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[lifeatfifty]

It's been a while since I've been on the forum but felt I'd like to share.

I've been on HRT for a year - estrogel & utrogestran.

I've struggled in that year with my dose of Utrogestan.

I started on 10 days x 200mg orally of Utrogestan. I hated this (made me so dizzy) and quickly changed to vaginally. I then changed to 7 days x 100mg and then 5 days x 100mg. I've been on this regime for 4/5 months now. ( I have a private prescription and through the advice of a private doctor )

My own GP asked me to consult with the local menopause clinic which I did though waited 5 months for an appointment. The consultant there was horrified at my level of Utrogestan, which I suspected would be the case.
I explained that I always had a 3 day bleed (reasonably light) 3 days after finishing my Utrogestan. Her concern, of course, was that my lining was building up.

She did perform a scan and was delighted to see absolutely no build up (I was on the last day of my bleed).

Even so her recommendation was to increase my Utrogestan or to fit the mirena coil.
I did explain that I struggled over the past year with low mood and anxiety and had only felt better since adopting the 5 day regime.
I also understood that she was following NICE guidelines.

Although I knew I felt better, I too did worry about a build up so was delighted by my scan results.

I'm basically posting not to say that everyone should try this, but just to say that we're all diffferent. I'm also aware that I still have fluctuations and possibly will for a while ( I'm 51).

[Hurdity]

Hi lifeatfifty - unable to sleep?!!!

Thanks for letting us know about your success with low dose utrogestan. The main point is that there is a direct link between either unopposed oestrogen or lower doses pf progesterone with the risk of endometrial cancer - but it is just that - a risk established from studies carried out on groups of women. The risk of endometrial hyperplasia (which can lead to cancer)  increases the higher the dose of oestrogen and the lower the dose/duration of progesterone. Like everything to do with our bodies it does mean that women will respond differently. The standard dose is set to ensure that it is safe for most women - since the NHS unfortuantely does not monitor our endometria routinely! It's great in your case that your womb lining has remained thin!!

What is your dose of oestrogen and are you still peri-menopausal do you know?

I hope it continues to work for you

Hurdity x

[lifeatfifty]

Thank you Hurdity for response and well spotted on time - I was on call last night.

Yes I'm aware of the risks of low dose progesterone but the high doses recommended were turning me into a jabbering wreck.

I also realise the NHS do an amazing job but sometimes there is no bending of the 'rules'.

I currently take 2 pumps of estrogel (1 morning & 1 night). There are times I vary this and reduce my dose slightly depending on how my breasst feel. I also aware I seem to produce more of my own estrogen every second month.....................so yes I'd say I am still peri.

Fingers crossed.

[SueLW]

Good news on the thinness of your lining.  If it works, don't alter it.  You can get a scan yourself from Ultrasound Direct when you need one.  I had one yesterday at the local Mothercare store.  Brilliant service.  I was afraid that my lining might have built up as I use a compounded cream and people are always warning me that the progesterone element won't be protective enough.  But my lining measured 2mm and nothing out of the ordinary at all.

[Mary G]

Lifeatfifty, well done for finding an HRT regime that works for you and as SueLW says, don't change it.

Like you, I am on a super low progesterone dose every 5-6 weeks and it works extremely well for me and all my scans reveal a post bleed measurement of about 2mm or sometimes a little more if I am slightly further into the cycle.  I am 57, 10 years post menopause and on a high dose of oestrogen.

I'm not suggesting women take risks either but if you are progesterone intolerant then a good solution is to reduce your progesterone dose and have regular scans, I can't see anything wrong with that approach and it should be available to everybody.   It could be argued that it's a safer option (i. e. having your ovaries checked) because you are protected by regular scans which the NHS don't offer routinely.  Far more flexibility is needed for women who are progesterone intolerant.

I heard via a former MM member that the NHS are conducting trials on the 5 day Utrogestan regime but I don't have any details.

[Kathleen]

Hello ladies.

I thought I'd add that when I saw a consultant privately few weeks ago she was not in favour of the long cycle regime. I explained that many women have success with it but all she said was ' well you can't keep scanning women‘. I wasn't very impressed with her response actually and hoped for a more enlightened opinion!  It seems there is still a lot of work to do to get everyone on board about this treatment.

Wishing you all well ladies.

K.

[lifeatfifty]

Thank you all for your responses.
MaryG certainly some of your earlier post led me to looking into the Prof Studd protocol.

Kathleen, I guess her point is there are risks everywhere and we need to weigh up the pros and cons.

SueLW - Mothercare. Who knew.

[Hurdity]

Since members have been posting their endometrium measurements I'm going to let you know mine!

