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[Dandelion]

Hello
This is something I have been worrying about since 2016 and am more than ready to lift this weight of worry.

Basically I have been weaning off diazepam under the NHS, and found out, after I went on progesterone for peri-now meno, that it is cross tolerant to benzodiazepines like diazepam.

While most women can stop progesterone without any trouble, women who have had a dependence on benzodiazepines cannot, without withdrawal symptoms as major as benzo withdrawal.
This is because the metabolites of progesterone act on the same receptors as benzodiazepines and benzodiazepines change them, hence them becoming "addicted" to progesterone and suffering major debilitating withdrawals when progesterone is stopped as in coming off HRT.

One lady even got her serious benzodiazepine like withdrawals from progesterone 8 years after her recovery from benzodiazepines, she was not aware of this cross tolerance.

While my GP is tapering me off diazepam gently and I am grateful for that, and having no troubles, I have always had this spectre of worry when it comes to getting off HRT after my benzodiazepine taper is over.

This is because I am on the fluid filled capsules micronised progesterone, 100mg orally and 100mg vaginally.

I cannot go onto the coil or synthetic progestogens as I need to stay on the same dose of micronised progesterone to keep my GABA stable, as I was on this before I went onto benzodiazepines.
When I was on sequi, I went nuts when not on the progesterone.

I have been under gynaecologists as I had bleeds and due to the diazepam, which is why I am on a not normally licenced dose for my age 57.

I think I have come up with a solution, a progesterone cream to taper off more easily than trying to cut fluid filled capsules and insert them up my chuff.

I just have one thing that I am (hopefully) paranoid about, will the cream be strong enough to cover my GABA receptors so I don't go into "withdrawals"?

I understand that the licenced regulated creams are stronger but cannot be obtained in the UK and I hope I am being paranoid and that the wellsprings serenity stuff will be enough to keep me from symptoms like akasthisia, and other severe symptoms that could potentially be life threatening or make me incapacitated.

All help would be really appreciated thanks, as I want a solution I know I can go to when I get off diazepam and hrt and stay alive and well.

[Dandelion]

Bump please?

[sheila99]

Sorry, i have no idea. Perhaps you could contact a bhrt clinic directly? Or Maryg as she seems to knows a lot about it?

[Emma]

Your situation is quite complex, involving the tapering of both diazepam (a benzodiazepine) and micronised progesterone. It's crucial to handle this under medical supervision to avoid severe withdrawal symptoms. Here are some key considerations and steps you can take to manage your tapering process effectively and safely:

Understanding Cross-Tolerance

1. Cross-Tolerance Between Benzodiazepines and Progesterone:
- Benzodiazepines and progesterone (specifically its metabolite, allopregnanolone) both act on GABA-A receptors in the brain.
- Prolonged use of either can cause changes in receptor function, potentially leading to dependence.

Tapering Off Progesterone

2. Tapering Strategies:
- Oral Micronised Progesterone: You've mentioned using 100mg orally and 100mg vaginally. Tapering should be gradual to avoid withdrawal symptoms.
- Progesterone Cream: Progesterone creams can be used to taper off progesterone, but their efficacy can vary. Prescription creams may be more reliable in terms of dosing compared to over-the-counter products.

3. Dose Equivalence:
- The potency and absorption of progesterone creams can vary significantly. Over-the-counter creams may not provide a consistent or sufficient dose compared to oral or vaginal micronised progesterone.
- Prescription creams or compounded formulations from a pharmacist might offer more reliable dosing.

Monitoring and Support

4. Medical Supervision:
- Close monitoring by your GP or a specialist in hormone therapy is essential. They can help adjust the tapering schedule based on your symptoms and response.
- Regular check-ins to monitor for withdrawal symptoms or any other adverse effects are crucial.

5. Supportive Measures:
- Lifestyle Adjustments: Stress management, adequate sleep, nutrition, and exercise can help support your nervous system during tapering.
- Psychological Support: Consider counseling or therapy to help manage anxiety and stress related to tapering.

Practical Steps

1. Consult a Specialist: Speak with your GP or a specialist about your concerns. They may be able to prescribe a progesterone cream or compounded product suitable for tapering.

