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[Blue Kingfisher]

Hello everyone,

I feel much better on the 200mg Utrogestan pessaires for HRT than I do the oral micronised tablets even when used vaginally. So, the routine i have been on is Utrogestan pessaires just for 7 days a month whilst on 5 pumps of oestrogel daily. I'm having trouble in the first half of my cycle on day 5 (counting day 1 as the first day I bleed after stopping the progesterone) right through to day 15 of my cycle when my natural progesterone seems to kick in. I think I might be too oestrogen dominant in the first half of my cycle but fine for the second half.

My questions is this, if I wanted to try taking the progesterone pessaires for longer, which I do to see if this improves the first half of the month for me.....how long should I take it for & when should I start in my cycle? I'm not sure if I have a natural cycle any more or no but currently take the progesterone on the first of each calendar month for 7 days. Not sure if I should start it earlier, taking it for 14 or perhaps even 21 days of the  I feel like I'm desperate for it from day 5 of my cycle so perhaps try the 21 days ? Or would it be more prudent to try 10 or 14 days first as the progesterone will build up over time in my body & I could swing to having too much progesterone & have issues there.....

What would be the most gentle way to find out for my body I wonder?

Thanks everyone xx

[Blue Kingfisher]

Thanks Stella Jane.

 I actually had a quick word with my gyne about dosing but I don't think they really get the issue! His stance was ‘if you feel better on it, take it for longer, take it for the first 14 days of each month. I don't understand what the problem is'.

I get what he says of course but he didn't seem to grasp that feeling ok on the 200mg progesterone wasn't the issue...it's the fact I feel terrible on days 5-15 of my cycle (on the regieme of just taking the progesterone for the first 7 days of the month) & therefore I'm looking for an opinion as to WHY I feel terrible on days 5-15 of my cycle as surely, a theory at least around this might give me some confidence that using the progesterone for longer will probably make me feel better rather than worse!?

The pattern is very clear, it's always on day 5-15 I feel terrible, this has to be hormones & if have thought a gyne might be able to guesstimate why this is?!

Perhaps it's just me but if it was that simple (which I hope it is & he is right) we could all be prescribing!

I guess I will have to try it for 14 days, see what happens for the rest of my cycle as I have to be careful that I'm not going in the wrong direction here! It might be if a feel a bit better then I need to give it time & possibly work the dose up to 25 days like you've suggested. If I feel worse....i will have to be back on the phone again for an emergency appointment 

[Hurdity]

If you still have a natural cycle that is regular then the first 7 days of each calendar month is going to make you out of sync - and anyway if you are getting a high dose of oestrogen may well be insufficient to protect your uterus.

I'm still confused about how you are counting your cycle? When does your bleed occur? Is it a couple of days after stopping the utrogestan? If so and you are post-meno then your cycle is around 30-31 days (because it is governed by the frequency of taking the utro.

If you are post-menopausal then consistently feeling worse on Days 5 - 15 is inexplicable (depending on how you are counting) since, once the utrogestan has left the system and you've finihsed your bleed - your hormones will be (more or less) stable until you start taking the utro again  .

However I would do as the gynae suggests for a few months - and record how you are feeling. If you are taking it from the 1st day of each calendar month then I would change the way you count your cycle ( as it's an artificial cycle) and start counting from the first of each calendar month as Day 1, but record the bleeds superimposed on this. Then it will be clearer how you feel on each phase of your HRT cycle?

Hope you manage to sort it out so you feel better more of the time!

Hurdity x

[Blue Kingfisher]

Hi Hurdity,

I count day 1 of my cycle as the first day that I bleed & yes, I've been bleeding a couple of days after stopping the progesterone. So, since I've been taking the progesterone for the first 7 days of each calendar month, I bleed on the 11th day of each calendar month like clockwork.

I have no idea if I am péri or post menopause. I've just turned 50 & been on HRT for about 18 months to 2 years.

