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[pastie supper]

Hi, I would like to learn any and every way to mitigate the awful progesterone part of HRT.

I'm ok with HRT most of the time, I use three pumps of Oestrogel and I'm supposed to have twelve days of 200mg vaginal utrogestan as well, but I find it difficult to stick with it. I'm 2-3 years post meno now, I don't bleed unless I use something to make it happen, like utrogestan. My GP seems to think I'll get cancer if I miss a single month and the side effects can't be that bad because it's a wonderful medicine with very few side effects.
I've given up trying to reason with her, either I manage the utrogestan better on my own or I quit HRT. I skipped last month's progesterone simply because I couldn't face it again, but I'm taking it now.

I wrote a list of my side effects, the main ones include being frightened 24/7, nausea, wind and indigestion, not sleeping, crying on and off, vaginal irritation and urinary incontinence until maybe 3 or 4 hours after I wash out the remains. I give it the suggested half an hour every morning and then rinse out the goo, sorry if this is TMI, that seems to be the nature of it, don't know how to describe it without, well, describing it! I rinse to reduce irritation and it also means I can wake the next day (if I slept!) without the crippling fear.

I use vagirux as well, 24 per month, it doesn't dissolve away like the Utrogestan, it's for the incontinence, apparently it helps in some way!

Would the two taken together interact? I forgot to ask the doctor, but tbh most times I've asked them anything regarding menopause, they don't know and often tell me to try google. It's really not taken seriously by anyone at the NHS clinic my GP is in, I feel the attitude is that I'm making too much fuss over a couple of hot flushes.

I know some women only bleed once every three months on HRT and I was going to try doing utrogestan every second month, but I'm day 5 now and I feel my life collapsing around me as usual on utrogestan, I don't function well on it at all and I hate the world in general, irritable is an understatement, my husband is tiptoeing around me and I am at breaking point until I stop taking it.

I've had a few other ideas, like asking for tibolone as the progesterone part even though it's not purely progesterone, it contains enough progesterone-like stuff to work. I haven't asked if that's allowed or can be done. I'm expecting a negative.

Another idea was to stop sooner than 12 days, what is the least days you can take it so it still makes you bleed?

I've got some 100mg utrogestan, so I've only been using 100mg a day this time, I think it's easier than the 200mg ones regarding side effects and the internet is full of doctors giving podcasts saying only 100mg is needed vaginally. Yet the 100mg are marked for oral use only, are they the same as the 200mg pessaries inside? They look the same except the size & shape.

Sorry for asking so many questions, I want a way to make taking utrogestan ok, but my GP says it's already the mildest one they have.

[CLKD]

You ramble, you'll B in good company !   

Ring the Surgery ASAP or look on the web site, to find out whether there is a GP or Nurse Practitioner interested in womens health and menopause.  If not then ask for a referral to a dedicated menopause clinic as there are waiting lists, both in the private sector and NHS.  If an appt comes through which U no longer require, you can cancel nearer the time.

Do send an e-mail to the Practice Manager to ask her why this GP considers HRT 'causes cancer'.  Many women find that they are unable to tolerate progesterone and some opt for a longer break between using it, with regular womb scans to check the lining, 5mm is 'normal'.  [I think that I'm correct].  Have U been offered a Mierna coil for the progesterone which delivers it evenly throughout the month?

Vaginal irritation with incontinence is treatable, your GP should know about atrophy.  Appropriate treatment with either 'ovestin' or 'vagifem' [Vagifex sp] seems to be cheaper but some don't find it eases symptoms.  Vaginal Atrophy mimics repeated urine infection-type symptoms really, really well  .

Perhaps put the regime into the search box on the formum : individually : to read threads that pop up.  Make notes ;-)

[Penguin]

No suggestions really as I am in the same boat as you and it's awful! The 100mg ones can be used vaginally, that's what I do x 2. I also struggling after the first two or three days, even vaginally use causes indigestion for me not to mention the issues with overheating,  not sleeping well and massive anxiety spikes, then leading to tearfulness and depression. I am now considering the mirena coil but will pay privately for it so I can get it whipped out ASAP if it doesn't work. I hadn't heard of tibolone as an option, do you have to be post meno for that?

[joziel]

If you don't bleed unless you do something to make that happen, then it's very likely you could switch to continuous utrogestan. Whilst that might sound worse at first glance, you might find it is easier/better - because it's half the dose (for the whole month). So - 100mg/night.

You can break one of the vaginal pessaries in half because they are 200mg. Or you can use one of the 100mg oral capsules, vaginally. Some menopause specialists (Newson) say you then need only half the usual oral dosage, if you are taking vaginally. So that would mean 100mg every other night. That reduction is slightly controversial and not everyone agrees with it.

