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[Hello101]

I was happily using 4 pumps of Oestrogel daily plus Utrogestan 100mcg at night for about 6 years and felt great on this combination. Loads of energy, optimistic, happy! However when my bottle changed to the cylindrical one a few months ago I felt rotten. I couldn't sleep and started having weird numb patches all over my legs.
I asked my GP to switch me to patches so she prescribed the equivalent dose of patch (Evorel 100) and upped my Utrogestan to 200mcg each night as she said patches are felt to be better absorbed than gel so I'd need a higher progesterone dose to cover me.
Ever since I switched I just feel I'm getting lower and lower in mood. I can't be bothered doing anything at all. I'm so pessimistic and feel bitter about everything. I feel like a zombie. I don't think I feel suicidal but the thought has started crossing my mind. I don't really think I'm depressed as I can still function no problem, I'm sleeping okay, I'm not bursting into tears etc.
I hate feeling so low and wondering how I could tweak my HRT to try and help. I think it may be the higher progesterone dose that’s making me feel so low. I'm seeing my GP for a review in a couple of weeks so thought I'd ask for advice here.

[Gnatty]

Firstly I'm really sorry to hear you are struggling. But this can be fixed! I would say your GP has kept your oestrogen dose exactly the same but doubled your utrogestan and as you suspect this is where it's going wrong. Who can say which one you would absorb better without blood tests or seeing how you feel after a few weeks? Why don't you drop down to the 100 mg of utrogestan and see if that makes the difference over the next few days? If you still feel out of sorts after you have given the extra utrogestan time to get out of your system then it might be you are not getting as much oestrogen from the patches as the gel. But sort the utro out first.
I too switched from oestrogel for the same reasons, but I stuck with gel and moved over to Sandrena. It's working really well for me after the initial bumpy first few days so this might be another option for you as you know that gel did used to work. x

[Hello101]

Thanks for this. I wonder if it’s safe though from an endometrial protection point of view to go down to Utrogestan 100 while I’m on the high strength patches. I would love to reduce my dose as I felt so much better just on one capsule each night.
This also coincides with the pharmacy supplying me with Gepretix instead of Utrogestan so this may be a factor too.
I might try one capsule orally and one vaginally each night to see if that helps.
And then try a switch of oestrogen to Sandrena. Thanks again!

[sheila99]

I agree the increased progestin dose is likely to be the problem but it may also be that you absorb less oestrogen this way. If you want to know if gepretex is the problem you could try a couple of cycles of sequi (200mg x 12 days) and seevif you feel different on the oestrogen only days. I'm not convinced your gp is right, 100mcg should be the same however you get it though it's possible that you absorb differently. 100 utro (and gepretex is supposed to be the same) should cover you for up to 100 mcg oestrogen. Though I think perhaps the guidelines may have changed recently?

[Hello101]

Thanks for the info! That’s an idea to try and take my capsules just 12 days of the month and see how I feel. Though I’ll probably get a bleed again won’t I? Ugh not sure I could handle that!

[sheila99]

Yes, you'll probably get a bleed. All in the interests of scientific research  . I prefer a bleed (6 week cycle) to being permanentl doped on utro. Once you know where the problem lies you can adjust accordingly and go back to conti again.

[joziel]

You could try taking 100mg orally and 100mg vaginally. That way it will get where it needs to but hopefully not be absorbed systemically.

[Hello101]

Yes I tried one orally and one vaginally last night. It might just be a placebo effect but I think I feel a bit better today. I don’t feel as sad and down. God I hope it continues!

[Hurdity]

Sorry to hear you were feeling low but glad you were feeling better last night! Hopefully that will last.

Just to add while doses are being discussed, that the dose of progestogen needed to counter the stimulatory effect of oestrogen on the endometrium is dependent on the dose of oestrogen. The dose of utrogestan in menopause does not take this into account - except if there are bleeding problems when the British Menopause Society recommends an increase.

In your case it looks like no bleeding problems and the progesterone was protecting you if you've had no bleeding. I agree though with Gnatty - how can the doc say that you will absorb more oestrogen from the Evorel 100 mcg? Both 4 pumps and 100 mcg are high doses so theoretically both should require higher progesterone doses - but as we vary individually it doesn't always follow.

I would also concur with sheila's suggestion of trying it cyclically - because I hate taking progesterone at all (no way would I take it every day) so a withdrawal bleed is the lesse of two evils. I am on a longer cycle though....

Hurdity x

[Hello101]

Thank you Hurdity! I actually had a little bit of bleeding last week. It was super light but lasted for a few days. I’ll obviously discuss this with my GP when I see her soon.
It’s very complicated!

[Hollyboll]

Hi
Sorry to hear you've been feeling low especially after a good improvement, I empathise with how disappointing that is.
As others have said, your GP is talking nonsense - the guidelines that suggest increasing utrog would apply equally to 100 patch and 4 pumps of gel, which is equivalent - what your GP probably meant is the guidelines have changed since you started on the gel and she's only just noticed she should have upped your prog then!
- and everybody absorbs differently so without (repeated to check for fluctuations) blood tests nobody can say what you absorb from which. 
I'm on 200 utrog daily, continually - because my oestr doses were pushed up (way higher than your 100) far too high.
I've had an awful peri/meno/whatever it is now - and I'm lucky to have ended up with a real expert consultant. 
I have repeatedly asked him (mainly after seeing the stories here) whether my symptoms now could be because too much utrog, and he is adamant very unlikely.  I think his view is that as I was fine when I was on a lower E and 100 utrog, I'm not allergic or intolerant to the utrog (but this is reading between the lines).
I've learned the hard way that it's often fluctuations that cause as much of a problem as levels in themselves so personally I am taking his advice and not trying cyclical because that just means more fluctations within a month.
That said, he was happy when I asked and I have now started taking 1 orally and 1 vaginally - my theory is that will make it easier when I eventually do get to lower my utrog dose as I hope will happen one day - and in fact he'd be happy for me to take all 200 vaginally, he's not bothered about the route. 
You don't say how long you've tried this new regime, but it could be symptoms are the change still - most advise 6-8 weeks (and some longer) to settle onto a new dose, even without changing product, as you've done.
On the patches, it's worth changing them every 3 days instead of the recommended twice a week (3.5 - 4 days).  They are meant to last 4 days but consultant said the very first time I saw him that for many there's a drop after 3 days, and that repeated fluctuation could cause many of your symptoms.  It's a total pain because it's not the same day every week so it's harder to remember, but the lesser of two evils?
Finally - I don't think being able to function and not weeping necessarily mean this couldn't be depression.  That said, I totally relate to (and am lucky that my consultant is very clear that) symptoms that many mistake for depression come from hormones and if this all started when the gel changed, that's a big clue.

Hopefully you are continuing to feel a bit better

xx