Oral progesterones are known to require higher doses to be effective as they are rapidly metabolized and it is the higher doses and the products of the metabolism that cause the side effects in some people.
There are studies that compare the effect of Crinone with other progesterones. For example, https://pubmed.ncbi.nlm.nih.gov/10689005/
Crinone is compared with 100mg Promterium (utrogestan) orally. The conclusion was Crinone results in greater bioavailability with less variability than oral progesterone, providing more reliable delivery of progesterone, compared with oral progesterone. The blood concentration was 5x higher for Crinone and it lasted longer. I have also read something that said tissue (rather than blood) levels were 10x higher using crinone than oral progesterone.
Therefore, compared to an oral progesterone, the effect of vaginal can be far higher than you might expect. 45mg daily equivalent should easily compare to 100mg or 200mg daily utrogestan.
I also compared it to a mirena coil as at least they have a similar site of action. As you say Mirena is synthetic but is similar in that it will also interact with the same receptors as natural progesterone that it is designed to mimic. I can't find any studies comparing Mirena with crinone or utrogestan.
FDA data sheets show however that steady state plasma levels for crinone as 5-15ng/ mL. That of mirena as 150-200 pg/mL(0.15 -2 ng/mL), albeit for progesterone vs progestogen.
As they always say, more studies required...
Hi Katie, if you don't mind me asking, where do you get your prescriptions from?
MaryG, you are in Spain, am I right? Not having to negotiate all this new british red tape that has tied the hands of the NHS?
Where I live the private HRT clinic is run by the same doctor who runs the two NHS HRT clinics, so I have no clue whether seeing her privately is better than seeing her on the NHS. Less fettered by rules maybe?
I've been on her waiting list since June 2023, they are seeing April 2023 patients now, so only a couple more months to go.
They said on the news the NHS waiting lists only increased by 10% from last year, but that jump is 8 months to 14 months, that's a 75% increase!!! I guess we are only women (an ironic joke clkd).
I've had a terrible time with progesterone all my life, so I take tibolone which definitely helps menopause symptoms like anxiety, fatigue, brain fog. All that is gone when I take tibolone but those symptoms are worse on normal HRT, I think because of the extra progestins and lack of testosterone in it.
Normal HRT takes away the sudden sweats better than tibolone. That is the oestrogen working I believe, but if I take oestrogen HRT then I have to do without the testosterone in tibolone and the mental/fatigue problems get worse again. Then with oestrogen HRT, eventually I've to take an isolated progestin, it all goes to hell again and I'm better off having natural menopause symptoms.
It is infuriating that they won't work with me to find a balance that works. It's all one extreme to the other, then abandon that medicine and repeat the same mistakes with a new one.
I've read about HRT a lot in my three years since menopause and it's clear to me my GP hasn't a clue (and treats me like an infant).
I need some more oestrogen and I need some more testosterone. I don't need much more progesterone than my body already makes from the two aforementioned hormones, I've always been progesterone dominant, I've not got a thickened lining, they checked, but the easiset answer is still no.
To cap it all, my symptoms of brain fog, anxiety and fatigue aren't what we are allowed testosterone for (it works perfectly for these symptoms). We are only allowed testosterone for increasing sexual desire, I wonder who thought up that rule?
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