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[aurora]

Hi all

I was prescribed estrogel and utrogestan in Uk but allergic to both! I think it was the oil in utrogestan and the gel in estrogel.

Now in Spain, managed to get Lenzetto (estradiol spray - European version of USA Evamist)

Noticed effect instantly and thus far no allergies!

I now need to find a progesterone to use with and I've read that sublingual is best.

Does anyone know the name of a sublingual progesterone available in Europe?

Thanks x

[Hurdity]

Hi there aurora - as far as I know there is no sub-lingual product for HRT containing progesterone - all the preparations are oral/vaginal capsules, or vaginal gel.

Something I read about the absorption suggested that this was very variable with sub-lingual products as it depends on the length of time the product is held under the tongue - so this presumably presents problems with trying to standardise the dose for endometrial protection.

You can use Utrogestan vaginally if you have digestive issues taking it orally. Also the formulation changed in recent years - it used to be peanut oil the micronised progesterone was suspended in but this was changed to sunflower oil ( I think).

The vaginal progesterone gel is called Crinone, and there are is also a product called Cyclogest - waxy pessaries/suppositories - the latter usually prescribed for fertility but would probably be less likely to have an allergenic ingredient I would have thought?

Hurdity x

[Mary G]

aurora, I am not allergic to Utrogestan (at least I don't think so) but a few months ago, I got to the stage where I just couldn't take it anymore, full stop.

Very long story short, I have been using 50mg body identical progesterone every day alongside oestrogen and testosterone for 3 months with excellent results.  So far so good, no side effects, no breast pain, no bleeding - yippee!!! My German gynaecologist pointed me in the right direction and said that sublingual/buccal progesterone is often used in Germany as part of HRT.  We had a chat about it yesterday when I had my transvaginal scan and she thinks I tolerate it better than Utrogestan because of the way it is absorbed through the mucous membrane which makes sense - I can assure you that in my case at least, it is a very different experience to Utrogestan.  I thought I was the most progesterone intolerant person on earth and went into this new regime with a great deal of reluctance but I was wrong, I am not progesterone intolerant per se, I just can't take Utrogestan or any form of synthetic progesterone.  I wondered why I didn't have any history of PMS pre-menopause.  Now it all makes sense.

My reasons for switching to this form of progesterone are different to your own - I needed hormone stability to avoid migraines and I also didn't want any more periods - but it might be worth a try?  If you have an allergic reaction you will know pretty quickly.

As far as I know, this type of progesterone is not available over the counter in Spain. 

Lenzetto is a great product isn't it?  Very user friendly too.

[dangermouse]

Thats so interesting Mary G as I too found Utrogestan very different to transdermal and sublingual progesterone, which may be to do with the oral route and it being too strong a dose.

The idea of progesterone intolerance just seems strange (unless purely talking about synthetics) as we produce it naturally even though many have been told by docs that they have this.

[Mary G]

dangermouse, it is an interesting subject isn't it?  Because of my bad experience with synthetic progesterone and Utrogestan (both orally and vaginally) I was terrified of starting this new type of progesterone thinking it would be the same but nothing could have been further from the truth, it has been a very different experience.  I voiced my concerns to the doctor who prescribed it and she said 'this exactly the same as the progesterone you have produced all your life and is not the same as Utrogestan' but I was still very, very sceptical.  Luckily I was wrong.

Certainly in my case, progesterone intolerance was a strange diagnosis because I had no history of it pre-menopause.  I suppose it might be different for women who did have problems with their own progesterone pre-menopause (PMS etc) but then again, it could just be that they produced too much of it. 

The key to success seems to be the dose and the way it is absorbed.  It seems to make all the difference and it certainly has a very positive effect.

[aurora]

Thanks very much Hurdity and Mary G - I actually had an even worse reaction to Utrogestan using it vaginally so I'm loathe to try others vaginally - my personal opinion is that sublinguals/buccals are far better absorbed than orals as you're not wasting a load in your liver so the endometrial protection should be greater, not less. I'm sure they don't do them in Spain though, unfortunately. The quest continues!

[aurora]

PS: If anyone knows a source of  sublingual or buccal progesterone anywhere - not necessarily Europe - I'd be really grateful if you'd message me. I know you can have them compounded by private doctors but ideally looking for OTC or online. Thanks!

[Perinowpost]

Interesting thread.  Mary G what is the name of the sub lingual progesterone you use ?  And can you can only get it on prescription? I ask because I'm in Germany (presume that's where you are) for the weekend and may try and source some. I've struggled with the progesterone part of hrt but have not given up pursuing a better alternative x

[Night_Owl]

Mary G, this is very interesting and no side effects for you, how fab  - just wish there was more choice of progesterone available on NHS  -  Utrogestan is not the answer for many women - to have a well tolerated, alternative choice of sublingual/buccal prog would be a godsend - we need more options.

[dangermouse]

I've used Progest-E which I bought online which is suspended in vitamin e and you rub it into your gums.

Mary Gs may be lozenges though which I've not tried.

