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[Conolly]

https://www.tandfonline.com/doi/full/10.1080/13697137.2018.1462910

[dangermouse]

Thanks Conolly. It's good that they are finally recognising the value of progesterone only HRT. It's excellent for hot flushes, which is proven here.

Progesterone cream is a very different experience from Utrogestan and I suspect women who have had intolerance to oral progesterone and progestins would feel good with the transdermal products. Hopefully NICE will approve soon so that we can get our cream on prescription.

Btw, you have a cute cat there Conolly!

[Conolly]

Hello dangermouse,


I'm glad you like them (the articles and the cat) 😎


Do you know if there's any difference between the micronized progesterone used in Utrogestan and that used in creams? Why would they have different effects? Do you think it's just a matter of quantity, route of administration or different fillers in their composition?


Good to know the progesterone cream is working for you!


Conolly X

[SueLW]

Hello dangermouse,


I'm glad you like them (the articles and the cat) 😎


Do you know if there's any difference between the micronized progesterone used in Utrogestan and that used in creams? Why would they have different effects? Do you think it's just a matter of quantity, route of administration or different fillers in their composition?

The creams will be micronised because otherwise the molecules are too big to be absorbed.  When progesterone was first isolated and produced it had to be injected into muscle because it was too big to work otherwise.

The biggest difference between Utrogestan and a cream is the volume of progesterone.  They really need to start making Utrogestan in smaller sized capsules.  100mcg is just too much for many women, especially if they have been deprived of progesterone for some time.  And the other difference is transdermal delivery.  It's much gentler on the body to administer through the skin. 

I used a combined compounded cream for 3 years, but it's stopped working for me now because my skin is very bloated with fluid, or mucin, which is a hypothyroid symptom.  I've had to switch to Utrogestan (vaginally because that's as close to skin absorption as we can get with it) and every other night at the moment.  I am trailing the oestrogen gel, my doctor thinks the alcohol base will encourage my skin to absorb the oestrogen better than the cream.  The jury is still out on that at the moment.

[Conolly]

Hello SueLW,


Thank you for the explanation. I hope the new regimen works for you. Maybe an interesting protocol could be achieved by using only progesterone cream before starting estradiol (gel or patch) and then switch to the estradiol/Utrogestan combination to avoid the high dose progesterone side effects? If I ever try HRT again, I have to be on a continuous regimen, I can't bear the idea of having periods again. Maybe the prog only regimen will work, without oestrogen. I have to decide that.


Conolly X

[SueLW]

Thank you for the explanation. I hope the new regimen works for you. Maybe an interesting protocol could be achieved by using only progesterone cream before starting estradiol (gel or patch) and then switch to the estradiol/Utrogestan combination to avoid the high dose progesterone side effects? If I ever try HRT again, I have to be on a continuous regimen, I can't bear the idea of having periods again. Maybe the prog only regimen will work, without oestrogen. I have to decide that.

I did progesterone cream only at the start of peri and it helped then.  But as peri developed I needed oestrogen as well.  As I said in my previous message, the compounded cream of oestrogen/progesterone/testosterone worked well for 2 years but then stopped being so effective and when I was tested last month my on the floor results showed that I'm not absorbing the cream anymore.  I need more hormones now.  I need to get my levels up.  My cream days are behind me I think.  I'm not finding every other day vaginal progesterone too bad at all.  But I think I will need more than 1 pump of gel eventually.  I'm just giving things time to settle and get used to hormones again.

[dangermouse]

Yes, I think it's a lot to do with the dosage. I can't understand why they have two standard high doses of Utrogestan but variables with the oestrogen. Also it's so important to take it regularly as all that starting and stopping would just make you feel awful from the withdrawal. Particulary a high dose and then nothing, rather than a low steady dose, similar to how oestrogen should probably be taken too.

I have been trying Ona's Natural progesterone cream (distributed from the UK or California) and she makes hers with either micronised progesterone or a combo of that and Vitamin E. The latter increases absorption because the micronised particles tend to be bigger (it explains it all on her website).

I think so many women would be surprised how many symptoms the cream alone deals with. It's stopped all my nausea (and mine is extreme), anxiety, hot flushes and given me energy back. I've actually found the even lower dose (30mg so 3%) is more than adequate due to the Vitamin E carrier.

For those on oestrogen then you'd need to be careful and have lots of regular scans if using the creams to keep the oestrogen in check. GPs in the UK are unlikely to support it as NICE don't recommend it as they seem to be going with the high dose Utrogestan to ensure very high doses of oestrogen are covered.

[Conolly]

Thank you ladies for such useful information.


Conolly X

[Hurdity]

Thanks for the link Connolly - I couldn't see the complete articles but recent abstracts are all listed.

Just to re-emphasise that no-one should be using any form of progesterone cream for endometrial protection as part of HRT when taking oestrogen. There are no standard formulations nor studies to determine how much is needed.

The dose of progesterone needed to be effective against hot flushes is in large pharmacaeutical doses ie more than most woman would want to take on a regular basis. The dose is 300 mg orally daily!! The value of some progestogens for hot flushes is well established - some synthetic progestogens also have this effect - but again only at large doses and for many women the side effects are far too great.  There are other concernes too. In addition it only provides symptom relief and therefore without the benefits to the body of replacing oestrogen. This is what it says on this website about MPS:

HIGH DOSE PROGESTOGENS (MPA) Medroxyprogesterone Acetate and Megestrol Acetate (Megace) are synthetic forms of progesterone which sometimes reduce hot flushes and sweats. They also offer a degree of bone protection. They have been prescribed to women who cannot take estrogen after breast cancer treatment but concern currently exists about the possible effect of progestogen on the breast and so are now used less often. The side effects of these drugs can sometimes outweigh the benefits. In particular there is known to be an increased risk of clotting with higher doses of progestogens.

https://www.menopausematters.co.uk/prescribed.php

Hurdity x

[dangermouse]

Many women do though (including myself) have symptom relief at much lower doses. 300mg would floor me!

Obviously if you need oestrogen then that's the one to replace but, certainly in perimenopause, progesterone only can be just what the doctor ordered! (Or didn't in most cases).