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[amy1235]

At my wits end

I hope and pray that someone can offer some advice.

After several years ( around 4 ) of using oral HRT containing 2mg estradiol and 0.5 mg noregestrel- on which I generally felt quite well) for the last year I decided to try and reduce my HRT use and go onto bio-identical hormones. My GP was happy to prescribe a 75mg estradot patch with 10 days utrogestan 200 mg used cyclically.( I used it vaginally as this is what was recommended in Greece).Things were reasonable on this regime for a while apart from dizziness and fatigue on the progesterone part- and to be honest, more or less all the times to some extent and just not feeling myself.Also a distinct drop in libido as all I want to do when  I'm not working is rest. I have no energy for any kind of social life as I'm always so tired. Anyway following the recommendation from Hurdity on here I use 100mg for the first three days , 200mg for the next five and back to 100 mg for the last three- this seemed to lessen the symptoms of the progesterone. I get a bleed- fairly heavy, about three days after stopping and then feel nearly normal for a couple of weeks. I had it in my mind to try and gradually reduce the estrogen over time so I would be able to also reduce the progesterone and hopefully feel better- my idea was to be able to come off by the age of 60- I'm 56 now . This last month I decided to try and go onto a continuous regime as my doctor wants to put me on some kind of combined pill but I said I would rather stick with the bio-identicals. I really hoped to be able to be bleed-free as I've had enough of periods now. So I  started to take the utrogestan 100 mg ORALLY about five nights ago ( it's inconvenient for bedroom activities vaginally -bad enough for poor hubby what with just not feeling like it for the last year..!) thinking to do the 25/28 use plan and continue with a 50 mcg estradot patch. I felt ok ish for the first night , a little wired the next two but unfortunately since yesterday the dizziness and intense headaches are just intolerable. So I'm going to stop the utrogestan tonight and see how I feel tomorrow.

I just don't know what to do now- is this due to progesterone intolerance? Am I suffering low estrogen levels due to the constant fatigue and lack of libido or desire to do anything? Should I reduce the patch to 37.5 mg and try a longer cycle with going back to utrogestan vaginally, say every two months? I'm wondering about maybe seeing a memo-specialist privately and getting some blood tests ? ( gp sent bloods for thyroid and fbc all normal). What should the hormone levels be anyway at my age? Will this give me any helpful information?
I'm sorry it's such a long post but I'm so sad to just not feel like myself for such a long time.

[Hurdity]

Sorry to hear you haven't got your regime right for you yet. No need to apologise - we are here to help

The side effects to utrogestan do not necessarily mean you are progesterone intolerant - just that large doses of progesterone taken orally may not agree with you. It has to be taken at high doses to ensure that sufficient is absorbed into the bloodstream and gets to the uterus where it is needed. if you are taking it contoinuously you may well experience these sdie effects all the time - although your body may well acclimatise after a week or two and you won't get them so badly?

Were you feeling fatigued before reducing the dose or starting the utrogestan continuously? There is no need to reduce the oestrogen dose - to 37.5 mcg - this may well lead to resumption of other symptoms and low mood. I know what you mean aboiut vag Utro not being advisable all the time! The only other alternative is to go back to taking it cyclically. Also I'm not sure why you reduced your oestrogen dose - if you felt fine on the 75 mcg? I know this is difficult to countenance but some of us do have withdrawal bleeds into our 60's - there really is no alternative if you still have a uterus, want to take HRT, but don't want to/can't tolerate progestogens all the time. Some women throw up their hands in horror - but tough eh? We do what we need to do to get the best quality of life. I take it on a long cycle but this has to be done under medical supervision and will depend on what your bleeds are like if you extend the cycle eg to 6 weeks rather than monthly? Also under medical supervision you may need be able to reduce the duration of progesterone but would need an understanding doctor!

The other thing is - lack of libido - this is common on the progesterone phase so again not ideal to take it all the time in your position - but this should be better on the oestrogren only part. If not and you are still fatigued  and have lack of libido and lethargy even after returning to cyclical HRT (if you decide to go down this route) then it could be you are low in testosterone. it may be difficult getting this prescribed on NHS but increasingly some GPs ( and most gynaes) are willing to prescribe it - although the stumbling block is lack of licensed products for women.

If your practice won't consider this then maye there is a menopause clinic near you that you can ask to be referred to - on NHS. Sadly for the testosterone you might have to go privately initially because it is not licensed but not for te other meds which are al available on NHS as you have found. I don't think you need blood tests personally - but need to tweak your regime until you feel right.

Good luck and let us know what you decide.

Hurdity x

[amy1235]

Well I decided to go back on the 75 mg estradot patch and taking utrogestan vaginally- I appreciate your advice Hurdity- I suppose,as you say, having the best quality of life is a fair price to pay for the inconvenience of the withdrawal bleeds- I decided to do a 11/12 day stint every seven to eight weeks on the utrogestan and like you suggested before, I take 100 mg for the first three days, then 200mg for five and another 100mg for the next three days. Its taken around four days for the bleed to start and it's pretty heavy for the first two days then medium for another two and then lighter for another three .So I'm guessing from the clots.on the first two days that most of the endometrium is shedding but I will request a scan every six to eight months- do you think that would be enough?
I suppose I shall probably wait until my early sixties before trying to gradually cut down the dose again..... My mother died of breast cancer and a couple of her sisters got ovarian cancer so I'm a little nervous. I had a breast scan a few months ago which was clear so also wondering what is the best way to keep a sharp eye out for these problems....Any advice on this? Yes, I am feeling better and I'm more "myself" in the bedroom department too. 😊

[Milamam]

Hello Amy,
I am in a very similar situation as you - but I am 47 now and on various types of HRT since 43. So your post and the responses of the very knowlegeable ladies here will be so helpful to me as well.
I am now on a 50 mcg estradiol patch since January, with 200 utrogestan used vaginally for 12 days each month. January and February were okayish but these last months I just get bonkers during and after the utrigestan - the dizziness all day, headaches, lethargy, depression, crying, no libido. I have become convinced in myself that this misery is due to the long days of utro but that I am not necessarily progesterone intolerant. I have done well on dydrogesterone before so my plan for this cycle is to stop the utrogestan and try dydrogesterone for the recommended 14 days in 10 mcg (this is the recommendation if dydro is taken as part of HRT).
I live in Bulgaria so dydrogesterone is available separately. I sooo hope this plan will work as I also tend to have thickened uterus lining and cannot possibly do a shorter or lower prog regime. I go to regular scans (every 3 months) and I also do breast ultrasound checks every 6 months, although I don't have a family history of breast problems.

Have you thought of trying another progestin as ,like me, you may not agree with the utrogestan? Reading from experiences here, not every woman likes it but may do well on some synthetic progestins. I hope you will find a solution soon and please post!

I will also try to update here after I do a course of dydro and whether there is any difference in mood and welbeing. I hope so!

Milamam xxx