2. Gradual Reduction Plan: Work with your healthcare provider to develop a slow and steady tapering plan for both diazepam and progesterone. Abrupt changes should be avoided.

3. Track Symptoms: Keep a detailed record of any symptoms you experience during the tapering process. This information can help your healthcare provider make necessary adjustments.

4. Consider Alternatives: If progesterone creams are not effective, discuss other potential options with your healthcare provider, such as lower doses of oral/vaginal micronised progesterone that can be gradually reduced.

5. Stay Informed: Educate yourself about the tapering process and what to expect. Understanding the potential symptoms and having a plan in place can help reduce anxiety.

Conclusion

Switching to a progesterone cream for tapering might be a viable option, but it needs to be approached with caution and under medical supervision. The key is to ensure the cream provides a sufficient and consistent dose to prevent withdrawal symptoms. Working closely with your healthcare provider, you can create a tailored tapering plan that prioritises your safety and well-being.

[Dandelion]

Your situation is quite complex, involving the tapering of both diazepam (a benzodiazepine) and micronised progesterone. It's crucial to handle this under medical supervision to avoid severe withdrawal symptoms. Here are some key considerations and steps you can take to manage your tapering process effectively and safely:

Understanding Cross-Tolerance

1. Cross-Tolerance Between Benzodiazepines and Progesterone:
- Benzodiazepines and progesterone (specifically its metabolite, allopregnanolone) both act on GABA-A receptors in the brain.
- Prolonged use of either can cause changes in receptor function, potentially leading to dependence.

Tapering Off Progesterone

2. Tapering Strategies:
- Oral Micronised Progesterone: You've mentioned using 100mg orally and 100mg vaginally. Tapering should be gradual to avoid withdrawal symptoms.
- Progesterone Cream: Progesterone creams can be used to taper off progesterone, but their efficacy can vary. Prescription creams may be more reliable in terms of dosing compared to over-the-counter products.

3. Dose Equivalence:
- The potency and absorption of progesterone creams can vary significantly. Over-the-counter creams may not provide a consistent or sufficient dose compared to oral or vaginal micronised progesterone.
- Prescription creams or compounded formulations from a pharmacist might offer more reliable dosing.

Monitoring and Support

4. Medical Supervision:
- Close monitoring by your GP or a specialist in hormone therapy is essential. They can help adjust the tapering schedule based on your symptoms and response.
- Regular check-ins to monitor for withdrawal symptoms or any other adverse effects are crucial.

5. Supportive Measures:
- Lifestyle Adjustments: Stress management, adequate sleep, nutrition, and exercise can help support your nervous system during tapering.
- Psychological Support: Consider counseling or therapy to help manage anxiety and stress related to tapering.

Practical Steps

1. Consult a Specialist: Speak with your GP or a specialist about your concerns. They may be able to prescribe a progesterone cream or compounded product suitable for tapering.

2. Gradual Reduction Plan: Work with your healthcare provider to develop a slow and steady tapering plan for both diazepam and progesterone. Abrupt changes should be avoided.

3. Track Symptoms: Keep a detailed record of any symptoms you experience during the tapering process. This information can help your healthcare provider make necessary adjustments.

4. Consider Alternatives: If progesterone creams are not effective, discuss other potential options with your healthcare provider, such as lower doses of oral/vaginal micronised progesterone that can be gradually reduced.

5. Stay Informed: Educate yourself about the tapering process and what to expect. Understanding the potential symptoms and having a plan in place can help reduce anxiety.

Conclusion

Switching to a progesterone cream for tapering might be a viable option, but it needs to be approached with caution and under medical supervision. The key is to ensure the cream provides a sufficient and consistent dose to prevent withdrawal symptoms. Working closely with your healthcare provider, you can create a tailored tapering plan that prioritises your safety and well-being.