I've been on HRT for 11 + years mostly on medium dose patch 50 mcg. I have had various scans for various reasons and my lining has NEVER measured less then 4.5 mm whatever time of the cycle it is done. I've been on approx 62.5 mcg for a few months. My last scan was a few weeks ago about 5 days after my bleed finished (I'm on 6-8 week cycle) and was 7.4 mm.  I take 12 days x 200 mg utrogestan vaginally every 6-8 weeks.

SueLW and MaryG - you are very lucky to achieve that ultra low measurement!!

I have no problems but I just want to reiterate a note of caution - many gynaes don't like long cycle regimes nor short dose/duration progesterone regimes - because of the repeat scans needs and the potential risks. Of course treatment needs to be individualised and especially those who have severe progesterone intolerance that has been mentioned here and many times elsewhere, but this needs to be available on NHS. Most women reading this (or who aren't!) cannot afford the private treatment and scans needed to choose such a regime.

Also to point out that those in early peri may well be OK because with regular ovulation there will be plenty of your own progesterone as protection. I think it's late peri and post-meno that more care needs to be taken especially.

I do so agree Kathleen - we desparately need more research especially on lower doses and vaginal use and with different doses of progesterone as well as different length cycles!

Hurdity x

[lifeatfifty]

Thanks Hurdity. It just shows how different we all are. A more individualised approach is definitely required but of course costs and time prevent this from happening. This should be available to everyone but of course the NHS struggle and it's not.
I personally do not have endless funds and work extra hours to save money away to see a private consultant. This is my choice and it is a struggle. I should be congratulated for taking some strain of the NHS but often feel I am being judged for my choices. Please note that I'm not talking about you here but I do see the faces of my friends or whoever I come clean to about my private prescription - even the menopause clinic were  judging!

As for progesterone - I thought we were pretty much running on empty by the age of 45. Good to know I still have some.

[Hurdity]

Hi there - of course it is a choice! I have used a private gynae myself ( for testosterone before the NICE Guidelines) - and it's great that you have managed to obtain an individualised apporach through this means. I think the message several of us are trying to put across is generally that most of the standard licensed HRT is or should be available on NHS. Sometimes some members tend to advocate going private ( or buying HRT) at the drop of a hat - and this can be disheartening for members who can't afford this and there is sometimes a lack of sensitivity about this I feel.  So not a question of judging individuals like you at all! I'm sorry if you feel that way. We also try to help and support women to get what they should be able to on NHS - but just to aim for this individualised approach from the bottom up.  MM rules! Enlightened and knowledgeable NHS doctors do individualise the doses and regimes but sadly there is so much education still to be done!

Re progesterone - age doesn't really have anything to do with it - it's a question of ovulation. Once your ovaries pack up, you reach menopause (at whatever age that is) and the production of progesterone in very large quantities ceases for ever. However throughout life, in men and women progesterone is produced for our metabolic needs and to enable the various functions in the body that it influences to be carried out. You don't actually need it in large quantities once you reach menopause because this much is only needed to support a pregnancy.

Hurdity x

[lifeatfifty]

Again thank you Hurdity, it's an education.

I hadn't realised that the site was run by NHS and as such we had to adhere to questions or info about NHS only. Is this the case? Are you employed by the site?

So what about me then? I have not felt listened to by the NHS and the menopause clinic I attended - in fact I've been summoned to my GP to discuss. Given that where I started, a year ago, was my GP I don't hold out much hope here. In fact I will be more knowledgeable on the subject than the young doctor I have an appointment with!

[Annie0710]

Hi

This (to my knowledge) isn't an NHS forum and some lucky ladies get lucky by who they see/where they live.   If they aren't lucky, they have no choice but to go private.  So far I haven't needed to, but wouldn't hesitate if the situation changes and I can't get my regime on the Nhs although I'd have to save first   

Go with how you feel, it's you who is suffering.  We won't all agree with each other but for as many who think one way, you'd be guaranteed to have ladies who agree with your way and certainly many more to support you x

[lifeatfifty]

Thanks Annie x

[Hurdity]

HI lifeatfifty

V busy as off out soon so no time to write in depth - buit just caught your post and amazing how language can be taken in several ways. Sorry I gave completely the wrong impression! I wasn't meaning Rules as in Rules and regulations but using the (outdated!) colloquial term  as in " is the best" or "is great"! Remember the full phrase "X rules OK" ? That's what I meant!!! The site is underpinned by NHS current thinking and was founded by NHS gynae and all the info on the site is either current recommendations or from peer reviewed bodies etc - so naturally there may be a bias towards referring to that information when giving advice. As to people being employed by the site?  . We're all members like everyone else (apart from admins)! The forum rules clarify this too: check out the registration agreement here:
https://www.menopausematters.co.uk/forum/index.php/topic,2650.15.html

Have to dash!
Hurdity x

[Cassie]

Hurdity just a question is your Dr happy with a lining of over 7mm? Mine too has never been as low as the other ladies even a few days after my last bleed, my last scan 2 mths ago showed 5.2mm.