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[Elmsey]

Evening Ladies.

I really need some advice.  I started on HRT in September 2017 and have been on Femostan 1/5 until March.  This was ok, but I was kind of spikey on it (according to my daughter), irratically moody.  I started to get a return of symptons flushes, anxiety and really bad heat palpitations in February and in late March paid to see a menopause specialist privately. 

I was prescribed gel and oral Utrogestan (2/4 pumps and 100mg continuosly).  I started to take the Utrogestan orally but had a lot of fluid retention and breast tenderness.  I have also been really up and down emotionally.  The number of pumps of gel did not seem to make a difference.

After a couple of weeks I changed to taking the progesterone vaginally hoping it would reduce the breast tenderness.  It did not seem to make much difference.

Two days ago I decided that it may be best to "start again" with the progesterone and let it clear my system and start again clean.  So I stopped taking it, thinking that I would have a week or two off and then start again.

Today I have completely crashed - suidcidal thoughts, crying all day, angry - extreme PMS symptoms.  This evening I have started to bleed - which seems really quick.

Now I don't know what to do.  Should i stick to my clearing out strategy of just start taking it again in the hope that it will settle down?

I am really, really confused with all if the contradictory information around.  Please does anyone have any experience they can share?

Elmsey

[Hurdity]

Hi there Elmsey

Sorry to hear about your bleeding problems.

I'm not sure what and where you have received contradictory information and what that is?

When you changed HRT regime you went onto a much higher average dose of gel, if you are absorbing it, but you were still taking the standard dose of progesterone - as this never varies although it should!

The reason for your bleed therefore is most likely because your lining has built up while on this regime and 100 mg progesterone is not sufficient to keep it thin. Eventually even if you hadn't stopped the prog you probably would have started bleeding but this would mean your lining had got too thick. Obviously I can't say exactly what is happening to you but this seems the most likely explanation.

That being the case then it would probably be better either to take the utrogestan x 100 mg with a 3 day break per month to allow the bleed, or to increase your dose of prog on the continuois regime - but most of us would not want that.

Interesting re vaginal prog being worse for you - in fact I have read that systemic prog levels are indeed higher when the same dose is used vaginally, but because it doesn't go through the liver before getting into the bloodstream, there are fewer metabolic byproducts. It is these metabolic byproducts from oral intake that some women find problematic with utrogestan - but seems like you are not one of them.

The crash you are experiencing is normal progesterone withdrawal and is like PMS - happens to most women to a greater or lesser extent when you stop the prog, last for a few days and then once it has cleared the system most feel oK again.

Asdie from the bleeding, it does sound like your symptoms may be due to the continuous progesterone - which is a much higher dose than for tablet HRT.

So - there are two things to think about - control of the bleeding and protection of your endometrium, and your symptoms. It sounds like your symptoms might improve through cyclical progesterone rather than continuous - but  a proper cycle not just a 3 day break ie 12 days prog per 28 (or per month). This means you will get the rise and fall in prog and those side effects (from prog withdrawal)  - but you need to choose the least worst option for you.

Another option for cyclical use is to go back to the Femoston but instead of conti take the cyclical - there is a Femoston 2/10 which would give you a higher dose of oestrogen but still give sufficient prog to bleed and thin the womb lining?

If you are at all concerend about your bleeding then do consult your doc eg you might have fibroids or polyps although to me the obvious explanation is the one I've given - but won't explain everybody's situation!

Hope this has given you something to think about - are you able to e-mail or phone your consultant or have you been discharged? if you plan to continue on NHS then important to get your GP on board, a GP who understands HRT and menopause.

Hurdity x

[Elmsey]

Hi Hurdity, and thank you.....

I have read different things about Progesterone in different places - that it is a mood enhancer and also that it is what can cause you to have low mood.  For me it seems to be a bit like the effects of an anti depressant - no highs and no lows (ie not normal!).

My issue  has always been low or irratic mood and suppressed Libido when on the pill.  Mini pill just made me feel awful and sick all the time.  So I just used a diaphragm and had bad PMT every month (but at least I knew when it would stop) which got worse as I go into Peri.

It was not that I felt worse when I was taking the Progesterone vaginally, the side effects just did not get any bettter - unbearabley sore breasts a lot of fluid retention and erratic mood.  Maybe the latter is because I am not absorbing the estogen consistently, but how do you tell?  Perhaps the former because the P had already bulti up and taking it vaginally just kept me at the same place.

I would not say I have heavy bleeding now, but some bleeding and period cramps, and only when I stopped taking the Utrogestron (3 days later).  This seems to stack up with what I have read on Proff Studd's website.  He supports 7 days of 100mg Utro and says to expect a bleed on around day 10. 

I am considering trying this 7 day regime and would welcom any comments from anyone else who has tried it, or taking the Utro every other day (saw someone on here talking about that), or the 12 day cyclical, but on 100mg.  I am assuming that the 7 day regime is simply to stimulate a bleed to get rid of the lining which has built up in the Estrogen only days.

My other option is to try the Mirena Coil - I have a referral to the Menopause Clinic at the Princess Ann in Southampton, but not until July 23rd!  I am seeing my GP on Tuesday with a view to discussing them fitting the Mirena Coil.  But even that would not be until June.

Any thoughts would be welcomed!

[Elmsey]

Update, I am now bleeding heavily, so clearly whatever the 20 days of Utrogestan was doing, it was not stopping the womb lining building up!

[Hurdity]

The 7 day progesterone Studd regime is very much off licence and is not proven to be sufficient to keep the lining thin for most women. Some women may find it's OK but you should not do this except under medical supervision and have regular scans. 12 day cyclical (per month) would be preferable especially if used vaginally at 100 mg but still off-licence so needing monitoring at least until you know who your uterus responds - which can take some months, and would probably need a scan per annum.

Yes the cyclical dosing of progesterone is to eliminate the lining which has built up on oestrogen only days/weeks. If you take it continuously the aim is to prevent the build-up - the progesterone interefers with the ability of oestrogen to stimulate the lining to grow - if at sufficient dose to match the oestrogen in your particular body.

Mirena coil sounds like a good option as most goes to the uterus where it is needed. Some women swear by this and love it - toehrs are not so keen! It would mean you could add oestrogen at the dose necessary to eliminate your symptoms.

Good luck with the doc and let us know the outcome. Fancy having to wait until June to have it fitted!

Hurdity x

[Elmsey]

Thanks Hurdity.

Yes, after a bit more research I established that I would need to be properly monitored to go the 7 day route.

I suppose the advantage of waiting until June for a fitting is I can try a couple of cycles of 12 days Utrogestan 200mg and see if I tolerate it and have the Mirena appointment as a back stop. 

There is also the option of having it fitted at a sexual health clinc I think _ will as the GP tommorrow.

Elmsey x