So if I was counting the first day of my cycle as the first day of each calendar month.....it would be on days 15-25 of the calendar cycle that I feel terrible. This bad phase starts on day 5 of my bleed(so about a week after stopping progesterone). I definitely do not feel stable at this time, I feel entirely unstable & literally crash a couple of hours after applying the oestrogel.

I'm wondering if it's because I have Hashimoto's, which is the autoimmune version of hypothyroidism, & having too little progesterone in my body or unbalanced oestrogen disrupts thé thyroid.

Anyway, who know WHY I feel so bad at this time but I can't help thinking it's because my sex hormones are totally screwed at that time of the month. In your opinion, is it unusual to feel bad on days 15-25 of the month (calendar cycle) & if so, I wonder if it indicates which direction I should travel in? I.e. I am hoping taking progesterone for longer will ease the problem phase. I'm just worried I could be pushing in the wrong direction & making things worse. Ones things for sure, I tried more oestrogen, that made matters worse, I tried 100mg progesterone oral tablets vaginally - let's not even go there as this made me feel dreadful. I feel good on the 200mg pessary version of progesterone & that's about all I know!

I know no one knows the answer & it's going to be continual trial & error...I just stupidly didn't realise it would take up to 2 years to get the answer.....silly me! 

Thanks again Hurdity it really helps being on this forum just to share with others who have much more understanding about these things than I ever could & the support from everyone is hugely appreciated xxx

[Wrensong]

Hi Blue Kingfisher.  Like you I have Hashimotos & am on thyroid meds & found this seemed to muddy the waters terribly in perimenopause.  I wasn't on HRT until postmenopause & felt absolutely dreadful in the second part of my cycle in peri - the last 10 days leading up to a period, however long that cycle had been, were horrendous.  I think with me it was too low oestrogen so that when progesterone was dominant it seemed to rev my thyroid - with terrible palpitations, feeling wired, very, very hot, anxious & with very little sleep. 

I had three trials of Utrogestan postmenopause & every one caused the return of the same symptoms described above, to the extent I had to abandon each time & revert to a conti regime with synthetic prog.  If you are possibly still in peri then a conti regime won't be feasible for you, but I just wanted to say go with your intuition about your thyroid & HRT possibly interacting & be vigilant to see if you can work out how to manage things.  Though you feel better on the prog phase & I felt worse, it still might be that there is some interaction with your thyroid condition.  I take it you are on Thyroxine? 

Unfortunately we have to do our own detective work when other conditions make menopause more complex - but there is no-one who knows your body better than you.  If you are not under an Endocrinologist, now might be a good time to ask for a referral.  I know with "simple" hypothyroidism (hope you can hear the irony there) this is not usually granted, but I would argue that it stops being simple when menopause muscles in.

[Blue Kingfisher]

Thanks for replying Wrensong & so good to hear from someone else who has Hashimoto's & can identify with feeling rotten in very distinctive patterns month after month - not that I would wish that on anyone, basically trying not to keel over, stay awake & not throw up! ive tried a few different theories, is it too much oestrogen, is it too little oestrogen, will it help if I take my Levothyroxine at night & my oestrogel in the morning, will it help if I strictly follow a low FODMAP autoimmune diet for six months (which I'm still doing)- basically the answer so far has been a big fat ‘no'! I'm now hoping because I feel better on the progesterone, by adding it in for a longer period of time....it will address the balance. Bit of a joke though as I don't know what is out of balance in reality.

No, I'm not under an endocrinologist currently, I haven't found them much good in the past which is why I switched to seeing a gyne. If anyone knows of a good endo that spécialisés in menopause I'd be delighted to know who they are! I think you are right in that I'll just have to keep trying & if this trial brings another disappointing disaster I'll have to consider seeing an endo again. The irony is, I'm struggling to hold down a new job & if I lose it....I won't be able to afford a good endo as no doubt I'll probably have to pay a fortune to see them! Perhaps I should start looking sooner rather than later on that note! Good idea Wrensong, I'll start a new post tomorrow asking if anyone knows of a good endo.

I'm glad to hear that the continuous routine is working for you, goodness me that must have been a huge and emotional relief! It gives my hope that in the future i might be able to be kept more stable when I'm definitely post meno.