You might want to give that a go and see how you feel on that dose... If you want to stay sequential, then yes - you can stop sooner than 12 days sequentially. But you might need a scan to check your lining isn't building up and you're doing okay on the reduced dose. (So you'd need your GP working with you if you were to trial that.)

The other thing you can try, is the Mirena coil. That way you can stop utrogestan entirely and the coil will do all the progesterone stuff for you.

[pastie supper]

Thank you for the replies 

Penguin, you sound just like me, I'm sorry you are suffering the same, I find one of the worst parts of this is how they say utrogestan doesn't cause these side effects, it's so demoralising to be told it's basically all in your head when I've seriously tried everything I can think of to help myself and they don't even see a problem!

Sorry I ramble so much, I think my meaning got lost in too many words, I should learn to edit 
Is there is a herbal remedy (or Anything!) that helps the progesterone phase? I don't think I had PMT much when I had periods, so I never took notice of what helps ease us through it more gently.

I already take only 100mg utrogestan because Boots had them and not the 200s this month. I don't think it's possible to cut utrogestan in half because it's a soft capsule pessary and the contents would run out, but it's a good suggestion, I could adjust the capsules so they have less in them, a sharp pin and pressure should partly empty it, so yes, I'll do that if I can only get 200s next time. I prefer the utrogestan 200s because they come with applicators, but I don't like the higher dose of course.

Stopping before the 12 days is a yes then? It should work to make me bleed? At six days, or ten, what do you think? Two more days is a full week, maybe that would be enough for this month? More trial and error. I just inserted a 100 utrogestan and set my 30 minute timer, that's when I will have my very thorough shower. (note, ten minutes later I'm struggling not to throw up)

I tried Biovea progesterone cream too, it's 20mg or mcg compared to 100mg or mcg utrogestan, such a low dose didn't work even though I used it the full 12 days, I didn't bleed that month. It might not even be the same type of progesterone, I wouldn't know, I'm no chemist, they both claim to be identical to the body's progesterone, so wouldn't that mean they are identical to each other?

I don't mind missing some months of bleeding, I wouldn't tell my GP though, she thinks HRT works but is a huge cancer risk, that is another long tale on its own, getting HRT isn't easy. I've found they treat these medicines like the holy grail, don't let you try them, until the appointed time, then suddenly we can try them. If at that point we say, "I don't like this HRT, it makes me feel worse not better", we are not believed. I'd been asking for a long time, so it looked churlish of me to not want what they gave me. It's frustrating.

My GP told me they won't normally prescribe what I'm getting now after a long fight because, get this quote from my GP, its because, "We can't know if a woman is taking the progesterone if we prescribe them in two separate products, so we only prescribe combined products, then we know she's taking both."

Because women can't be trusted, right? That's why it took over a year to get it prescribed?

I am prescribed 24 vagirux a month, so that would be instead of vagifem, I think they are the same and it's just a cheaper brand for the NHS and while it doesn't work well, it's even worse if I stop taking them. I had my womb lining measured quite recently, declared nice and thin, 2.6mm I think and it was soon before a bleed.

I tried continuous HRT with the every day dose and it wasn't for me. I was depressed all the time and bled each month even though it was continuous. My mother was the same way with HRT, she finally gave up on it when the controversy hit, 25 years later it's my turn!

Ok, 12 minutes until I shower, thanks again for the responses, it's good to know I'm not the only one finds HRT problematic. I'm so sick of hearing how wonderfully well it works!

[CLKD]

Morning. 

My GP told me they won't normally prescribe what I'm getting now after a long fight because, get this quote from my GP, its because, "We can't know if a woman is taking the progesterone if we prescribe them in two separate products, so we only prescribe combined products, then we know she's taking both."

Because women can't be trusted, right? That's why it took over a year to get it prescribed?


Quite frankly she should be struck off from practicing.!!!  Do report to your Practice manager and to the British Menopause Society, explaining the problems U have had trying to get treatment that eases your symptoms.  It's time that these ignorant medics are taken on a year-long course to update their knowledge.

[Dotty]

Hi if you’re post menopause then you shouldn’t be having bleeding and you don’t need to force a bleed.

The dosage for post menopause is 100mg of Utrogestan every day . x

[pastie supper]

Morning. 

Quite frankly she should be struck off from practicing.!!!  Do report to your Practice manager and to the British Menopause Society, explaining the problems U have had trying to get treatment that eases your symptoms.  It's time that these ignorant medics are taken on a year-long course to update their knowledge.

After having so much trouble getting anything, I emailed both my GP and the practice manager.

The practice manager phoned me and had oestrogel and utrogestan pessaries put on my repeat list as her response.

