a Mirena coil for contraception at the time - I don't get headaches with mine.  I had never had them before menopause but it was the combination of the progesterone in the coil and my own low oestrogen that set them off.  Therefore, I have to maintain high levels of oestrogen and very low levels of progesterone.

I hope that helps but please do come back with more questions if you need to. 

[Honey43]

That does help.  Thank you so much, I really appreciate it.  Lots of info to go back to Consultant with.  So pleased you found a way to make it work x

[Hurdity]

Hi Mary G, thanks so much for your reply.  Silent migraines were my very first symptom of perimenopause 3 years ago.  I'd barely even suffered a headache before (apart from wine induced!)  But for 3 years, and with lots of other symptoms starting up, I was told I was too young for these to be caused by hormones.

So now I've been heard and I've started on the HRT mentioned above.  What I'm experiencing are all the symptoms I used to get during the 'migraine hangover' - not the full aura experience with the zigzaggy lines that end up moving off to the side and disappearing.  But the odd bright light here and there, aching all down my left side, tingly face, completely exhasuted, low mood, anxiety, jelly legs.  It used to last for a couple of days, but this has gone on since about 3 days into the Utrogestran - so this is my 5th day.

Consultant just said Utrogestran is not licenced to be used that way and I may not be taking enough.  I would have been due on tomorrow with my natural cycle and she said the low dose of Utro could be allowing my own cycle to break through.

I feel truly awful.  Just hoping I can get to the 12 days and then see for sure if it's been the Utro.

This is an NHS Consultant but also holds private clinics.

What do you take now Mary G?

Thanks again for your reply x

Hi Hiney43

First of all  .

Your symptoms from Utrogestan do sound just like the sdie effects some women do get from oral use. Just to emphasies there are many more metabolic by-products produced when utrogeastan is taken orally - due to it being metabolised first by the liver, and it is these by-products which can cause worse side effects in some women. From what I recall in a paper I read, these by-products are not produced when utrogestan is used vaginally (or at least, in insignificant amounts).  I only started to get migraines pre-menstrually - when I was in the late reproductive stage - just before peri-menopause and in early peri - as you do.

I have only ever taken utrogestan vaginally - and even so I do still get some of those symptoms as the progesterone builds up in the system ie feelings of hangover, fatigue, foggy head and sometimes headache/migraine - although I can also get migraine on withdrawal until the prog has gone.

There is a post I keep referring to where I have summarised the research on vaginal use.  I don't know what your consultant means about the progesterone allowing your cycle to break through? On that very low dose of oestrogen your cycle will not be suppressed completely and will carry on as normal although by taking the progesterone for 12 days it might be possilbe to normalise the cycle length to 28 days so perhaps that is what the consultant means? (You mentioned your  natural cycle had got shorter to 24 days - and this is classic Late Reproductive Stage (according to STRAW classification - can look it up on Google!) - just before peri - when hormones begin to go awry but ovulaton is still regular and some women begin to get menopausal symptoms and many get worsening pms.

I presume you have been given a low dose of oestrogen just to prevent the lows at the end of the cycle - since hormonal fluctuations become more extreme as you enter the peri-menopausal transition?

Very high doses of oestrogen are needed to suppress ovulation - with corresponding doses of progesterone to give a bleed. Alternatively have you thought of the CCP - there are two types which have the same oestrogen as in HRT ie estradiol - and they are called QLAIRA  and ZOELY. Qlaira has one of the more modern progestogens so maybe fewer side effects?

Hope this helps and let us know how you got on with GP.

Hurdity x

[Honey43]

Sorry Hurdity, I've just seen this.  Thank you so much for this info - so helpful. 

I was on a very slippery slope mentally on the Utrogestan.  Had to stop taking it after 9 days. 

I've seen another GP who was amazing.  Between us we are trying to speak to my Consultant but I have been told by the GP not to take any more Utro after the awful slide in my mental health over those 9 days. 

I've had a bleed.  The GP told me if I'd not heard from the Consultant by today then I need to remove the Evorel patch.  So, it's looking like my journey with HRT is over for now.  I was feeling so positive about it all, but it's maybe not the right thing for me now. 

My mood has lifted since stopping the Utro but I have had a headache that's not shifted since I started it.  Can't carry on like this.  Not sure what to do next but I see the GP again in a week and a bit and we'll take it from there.  I'm utterly worn out from the whole thing!

Thanks again x

[Mary G]

Honey43, I really sorry to hear that.  If you reacted that badly to the Utrogestan then it puts you into a special category and you should be able to do what I do and take just a few 100mg Utrogestan capsules every 5-6 weeks and have regular scans.  I am lucky because I can take a very small dose and get good womb lining clearance and my gynaecologist is prepared to work with me on this and actually does the uterine scans herself so I can talk it through with her properly and she can see what is going on first hand. 

Firstly, you need to find a dose of Utrogestan (or a different progesterone) that you can live with.  Then, after a few months, you need to have uterine a scan to see if that dose is working properly.  Do you remember what your tipping point was with Utrogestan?  For example, my tipping point is day 4 onwards.  It could be that you will need a few scans every year but that is better than having to give up on HRT altogether and going back to square one. 

If it's any consolation, I would not be able to take Utrogestan for 9 days and if I did, it would take me several weeks to get back to normal. 

There is nothing wrong with taking a low dose of progesterone under supervision and this option should be available for all severely progesterone intolerant women.  The only other alternative is to have a hysterectomy.

Please don't give up on this, try and find a progesterone dose that works for you.

[Hurdity]

Did you take your last utro on Sunday? If this is the case then you might expect a withdrawal headache or migraine and hopefully it will shift soon. It is a pain when this happens regularly. I used to get it when I used Cyclogest pessaries as progesterone for 11 dyas per month in my early days on HRT.

You are only on a very low dose of oestrogen, and if you are ovulating regularly and even more frequently than monthly (as indicated by your periods) then actually you should not need to take nearly as much progesterone (because you should be producing plenty of your own) - it is in late peri-menopause and post-menopause when ovualtion is rare or has ceased that it is especially important to take the recommended dose and only to reduce this under medical supervision. It seems your consultant wants you to take the high dose. Sometimes though due to heavy bleeding at this point the additional progesterone is helpful - but not if it has such dire side effects.

Maybe your body is not ready for HRT yet. Have you thought of the gentler CCP types that I mentioned? If you are under 50 then these might be more appropriate at your stage? They aren't prescribed to women who have suffered migraine with aura though Unless these are hormonally induced and maybe exceptions are made here?).

There is also Femoston which contains a progestogen very similar to ours but is fornulated in such a way that it can be taken in far lower doses and so may not be associated with such severe side effects (utrogestan needs to be taken in large doses because it is unstable as a compound and breaks down quickly). A mirena coil delivers a lot of progestogen locally and allows the addition of as much oestrogen as you need while still protecting the womb.

Hurdity x