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[Gilla999]

Hi all - a newbie here who is about to start taking HRT. I'd really appreciate your feedback on whether you think I'm doing the right thing, as I feel a bit lost with it all.

I'm 42 years old, and at 39 I first started experiencing very bad breast tenderness for 2 weeks before my period. Some hormone tests showed I had low Progesterone/high Estrogen ratio; I didn't do much about it. Then around 18 months ago I started to experience extreme problems which have increased in their frequency and intensity. The main thing I am experiencing is night sweats and rampant insomnia - usually sleep maintenance insomnia, which is very unusual for me (ie I wake up at midnight after 2 hours of sleep unable to sleep again) plus anxiety. It's hard to say which of this trio - night sweats, sleep maintenance insomnia and anxiety is coming first.

All of these symptoms only ever happen at the same time every single month - it used to be 7 days before my period up until 2-3 days into my new cycle, but now it has increased from day 14 onwards until day 2-3. Outside of this time frame I sleep like an absolute log, feel great, with absolutely no problems at all. As you can tell, my periods are still regular - the only change there has been a gradual reduction in cycle length. The fact that I still have regular periods has meant it has been incredibly difficult to get any doctor to take me seriously. I cannot express the negative impact that this cyclical night sweats and insomnia are having on my life - literally two weeks out of every four I'm having to stop my life because it is so bad.

Because no doctors will help me, I paid to see a private hormone doctor who prescribed low dose bio identical progesterone but that didn't help at all. I have just started taking Utrogestan but althugh it has helped with sleep a little, I'm still waking up in the night, still having night sweats and I'm very tired still the next day (I guess this could just be start up side effects).

I'm not feeling certain if it really is the low progesterone that is likely to be causing this, or if it could be caused by low Estrogen or a sudden drop in Estrogen at certain points in my cycle. And I'm wondering whether I should just try adding the lowest dose Estrogen patch and take cyclical full HRT. However because my cycle is still regular no one seems to think Estrogen could be the culprit, but I'm not sure why the Utrogestan isn't really helping..... Does any of this sound familiar? Any thoughts / suggestions? Thanks so much x

[Gilla999]

Thanks so much for your reply Birdy. Yes I agree on the blood test "moment in time" thing. My logic has also thought that even if my progesterone was indeed low when I was having terrible painful boob symptoms a couple of years ago, that if that was also the cause of my current insomnia and night sweats, why wasn't I also experiencing night sweats and insomnia when I had low progesterone a couple of years ago? The cyclical insomnia and night sweats are something very specific that only started 15 months ago and wasn't every cycle at first, but has now progressed to every single cycle at exactly the same time. I also know that between day 3 to day 14 of my cycle I am absolutely fine - I sleep like a log, and have no problems at all.

The spanner in the works is that yes, my periods are still regular.

I think I may try persevering for a few more days and if that hasn't helped try adding in a low dose Estrogen. Sorry if this is a very silly question, but you always have to take Estrogen every single day don't you? There's no option to take for only half the month? And utrogestan on its own always has to be 200mg for 14 days a month? You can't take any lower than that?

[sheila99]

I have no idea what's going on, I can only say that my insomnia was the same as yours but it wasn't cyclical. It was cured by oestrogen. As you're still producing your own hormones you can probably play about with doses more safely than the rest of us. I tried increasing oestrogen to counteract tiredness on Utrogestan but it didn't work, I concluded it needed a build up in the body though I may be completely wrong and it may work for you. I agree if you're producing your own progesterone 200mg utro will probably be too much. It would be best to act under medical supervision, if you go off piste  you need to be particularly careful if there's a possibility of pregnancy and to be aware of any menopausal changes.

[Gilla999]

Birdy, just checking - when you said "some take half Utrogestan vaginally", did you mean to say 199mg? Or 100mg?

"200mg left me unable to function" - that's exactly how I've felt all day. There's not much point in getting sleep if you still feel horrendously exhausted the next day 

@Shella I totally agree about going off piste - it is definitely not great. I just don't have the money to keep paying for private doctors and I've tried three times speaking to a GP only to be told "you're still having periods, it can't be anything to do with hormones". They keep trying to throw antidepressants at me as that's all they know and no one is listening to me when I explain the night sweats and insomnia are completely cyclical. Could I ask what you meant when you said "I concluded it needed a build up in the body"?