Hi Emma and thanks for taking the time to reply to me.
I hate that my situation is quite complex.
The diazepam tapering is not a problem, my Dr is helping me with that, thank God.
It's the progesterone that scares the hell out of me.
I noticed women come on here and benzobuddies, worried, as they are on benzos and progesterone, then they suddenly disappear. My GP knows the progesterone messes things up, she offered me the coil, that's no good. I don't want to stay on hrt, I am fed up on being reliant on pharmacies and want to be un-reliant on them when off benzos, but fear this progesterone will cause problems if I just sack it off and come off it.

Understanding Cross-Tolerance

When I learnt about Cross-Tolerance Between Benzodiazepines and Progesterone in 2016, I have been worried about it ever since.
I tried to see if I could buy allopregnanolone but I can't.
My receptor function has changed, you are right.

Tapering Off Progesterone

I have no clue how to taper off these fluid filled capsules of micronised progesterone. I read about women who **** a hole in them and squeeze a bit out, that's far too inaccurate for me.
- Progesterone Cream: I saw Wellspring and other online places do rogesterone creams but I fear they are too weak, as I take 200mg. I fear needing a whole £29.99 jar of it a day.
I am in the UK and cannot get prescription progesterone cream, dunno why as they can get it in the US.
Cream would be much easier. I'm really fed up that the UK does not do prescription progesterone cream.

3. Dose Equivalence:
I also read the potency and absorption of progesterone creams can vary significantly. I wish it was as easy as buying over-the-counter creams, and hate that I might not get a consistent or sufficient dose and hate that even this could make me seriously ill. 
I wish I could get prescription creams or compounded formulations in the UK but I cannot see how.

Monitoring and Support

4. Medical Supervision:
The NHS just seem interested in cuts, and I have never seen a hormone specialist.
I touched upon my GP above, the other thing they could offer is synthetics, but again the dose is not high enough, and I don't absorb the oestrogen in pills. I don't care about coming off oestrogen, I am only on 25mcg.
My GP is nice but they are all clueless about this sort of stuff.

5. Supportive Measures:
I cannot get rid of my stress, as there are physical (non-meno) problems I have, which I can do nothing about. Adequate sleep-I either lay awake or wake up too early, so I don't know how to get more sleep. I try with nutrition. My depression has taken away motivation for everything including exercise.
- Psychological Support: I was recently discharged from mental health services after being diagnosed with CPTSD in September. My GP recently spoke to the psychiatrist who does not think I need them still, they think my property and legal problems are the cause, which they are right and my GP said if I can get rid of them I will be much better, I can't but she is right, but this does not solve the progesterone problem.
I wish I had never gone on HRT. My old GP said progestoene would mess up the taper, and I asked for oestrogen only but she could not give me that for obvious reasons as I had a womb. I used to need 100mcg oestrogen as my flushes used to be out of this world.

Practical Steps

1. Consult a Specialist: I could speak to my GP, but I am really sensitive about disappointments at the moment, they literally make me want to go to bed and "end the day" and set me right back. They put me on gepretix recently for cost cutting. Cost cutting is their priority and I can't afford private.
2. Gradual Reduction Plan: I am working with your healthcare provider on a tapering plan for diazepam but nothing is on offer regarding the progesterone, and I believe I could die if I cold turkeyed 200mg of it, sorry for being dramatic.

The micronised progesterone I take only comes in one dose, again it's figuring out how to taper the capsules.

The more I read about benzo dependent women and progesterone the more scared I get.
I was in touch with an American who got off benzos, and got tolerance to the progesterone and had to come off. She became incapacitates and stopped messaging me.
Conclusion

Switching to a progesterone cream for tapering sounds like a viable option, but the medical supervision part is a hurdle. Thanks again for your post.

[CrispyChick]

Hi

You can get compounded prog creams in UK through the bhrt clinics. But it's expensive. Marion Gluck, London hormone clinic etc...

Alternatively, have a look at Onas cream. They do different percentages, so you can get a pump that gives you 100mg at a time. However, they are also the first to say that many absorb the lower percentage creams best. Their lowest is 30mg per pump. But as you want to reduce, you wouldn't get on 7 pumps too long.

But yes, I doubt it'll feel the same as utrogestan.

I've used both compounded and onas creams. I find them strong. But we will all absorb differently.

Anyway, this hay be useful information to you. Xxx