Hi Norma
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Do I understand you are using 100 mg Lutigest vaginally for 12 days per month? Presumably prescribed by menopause clinic?
You will need to tell us more about where you are in menopause (in terms of cycle length and flow etc, and how long you've been experiencing cyclical changes etc), how old you are and what symptoms you had that led you to start HRT. Then we can help you better.
The fact that you have flushes suggests the oestrogen dose is too low.
In terms of not much bleed - that partly depends on your answers to Qs above ie where you are in menopause - but lack of or little bleeding can either mean the prog dose is insufficient to thin the lining and cause it to shed (in which case it will build up and be shed eventually but possibly unpredictably), or that it is plenty enough and your lining is not building up sufficiently each month to need to shed! This depends on the dose of oestrogen to some extent.
Also the licensed dose of progesterone is 200 mg for 12 days per cycle, though less than this is often prescribed off licence ( and Lutigest is not licensed for HRT anyway rather, luteal support during pregnancy - but is useful as an alternative to Utrogestan if specialists are willing to prescribe it.)
I find when on the progesterone part of my cycle I get disturbed sleep anyway - partly to empty bladder and partly vivid dreams, though I don't get hot because my oestrogen dose is adequate.
Depending what dose of Sandrena you are on, it sounds like you might benefit from an increase? Discuss with your GP or menopause specialists maybe?
Hope this helps
Hurdity x
Thank you for your response. Sorry I'm late in getting to this. Re your questions, I've just turned 50 and started HRT a couple of years ago. I've had long term issues which chronic fatigue-type symptoms and perimenopause really excerbated these - extreme brain fog, fatigue so I couldn't function, lots of muscle and joint pain. I also started with flushes and disturbed sleep. My usual short, easy cycle at 26 days (light, no pain, little PMT) became a bit longer and I was feeling more hormonal throughout the cycle (stressed, irritable, less resilent). But i went on HRT quickly because it was impacting my other health conditions which I'd made such great improvements on until then.
I've struggled with the meds (I have suspected MCAS with includes histamine intolerance which can be exacerbated with oestrogen and I'm always hyper sensitive to any medication/supplements). We tried lots of oestrogens and progesterones before getting here. But I tolerate Sandrena well and am feeling pretty good on 100mg. I couldn't tolerate Utrogestan (constant or sequential, oral or vaginal) at all. I tried for months and months and felt terrible. Days of not functioning brain and energy-wise and sometimes prone to incredibly low mood which I've never had before. I was feeling awful for 3 weeks out of 4.
Newson Health have prescirbed me Lutigest 100mg vaginally for 12 day pm and my GP has agreed to take over the presciption. I'm definitely better on it. Probably now have 7-10 days when I don't feel so great but I can still work and function so that's ok with me.
The flushes have settled more so I just some (day & night) when taking the Lutigest, not all month. My sleep is lighter on it but again it's manageable. My concern is I'm not getting much, if any, of a breakhtrough bleed and I thought this was the whole point of taking the sequential progestrone (I was still getting periods when I started). I thought the bleed helps protect against the increased risk of uterine cancer without the progesterone.
Do I need to go back to prescribing doctor? I'm trying to avoid the consultation cost now that the GP has taken over but not sure they're so up to speed on it. Or from what you say, it seems that erractic and no breakthrough bleeding is ok?