I think I'll try switching to 100mg Utrogestan vaginally and see how that works. If it doesn't help, I'll try adding in the lowest possible dose of Estrogen. I'm just so nervous doing these things myself, it's so far from ideal 

Thank you both so much for your replies, it's really appreciated x

[sheila99]

I was on 12days x 200mg in peri and was so lethargic on it I couldn't function. It has got better as my own periods waned so I think it was too much progesterone. I tried increasing oestrogen when I was on utrogeston in the hope I'd have a bit more energy. It didn't work. When you have meno hot flushes it takes a week or 2 for them to go and my anxiety and insomnia took 3 months. That's why I think the results aren't immediate.
Progesterone (utrogeston) is only 'required' so your womb lining doesn't build up. Some people are OK on 12 days x 100mg, their lining remains thin. Normally advisable to have scans to make sure it isn't building up and best done with low dose oestrogen. As long as you are having proper regular bleeds you should be OK.
If it was me (and this isn't advice) I would use 12x 100mg utro and 25 mg oestrogen all the time. There could be a problem with this as you may not know if your periods become irregular (longer, shorter or erratic are all peri symptoms).
You may already have found out many GPs only recognise meno when you have  hot flushes so be prepared to fight your corner. 'You're still having periods' - do they know you need treatment in peri menopause?

[Gilla999]

Thank you, this is all such helpful info. After thinking about it some more this evening I've decided to bite the bullet and just try the 25mg Estradot I have from today onwards, along with the 100mg Utro (for 12 days).

I have a hormone blood test on Monday that I'd pre paid for so I'm hoping if I'm doing anything too drastic that it would show up on that.

Can I ask why you feel "all the time" is better than sequential? My natural instinct was to want to go for that too (less ups and downs) but I couldn't see any info online that said it was ok to do if you're still having regular periods? I completely understand you're not recommending - it's just really helpful to hear of other's experiences.

Truly, the GPs I've seen have been AWFUL. I genuinely don't think 2 of them had even heard of peri menopause. I was told by 3 different GPs that it can't be anything to do with "menopause" as I'm still having periods and "too young anyway" (I'm 42). All I got offered was either ADs (I'm not depressed) or the pill (tried many different kinds in my 20s and had awful reactions to all of them, so not an option). In the end I resulted to getting a private prescription online for Estradot which I know isn't great - I'm just not getting help from anywhere else that doesn't cost £200 per consultation!

I'm a little nervous with what to expect on the Estradot!

[sheila99]

Sadly there are many ignorant GPs. I didn't have flushes so 2 different GPs didn't consider peri even though I was 56 and 57 when I saw them - that should have been a clue! Both conti and sequi hrt use continuous oestrogen, it's the progesterone that's different. If you're peri you should be on sequi so you have progesterone for 12-14 days synchronised with your own cycle and bleed a couple of days after progesterone has stopped. When you're meno you're usually on a conti regime where you have oestrogen and progesterone daily and don't have a bleed.
Just a thought but if you want continuous progesterone you could try a mirena coil. Also there are 2 contraceptive pills that contain oestrogen as well as progesterone so are sometimes given to younger peri women. I can't remember what they are but Hurdity can tell you. I'm not 100% sure but I don't think you can be peri unless your periods change so it's odd that you're getting some peri symptoms.

[Cassie]

I would use a low dose of oestrogen, I use 1 pump of the gel and 100mg of utrogestan for 12 days, every 2 months.

[Gilla999]

A lot of info I've seen says you can be peri even with regular periods, though I agree the fact that I still have regular periods but have such strong symptoms does throw a spanner in the works!! The only change to them is that they've reduced over the time I've been having these symptoms from 33 days to 29.

I slept like an absolute log last night  - my first day on both Estrodet and Prog. It may be psychological but will see how the next week goes. From yesterday I decided to use the bio identical Progesterone the hormone specialist prescribed me, as the Utro made me fee cruddy. I feel fine with the bioidentical prescription lozenge, though I know there is a lot of split opinions about bioidentical. I'm going to stick with this combo for the next while and see how I get on.

@Cassie yes - that's my plan  though I'm using the Estradot patch which is 25mg - it was the lowest dose I could find??

[sheila99]

We just thought your maths was bad 

[Gilla999]

It was through Dr Laila Kaikavoosi - she practices at Marion Gluck I believe but she also now runs a private online clinic called The Online Menopause Centre, which is how I found her (quite a bit cheaper than MG!). It has been such a relief to speak to someone who didn't just dismiss me because of my regular periods.

The Utrogestan made me feel horrendously tired but I've had no side effects from the lozenge she prescribed. However I know there are lots of different opinions out there about bio identical hormones xx