Two weeks later my GP phoned as well. She told me the above reason for why it isn't the way they do things. Then she took utrogestan back off my repeats and left oestrogel on the list, which makes no sense at all. She maybe got them mixed up? 

[Mary G]

Pastie supper, your GP is appalling.  This kind of behaviour is infantising patients (particularly women) by treating them like children who need protecting from themselves.  My niece is a junior GP and many of her colleagues have only very scant, textbook knowledge on HRT.  They have very strict prescribing guidelines and have to prescribe the cheapest stuff first and hope the woman goes away and gets on with it - they particularly like to prescribe oral HRT.  They are not well placed to deal with complex menopause/HRT issues and most don't have that level of expertise.  Another problem is the NHS don't routinely offer uterine scans so they have to cover themselves by prescribing very high doses of progesterone.

That is why so many women choose to consult a private menopause specialist.

Back to you.  There are various options.  You have a very good womb lining measurement so for now, I would take 100mg Utrogestan vaginally for 7 days, hi have a bleed and then have a rethink.  For some bizarre reason that nobody ever been able to explain, Utrogestan is not licenced for vaginal use in the UK but you can use all Utrogestan capsules vaginally. 

If you are post menopause, you can take 100mg Utrogestan every other day.  Many women do this successfully and there is nothing wrong with it.  You just need to have a yearly TVS scan which is easy to arrange and costs about £100 in the UK I think.

You could try Cyclogest vaginal pessaries but good luck with getting your GP to prescribe them. 

Crinone is a vaginal progesterone gel that is also worth trying.

There is oral progesterone and many women find Provera easy to tolerate.

You could consider a progesterone coil but I would definitely opt for a lower dose Myleena or Jaydess coil.  If you have any issues with progesterone, a Mirena is a risk because the dose is higher.  You would need annual TVS scans. 

This is a fact sheet from the Chelsea and Westminster menopause clinic:

https://www.chelwest.nhs.uk/your-visit/patient-leaflets/medicine-services/levonorgestrel-intrauterine-system-with-hormone-replacement-therapy

Once you have exhausted all the conventional progesterone options, the only other option is compounded, tailor made progesterone.  This has fewer side effects and you might want to read my thread in the Alternative Therapies section on here.  I found compounded progesterone at a 50mg dose had zero side effects.

Utrogestan is not well tolerated and in my opinion, it is prescribed in doses that are extremely difficult to tolerate.  I'm not progesterone intolerant but I wouldn't go near Utrogestan again.

The thing that saddens me the most on here is seeing so many women struggling with the wretched Utrogestan (amongst other things) with very little help or flexibility from their doctors.  So many women just give up on HRT altogether and then suffer the consequences with debilitating menopausal symptoms for years on end.

It would be better to amalgamate menopause clinics with walk in birth control clinics because there is a definite crossover between the two with the pill and progesterone coils etc.

[CLKD]

   Mary G.

[joziel]

I think you probably need to experiment with other progesterone options if you're getting these side effects. To do that you'll need a cooperative GP....

You could consider the Mirena coil, as I mentioned before. Or there are synthetic progestins you can try. Sometimes women are fine with one of these and not with others. There's even the POP desogestrel which isn't licensed as HRT but you can use it to that end (the studies have been too small to properly licence it but they have had good results for protecting lining of uterus).

It might be worth going private with Newson so you can work with a GP who understands the full arsenal of options available to you and can help you trial and error some stuff until you get settled on something that works and then they can write to your GP and tell them what that is, so your GP can continue it....

[pastie supper]

Thank you all, I started bleeding heavily on day 8, so didn't insert the utrogestan after day 7.

They tell you progesterone is to make you bleed and I agree that if I don't take it I don't bleed, but it just seems such a high dose so I'm ill when I take it then I bleed very heavily and feel not great.

Then I'll get maybe three or four weeks feeling ok until the next bleed which will happen because I have progesterone in my body and it stays there for weeks.

The second period after using progesterone is lighter, but happens, so it's still in my body and I feel so negatively towards progesterone that I simply call it poison.

Anyway that's all the poison I'm taking this month.

I asked for Tridestra and explained that it only required progesterone to be taken every third month. My GP said there was no way she could stand over anything like that, I'd have to see a specialist.

She is referring me to an NHS menopause clinic, I won't hold my breath!

[joziel]

You really need to take progesterone as prescribed to ensure you are protected against endometrial cancer. If you can't do that due to side effects and are waiting for a referral to come through, you should consider stopping the estrogen as well - you don't want to be taking unopposed estrogen for months.