[aurora]

Dangermouse - how did you get on with it? Is it as strong as Utrogestan etc? I've looked online but can't see what oil they use - is vitE an actual oil or is it suspended in oil, as it were? I've also seen sublingual drops but am worried they wouldn't be strong enough to use with  Lenzetto/estrogel etc

[Hurdity]

Hi again

It is well known that transdermal or similar delivery ( provided that you have the right formulation!) of certain hormones or drugs is preferable to oral intake as they are absorbed directly into the bloodstream - vaginal, buccal, or sub-lingual and transdermal proper ( ie outer skin surface).

This is well established for progesterone. Much is lost through digestion after oral ingestion and the products of metabolism after going through the liver are many - and it is these that are responsible for some of the adverse sdie effects of Utrogestan.

Both transdermal proper and sublingual will deliver into the bloodstream andf then be carried to the target organs.

With the right product -  for progesterone, then theroetically transdermal proper and sublingual will be far better than oral.

However because progesterone is needed to protect the uterus in fact vaginal delivery is far superior to the other transdermal or sub-lingual methods in terms of getting to where it is needed. The only disadavantage is that systemic absorption also takes place. A paper on prog I read observed that much hi8gher concentrations were held in the uterus after vaginal use - than other methods.

I'm not sure whether there has been sufficient research into modern sub-lingual preparations eg the drops?? As I said the research I looked at probably now out of date said that the absorption of the stuff that had to be held under the tongue was obviously variable.

In your position aurora - I would want to try something else vaginal. There is another type of progesterone called Crinone gel available for fertility and this might have fewer side effects than Utrogestan. (Have you used utrogestan recently - as I said the oil in which the micronised progesterone is supended was changed from peanut to sunflower so less allergenic). There are papers about its use for endometrial protection which I can dig out ( have posted in here) at some point if you want. You would need less of this than anything sub-lingual to protect the endometrium.

As far as I know the only sub-lingual preparations available are from compounding pharmacies and they are  NOT recommended for protecting the endometrium. I doubt you would be able to buy anything suitable online - beside if you are using something non-standard and untested/unregulated - you would need to be closely monitored by a gnayecologist to make sure your endometrium is protected.

Mary G probably goes to a private gynae and is closely monitored through regular scans - all this costs money. This is not available to most of us.

Clearly there is more work needed - it is shocking that there aren't enough products available to women.... if sub-lingual drops could be developed for example - then lower doses could be taken if the drops were used more reguarly.

The reason many of us hate progesterone is that we have to take large doses of the stuff because it is poorly absorbed and rapidly metabolised - and we don't want to take it more than once a day.Iif taken vaginally also this would be inconvenient (especially if you've had a few children!!).

Anyone using progesterone for therapeutic purposes rather than endometrial protection - then it doesn't matter what it is and how little you get of it - but for HRT this matters!

Aurora - I would seriously look into Crinone gel if you can.

Hurdity x

[aurora]

Thanks very much for that Hurdity - yes I know about the formulation change for Utrogestan - I originally got some online from Bulgaria I think and used vaginally and wasn't too bad but not great - it was the larger soft capsules - then got some from NHS dr and it was the small hard ones and I had a very bad reaction orally and even worse vaginally!! At the time you said the oil had changed and it was possible the first I got were old stock - therefore it seems likely I react way worse to sunflower than peanut oil (I've also had probs with supplements in sunflower oil) My reaction was basically getting very dry and itchy - but back to normal once stopped using. I am also very allergic to estrogel (applied topically to leg of course) due to the gel so I certainly don't think it would be good for me to use a gel vaginally or anything tbh.

 My feeling is that if oral utrogestan protects the uterus when we know so much is lost in the digestive system and liver then sublingually must also work (as long as you get the right product) If the only method that protected the endometrium was vaginal that would be different but I'm comparing sublingual/buccal with oral. However I do think you're right in that it seems the only way to get these are through private doctors. I've seen drops etc on line but again I agree that if you were to experiment with those you'd need to have regular scans etc which would be expensive.

 Although I am wondering whether if you use any form of progesterone which is strong enough to induce a withdrawal bleed, then surely that shows that the endometrium is being kept thin naturally? Just a thought ... xx

[Mary G]

aurora, re your last post, this might help to put things into perspective.

My latest blood test results are as follows:

oestrogen: 237 pg/mL which is about 870 pmol

progesterone: 7.95 ng/mL

As you can see, my oestrogen levels are high which I need in order to feel good and keep the migraines away.  I am very pleased with the progesterone result - the blood was taken 12 hours after I took the progesterone.

I had a transvaginal scan on Tuesday and my womb lining measurement was under 5mm and the gynaecologist was very happy with that result and said it all looked good - she does the scans herself so she can see it all first-hand.  When I was on a cyclical regime, I used to have a measurement of about 2mm immediately post bleed and this latest reading is higher than that but she said it is to be expected on a high level of oestrogen on a continuous combined HRT regime.

When I was on a cyclical regime and low dose Utrogestan, this level of oestrogen gave the a very heavy bleed so the progesterone is obviously doing its job.

My greatest fear was that the progesterone would drown out the positive effects of the oestrogen and would have a drag-down effect.  I'm glad to say that I was wrong and after being on this regime for 3 months, I am happy to say that I feel very good, the same as I did on oestrogen only.

I hope that helps.

[Perinowpost]

MaryG

Can you tell us the name of the progesterone and if you have to go private to get it? Glad it's working and you're feeling well btw x