Thanks again Wrensong, lovely to hear from you xx

[Wrensong]

Blue Kingfisher - if you like, PM me with your location & I will let you know who my Endo is if the area is appropriate for you, though a good Meno Clinic might be the most helpful if your concerns are mostly getting HRT sorted.  Endo is private I'm afraid - no longer does NHS work.

On diets to help autoimmune conditions - I was asked to go wheat-free to help with digestive issues & when this wasn't enough went GF for 13 months.  During that period my thyroid antibodies were tested & found to be negligible, whereas before they had been sky high.  You will know there's a lot of stuff on the web about GF being possibly beneficial with Hashimotos.  Low FODMAP is so restrictive, hats off to you if you can manage that - impossible for me as I need it to be high fibre.

How stressful for you with the new job in these circumstances - I do hope you manage to get the gynae/thyroid issues sorted.

I am not currently on systemic HRT - sorry if my post was misleading - the Evorel Conti was some time ago.  Long story.  I do think a conti regime with the same amount/mix of gynae hormones every day is possibly easier for the body to tolerate when on thyroid meds, but that may be because I need T3 (as well as T4) which causes its own peaks & troughs.  I know there are other hypothyroid women who post here doing fine on sequi regimes, so don't give up hope.
Wx

[Blue Kingfisher]

Thanks Wrensong, will PM you but just to say....I used to have T3 conversion issues but not anymore. I never got on with T3 despite the fact I couldn't convert in the past. Having said that, I'm loosely working on the theory that in my oestrogen dominant phase cannot convert to T4 & it's that that's leading to the crashing I.e. too much unconverted T4 for the body to handle so I literally turn yellow whilst my poor adrenals try to process too much thyroxine......I could be thyrotoxic at these times.

I hear you about the anti-bodies, I've been gluten & now grain free for many years!

Anyway, thanks for the offer of a referral suggestion, will PM you. If they look like they might be a good fit for me...I'm more than happy to pay & travel!! Desperation looms! :-)

xx

[Wrensong]

I find T3 tricky to manage Blue Kingfisher as it's so powerful & I'm pretty tiny, so a little goes a long way!  Really, really wish I could do without it (especially with the NHS trying to withdraw it), it so complicates everything.  But bloods consistently show I convert very poorly & cannot get above bottom of ref range without it.  With the short half-life, my blood T3 is well below bottom of range when the early morning dose wears off.  Can currently only tolerate 1 dose daily though I need 2 according to TFTs & my lovely Endo was hoping to get me on 3.  No chance of that!  Could tolerate 2 doses on systemic HRT & felt better for that combination. 

The thyrotoxic feeling is absolutely horrible - I'm so sorry you're feeling that way.  Are you losing weight?  Are you able to get TFTs approved often enough to be sure your Thyroxine dose is not too high (in theory)? 

Trouble is, with the sex hormone fluctuations & the long half life of Thyroxine I think we can swing from hypo to hyper due to the effects of oestrogen on TBG.  I am pretty sure progesterone potentiates thyroid hormone for me & have read it can do this, though medics haven't answered when I've put that to them.

I wasn't on T3 in peri - though I had been beforehand, but stopped taking it during peri years as symptoms were so confusing & I was afraid of being effectively hyper & didn't want to risk that.  No-one seemed sure whether symptoms were due to thyroid or menopause & I was more or less left alone to cope with it as I didn't manage to get a referral to my current Endo until I was nearly 3 years postmenopause.  During peri years & for the 3 years post before HRT I was permanently hot, anxious, sleepless, with very frightening irregular palpitations day & night, lost almost all muscle & went down to under 7 stones in weight.  Visualised bones crumbling & heart giving out - the full catastrophe!  Still here to tell the tale though!

It can be so tricky trying to balance HRT with thyroid meds - you have my heartfelt sympathies.  Would love to know how you get on & what you manage to work out about what's happening as regards interaction.  I do hope you can find the right balance soon.  Don't hesitate to PM me if there's any way I might be able to help.