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[itsmejojo]

Hi

I'm new to the MM forum, I posted on the Utrogestan/Estrogel support group thread last week and had a couple of replies but  wondered if anyone else out there has any advice.

I'm 47 and been in the perimenopause wilderness for about 5 years, attempting to manage with the usual ‘alternative' stuff but the last 6 months have been awful. I had to give up my job last November, 3 hours of commuting everyday became impossible and brain fog/recall embarrassing.  I worked in a male dominated business and there was no understanding or consideration for my situation.

A history of thrombosis, TIA/stroke in my family had put me off HRT for a long time but symptoms got too much…night sweats, insomnia, fatigue, joint pain (hips, lower back and hands), brain fog, recall, weight gain etc, etc.

I read a lot of information and saw my GP a few times to discuss options before finally deciding, she advised the oestrogen patch and Mirena coil was the best route. I was reluctant to have the Mirena as I'd had a bad experience in the past where it got stuck in my cervix and had to removed.

I found the Easy HRT prescribing guide on the PCWHF and took it back to my GP.  She was happy to listen and asked for a copy of the guide to share with her colleagues!  She prescribed Estrogel and Utrogestan and told me to start taking it immediately.
 
On 1st March I started on 2 pumps (1 morning and 1 night) and 200mg (2 x 100mg capsules) Utrogestan orally at night.  I am still having periods, but they aren't regular and on day 3 I had the first one in 11 weeks.
 
I felt anxious, emotional and irritable all the time which weren't really issues pre HRT, I had a phone appointment with my GP and she advised increasing to 4 pumps of gel per day and to stick with it, everything will settle down.  On 4 pumps I felt much worse than before, so I made the decision to stop everything.
 
I promptly spent a small fortune on a new batch of alternatives including CBD but I can't help feeling that if I'd had some proper advice and support I could have persevered and found a level that worked.

After reading the various threads I've learned so much.  The knowledge and dedication of members is amazing and reading about those of you who have had huge improvements in your quality of life, it's given me hope and I want to try again. 

But, I have so many questions and I know my GP won't have the answers...

•   Were 4 pumps too much, too soon?
•   Should I have waited until day 16 to start taking the Utrogestan?
•   Was Utrogestan responsible for causing the mess I was in emotionally?
•   Should I try Utrogestan vaginally?  Maybe I'm sensitive to it?
•   Utrogestan day 1-25, or for 12 days from day 16-28 or for 12 days every 2 months?
•   Gel on arms or legs?
•   Should I wait for another bleed before I start again to override my own hormones?

Any advice very welcome.

Thanks!

X

[CLKD]

Probably 4 pumps too soon?  The body doesn't get where it is suddenly unless there's surgical intervention so it stands to reason that any additional hormone input will take time B4 one feels benefit.  It can take 3-4 months B4 the body begins to settle. 

Your GP sounds like she is on board and listens!

[Tc]

Itsmejojo. Welcome to the forum.good to have you on board.
I cant confidentally answer all your questions so I will leave it to someone else to go through them all for you as im sure someone will. but I would just like to say as you are worried about  DVT the risk is less with patches and they are generally regarded as safer in this respect.
Xxx

[LouLou]

Hi,
I don't think I can answer all your questions, but I'm new to this forum & I'm taking the same HRT as you - I've literally just posted in the "New Member" section.
4 pumps daily sounds a lot to start with?
I started on 2 pumps daily & my GP advised to do them together, so I do 1 pump on each arm after my morning shower - don't rub the gel in, just smooth it on the skin - I smooth it in from shoulder right down my arm - it dries very quickly I believe you can also do it on the inner thigh I just think it's easy to do on my arms.
I had horrendous anxiety pre-HRT, and now it's gone and this is my 4th week on HRT.
I take Utrogestan (1 tablet in the evening - 2 hours after food) & take it on days 1 - 25, then I will have a break of 3 days, and GP has advised that I may or may not have a bleed. I will stop taking it tomorrow (Wed) as that is day 25 for me. However, I haven't had a period in 9 months, so I'm not really sure how it works if you are still having periods
I had a provoked DVT in 2016.
I hope you can get things sorted and really hope you start to feel some benefit.

[NorthArm]

Hi Itsmejojo

200mg Utrogestan daily, is a very large dose. If you're still having periods, your best bet might be to wait until you start your next one, use the two pumps of gel daily as initially prescribed, then start the 200mg Utrogestan on day 15, for 12 days (take it orally at night, on an empty stomach as it's very sedating) - you should then have a bleed. This is the usual regime for gel and Utrogestan.

It's also important to remember to give any hrt regime about three months to settle in - keep a diary, so you can compare on how you're going along. After this initial time, unless things are really awful, then you can start tweaking gel doses, etc. If you find, after the initial month, that you're getting symptoms from the Utrogestan, try it vaginally as some ladies tolerate it better that way.

There is no ‘quick fix' for this, it truly does take a bit of time, so be patient and kind to yourself xx

[Dancinggirl]

Hi itsmejojo -

Here is the link from this site that tells you how to use your regime:
https://www.menopausematters.co.uk/to_progestogens.php

As you are peri menopause, you should be using the sequential version of the patch and Utrogestan regime.

Starting Utrogestan at such a high dose everyday was not the best route - 200mg is for the sequential version and should only be taken for 10-12 days each month from day 16 of the cycle - if doing the continuous post menopause version you use 100mg per day.  Using the high dose every day from the start this would have given you more side effects. Though not licensed to be used vaginally in the UK (most other countries do recommend vaginal use), Utrogestan is often tolerated much better by many women when used vaginally. I personally didn't get on with Utrogestan that well and there is an alternative, Provera, which some women find easier to cope with. The Mirena can also be a very good option.

To simply increase your oestrogen use so dramatically was a mistake.  I was advised one should start really low with the oestrogen and gradually increase over a number of weeks till you get to a level that your flushes are under control.

I personally preferred using the gel on my inner thighs and only ever applied the 2 pumps per day in the morning (avoid intimacy with partner for at least 2 hours after use). Many women do find using on the arms easier but I didn't want to get anything near my breasts.

I would definitely start the HRT regime again a couple of days after you start your next natural period. Maybe use just one pump per day for a week then increase to 2 pumps and stick with this level for 3months - only increase further if you are not getting symptom relief. I found 1-2 pumps of oestrogel worked well for me. Perhaps try the 200mg Utrogestan vaginally from day 16 of your cycle for 12 days each month to see if you get fewer side effects. You should get a withdrawal bleed a day or two after you finish using the Utrogestan - this sheds your womb lining and protects the lining from building up and causing problematic bleeding. Some women find they can use just 100mg each day when used vaginally but again it's best to stick with the licensed dose at first - once you are well into post meno, then I believe less progesterone is sometimes not so necessary for a few women - we are all different so HRT types and dosage will vary greatly.

All HRT regimes give some side effects - it's about finding the regime that gives the most benefits with the least side effects. To reduce your risk of a DVT I'm sure you know you need to keep the weight under control, have a good diet, avoid alcohol and get plenty of exercise like brisk walking.
Keep us posted.  DG x

[itsmejojo]

Thanks everyone for your advice.

I've started again - 2 pumps gel (1 morning, 1 evening) and will start 200g utro on day 16 for 12 days

Feeling positive and grateful for support and guidance, this forum has been a lifeline for me!

X