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[Anonymous1]

Hi there,

I recently started Cyclical HRT (Esterel 50 & Utrogestan 100mg x 2/day orally).  I have underlying health problems; chronic fatigue due to long term mental health; incl anxiety, type A personality type, chronic stress, over exercising when had symptoms and extra demands on body of peri-menopause/menopause.

Within 2 days of starting the Esterel (Oestrogen) I noticed a signficant improvement in my mood.  I felt more like my normal self.  Unfortunately, I experienced significant side effects when I started the Utrogestan (Progestogen) part including headaches, nausea, feeling groggy, tiredness and depression.  I felt worse than I did before starting HRT.

I switched to taking the Utrogestan vaginally and reduced the dose to 100mg/day.  I'm still experiencing the side effects; although they are slightly better.   However, I haven't found it that convenient taking via this route.  I bought a pessary applicator and the tablet got stuck in it.

I have come to the end of the first cycle and am planning to stop the HRT for now.

I am now familiar with the other types of Progesterone available; thanks to peoples responses to my prevous two posts.    I also found this good summary here:
https://www.mymenopausecentre.com/gp-resources/the-key-things-you-need-to-know-about-progestogens-and-progesterone/

I would like to know if there is a particular order to try the alternative forms of HRT?

I know I have not given the Utrogestan very long but I was not able to tolerate the further reduction in my mood on it under my current circumstances. 

[Mary G]

It sounds like you will never get on with Utrogestan so it's time to try something else.

There is no particular order to try them but I would try Cyclogest @50mg next.  I'm afraid that is also vaginal but you can use it rectally too.  If that doesn't work out you could try some of the synthetic forms of progesterone like Provera which is well tolerated.  Failing that you could try a low dose coil either the Jaydess or the Kyleena but I wouldn't risk the higher dose Mirena if you have problems with progesterone.

Once you have worked your way through that lot, the only other option is the compounded route or a hysterectomy.  I'm not progesterone intolerant but I really couldn't stand Utrogestan however I got on extremely well with bespoke compounded progesterone @50mg.  I think the key thing here is the dose and 100mg is too high for a lot of women.  That said, I doubt I would react well to Utrogestan at any dose.

I hope that helps.

[Anonymous1]

Thank you Mary.  That's helpful.

[Anonymous1]

UPDATE

I booked an appointment at a private menopause clinic (Online).  It was expensive but I did find it helpful.  The nurse was very knowleageble and I felt less on my own with it. 

The nurse suggested that I go on Everel 50 for a month to get my Oesterogen levels up and then re-introduce Progesterone continuously as I am not far off 12 months without a period.  Either Utrogestan 200mg/day vaginally or one of the alternative forms e.g. Cyclogest pessaries 100mg/day or go on to Everol Conti patches.  Alternatively, I could try the Mirena coil.  They said that the coil might cause a hormonal surge intially and take time to settle.
They said that there is not really a preferred order to try the different forms of progesterone.  They recommended that I try things for a month if possible.
 
I stopped the HRT on Sunday and feel a lot better than when I was on the Utrogestan e.g. Increased mood.  I guess my oestrogen levels might still be raised from the month on Evorel 50.

I might buy some Cyclogest pessaries from an independent pharmacy and then ask the GP for them on prescription if I tolerate them better than Utrogestan.