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[Anonymous1]

Hi there,
I posted a few days ago.  I'm in the UK.  I recently started Cyclical HRT:  Evorel 50 patches and Utrogestan 100mg x 2/day orally.   

I noticed significant benefits to my mental health on Everol.  I have experienced unpleasant side effects with Utrogestan; including a worsening of my mood.  I started taking it via vagina after 3 days and reduced the dose to 100mg/day.  However, I still feel worse than before I started HRT. 

I have chronic fatigue and long term mental health difficulties.  I am working with a Naturopath Re:  Fatigue and related symptoms e.g. Sleep disturbance, low mood. feelings of overwhelm.  I am already on a lot of supplements.
My fatigue and related symptoms first started around the time my periods started changing.  However, the cause is thought to be my long term mental health difficulties, chronic stress as well as the additional demands of the body from the menopause.  I am used to trialling treatments/adjusting tablets on my own as their is very limited support from NHS available for my health conditions. 

I am 51.  Private tests show I am low in oestrogen and progesterone.  As yet I have not had any hot flushes or night sweats.

I feel like the benefits of the Esterel 50 wear just before I am due to change the patch.

At the moment I am planning to finish this first cycle of HRT and then discontinue. 

I don't know whether it is worth trialling some other forms of Progesterone e.g. Cyclogest vaginal suppositries, Evorel Sequi patches or the Mirena coil.  I am not that keen on the idea of the coil as it won't be so easy to stop it if I don't tolerate it.  From what I have read there is still a strong likelihood that I might experience some side effects form these alternative sources of progesterone too.  I wondered whether increasing the oestrogen part might help.

I have seen that you can purchase a private prescription of these alternative sources of progesterone; including those which are off licence.  Therefore, I wondered about trialling one of the alternatives for a month on my own and then seeking professional advice.

There is no longer a GP specialised in menopause at my GP practice.  I don't know whether it is worth paying for a consultation with a nurse at a private menopause clinic.

What have been other people's experiences?
Has anyone else experienced unpleasant side effects with Utrogestan and found a consultation at a Menopause clinic helpful?
Has anyone else purchased alternative sources of progesterone online and trialled them for a month on their own?
Will increasing the oestrogen part help?

[pastie supper]

I tried utrogestan, Evorel conti patches, cyclogest and mirena coil (not in that order) my mood crashed on all of them, time frames were different and conti patches were the least bad, but still too bad to want in your life. It made me feel worse overall even though some physical symptoms improved.

I tried a progesterone cream off the internet, biovea, it was nice, which led me to believe it wasn't working, lol. It didn't even induce a bleed and I bleed with everything. Not strong enough was my conclusion. I could have used more, but it's expensive.

For women who are intolerant to progestins, the NHS prescribes tibolone as HRT.

It's fallen slightly out of favour with the recent move towards transdermal HRT. Tibolone's in a pill form, but I consider that an advantage as well.

The other problem is that all HRT preparations say they are only for post menopausal women. Some are used so commonly for peri women it's almost an official use now, but tibolone is used less frequently to start with, so if you've not had your period free year yet it's an extra fight to get it. I first got it age 52.

The most noticeable effect to start with is increased energy, followed by an improvement in my confidence, anxiety goes away.

It does less for flushes & night sweats, but that bothers me less. I've severe and sudden sweats day and night without HRT, tibolone reduces them a bit so it's more manageable.

It sounds like it might be a good fit for you with chronic fatigue and mental health as your main menopause challenges.

After a few months on tibolone I didn't need fluoxetine any more. First time I took it that was, then they got scared about my bleeding and took me off tibolone, so back on fluoxetine. Now I'm on both again, it takes 2 or 3 months for tibolone to work fully, then I'll try going without ADs again.

[sheila99]

A private clinic won't be able to tell you which you'll get on with which is probably what you want to know. You just have to try them and see. They are more likely to give you a prescription for something off licence such as cyclogest or lutigest. There are also iuds with lower amounts of progestin than the mirena such as kylena that can be difficult to get via a gp. Unless you have lots of money I'd suggest you find our about options and see what your gp will prescribe first. You gp can refer you to an NHS menopause clinic but you may have a long wait. Just because you have problems with utrogeston it doesn't mean you won't tolerate anything (although a few people can't). Up to you of course but I'd try other options from your gp before paying. I get fatigue with utro but am fine with progestin in evorel combined patches even though utro is body identical and evorel isn't so it should be the other way round. Insomnia, anxiety, low mood and fatigue can all be symptoms of oestrogen deficiency, the fact that they started around the time your periods changed would indicate to me that they're more likely to be meno related. I had these symptoms too and no hot flushes, they took 3 months on hrt to go. At less than a month it's unlikely you've seen all the benefits so imo it's worth persevering. It's worth remembering that the experiences you get on this site are a bit skewed as people are here because they have problems. If they're fine on hrt they get on with their lives instead.

[laszla]

Also worth considering that one's reaction to utro can change. When I took it sequentially I felt bad, then that morphed into feeling bad a few days after stopping it, ie withdrawal, then I shifted into continuous, 100 mg p.v. (I skip perhaps 2-3 days a month) and it settled. My then consultant at the Chelswest meno clinic said that women can indeed get accustomed to it.

[Anonymous1]

Thank you for all your responses.

It sounds like it may be helpful to have a consultation at a private menopause clinic.   

I wondered wether there is an order in which to try the alternatives to Utrogestan?
 

[Mary G]

I would suggest trying Cyclogest @50mg next.  They are wax pessaries that can easily be cut into tolerable doses and I found it to be much better than Utrogestan.  Then there are the lower dose Jaydess and Kyleena coils that Sheila mentioned but obviously if you don't get on with it you then have the hassle of getting it removed.

Failing that, you could consider compounded, bespoke progesterone.  I have a thread on compounded hormones in the Alternative Therapies section on here which I will bump up for you.  I had great success with bespoke progesterone but I am no longer able to receive them here in Spain thanks to Brexit so now I use a branded transdermal progesterone gel which is very good and I occasionally add in 50mg Cyclogest just to be on the safe side but I don't really need it because the gel provides good womb protection even though it's not supposed to!

So you have to few options to try but you will probably have to go privately because I doubt any of those options are available via the NHS.  You might have some joy at the Chelsea and Westminster menopause clinic but they have a very long waiting list.

Has anyone managed to get Cyclogest on the NHS yet?

[Anonymous1]

Thank you.

[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 for them on prescription if I tolerate them better than Utrogestan.