And it doesn't matter if you get a bleed or don't get a bleed, you still need to take the progesterone as prescribed. For eg - last month I started bleeding a week early on day 21 due to increasing my estrogen dose. I continued taking my progesterone for the full time I would have taken it, right through the bleeding. Then I started again on day 15 of the next month. Bleeding doesn't mean you don't need to take the progesterone. Unopposed estrogen is very risky if you have a uterus...

[Mary G]

joziel, there is absolutely nothing wrong with taking a low dose of progesterone if you have regular transvaginal scans.

Not everyone needs the same dose of progesterone.  Some women need a very high dose and some women like myself achieve excellent womb lining clearance with 7 days of 100mg Utrogestan. 

You can't guess how much progesterone you need, you have to find out and the only way to do that is by having a TVS.  Speaking to someone on the other side of a desk is not proper monitoring.  A scan is the only way of knowing what dose of progesterone you need.  A womb lining measurement over 5mm immediately post bleed or on a continuous combined regime is considered to be above the danger line and high risk so as long as you are below that level, you have nothing to worry about.

The NHS don't routinely scan women so they have to prescribe high doses of progesterone to cover themselves. 

[pastie supper]

joziel, there is absolutely nothing wrong with taking a low dose of progesterone if you have regular transvaginal scans.

Not everyone needs the same dose of progesterone.  Some women need a very high dose and some women like myself achieve excellent womb lining clearance with 7 days of 100mg Utrogestan. 

You can't guess how much progesterone you need, you have to find out and the only way to do that is by having a TVS.  Speaking to someone on the other side of a desk is not proper monitoring.  A scan is the only way of knowing what dose of progesterone you need.  A womb lining measurement over 5mm immediately post bleed or on a continuous combined regime is considered to be above the danger line and high risk so as long as you are below that level, you have nothing to worry about.

The NHS don't routinely scan women so they have to prescribe high doses of progesterone to cover themselves. 

You really need to take progesterone as prescribed to ensure you are protected against endometrial cancer. If you can't do that due to side effects and are waiting for a referral to come through, you should consider stopping the estrogen as well - you don't want to be taking unopposed estrogen for months.

And it doesn't matter if you get a bleed or don't get a bleed, you still need to take the progesterone as prescribed. For eg - last month I started bleeding a week early on day 21 due to increasing my estrogen dose. I continued taking my progesterone for the full time I would have taken it, right through the bleeding. Then I started again on day 15 of the next month. Bleeding doesn't mean you don't need to take the progesterone. Unopposed estrogen is very risky if you have a uterus...

Thank you, both of you make good points here, but I have to agree with MaryG more for my situation. I was using 100mg Utrogestan vaginally before my scan showed a 2.6mm uterine lining, which indicates I'm using enough, if I keep doing that.
You're right Joziel that I've strayed off that plan. Next time I'll take it for 12 days. It's hard to stick to a plan which involves taking a medicine that messes up your thinking! My mind has only cleared today, that's three days since I took any.

I know my GP wouldn't like it, but she has shown a shocking ignorance on the entire topic, so I'm forced to do my own research and make my own decisions. Besides, I'm only trying out a few options. After I know what works, I'll decide if the risks are worth it, so it's very short term and won't affect my long term cancer risks.

At first with Utrogestan I tried 200mg orally as prescribed and nearly died from the pain of indigestion from it, so I found out online I could take it vaginally and did that with 200mg, still it was ruining my wellbeing. Next month I tried 100mg vaginally, wasn't as bad.
I believe 100mg Utrogestan is enough for me, I had my lining checked and the thickness was perfect. Online doctors say 100mg is enough. So if 100mg is enough, it would be detrimental to take more than I need, that is the general rule with medicines.

I wouldn't suggest anyone else goes off script unless they felt they had to, it's very individual.
I had to go my own way because I don't have a GP's support and there is no opportunity to change GP.
I am continually considering stopping all of it, even the Oestrogel which I find works fantastically well for me, because the risks are so unstudied and unquantified we really don't know what the risks are for any of us.

Studies I found are scant and perhaps unreliable, for example I read that adding progestins instead of having unopposed oestrogen will halve the extra risk of endometrial cancer in this study;
https://pubmed.ncbi.nlm.nih.gov/10695959/

I read using progestins increases my overall risk of breast cancer by 10% and there are other conditions seen more frequently in progestin users like blood clots and so on from this study;
https://pubmed.ncbi.nlm.nih.gov/10675382/

There aren't enough quality studies to know much for sure, those two are really old. I want to find a tolerable form of HRT going forward and that requires me to try out things to see what works for me.
If I stay on HRT I'll keep getting scans done. I don't think 200mg of Utrogestan is needed, that seems to overdose me and causes problems.