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[Hurdity]

Hi lifeatfifty

  from me too.

At you stage in menopause you should still be on a cycle anyway as you are still peri-menopausal - continuous combined no-bleed regimes are only recommended for women who are post-menopause ie without a natural bleed for 12 months. Many of us continue with a cycle for the same reason - it doesn't feel "natural" to take progesterone all the time for years on end and certainly does not occur in nature ( pregnancy only lasts for 9 months!). Also the side effects either form large doses of progesterone or the synthetic progestogens are not tolerable for some women.

Some HRT preparations are cyclical as is one of the CCP types that is similar to HRT. Trisequens has two different oestrogen strengths and QLAIRA  ( CCP) has 2 different doses of estradiol during the 28 days. However if you are still having some sort of cycle then this will add to the mix so trying a regime with different oestrogen doses is less if an issue since you will be cycling anyway? Some women also take a higher dose of oestrogen when on the progestogen phase of their cycle - but again this should be under supervision to ensure the prog dose is sufficient to protect the lining.

Also HRT is designed to prevent the oestrogen dip that occurs at the end of the cycle so avoiding the worst of pms - surely the rhythmical method isn't designed to do this? As has been said you can get bio-identical hormones on NHS and the problem is that of misunderstanding the terminology. Estradiol and progesterone are the hormones available - estradiol as tablet, patch or gel , and progesterone in micronised form as utrogestan,. No need to see a private consultant. Yes the recommended minimum for progesterone is 10 days although some private gynaes prescribe less for progesterone intolerant women but must be done under medical supervision as you are doing. Many of us prefer to use the vaginal route for progesterone - as this avoids the liver and the dizziness/tiredness is lessened. Exactly the same capsule is used - but this is off licence too, although demonstrated to be at least as effective  (if not more so) than the oral route.

What testosterone are you using? If it's Tostran then 1 pump daily may be too high, I would suggest. Also what type of gel?

Hurdity x

[Peacegirl]

Thanks as always Hardily - lots more helpful info for me to chew on

[lifeatfifty]

Hi Ladies,
sorry I've been offline.

Thank you all for your welcome and response.

Shortie - here's a link to the Wiley Protocol http://www.thewileyprotocol.com/about/
              Basically your estrogen is increasing over the first half of the cycle with it peaking, as it would in nature, at midcycle. You are given tailored
             doses to take on each day and if you don't know when your last cycle was you follow the cycle of the moon!

             I did ask my doc about this and she said she wasn't keen as the levels of estrogen taken at mid-cycle are huge (exactly as a 20 year old girl
             would).
             I have read many interesting reviews with woman saying how fit they felt. The premise is that you need the peaks and troughs to turn on the
             estrogen and progest receptors in the brain to trick it into remaining in homeostasis and the body healthy.

Cassie - I'm on 2 pumps daily (1 in morning and 1 at night)

Michelmabelle - Nice to know that the scots are here. So many of my friends have been struggling with prescriptions for hrt. Many just offered the
                       one tablet fits all for or the mirena coil!
                       I'm not taking the progest vaginally but have ask to try this - I will update my changes at the end of this post.

Hurdity - Thank you for all the info. I've read many of your posts and they are always so informative - are you medical?
               My bloods taken by local gyne stated I was postmenopausal - but then that's only a snap shot in time and not over my cycle.
               The Testosterone I take is a compounded cream. Each pump provides 0.75mg of Testosterone.

I have been on my hormones for 7 weeks now.
I definitely feel that every second month I am definitely producing my own estrogen but not so much on alternate months. This month my estro was low and I had a very light bleed.

Although hot flushes have gone I'm still not sleeping well and sweating at night.

I am due to have hormone blood profile taken on day 21/22 of this cycle and then we will alter and fine tune again.

At the moment I am to swap to the vaginal Utrogestan. I did ask if I could just use the oral stuff but was told it wasn't licenced for that. Although I haven't received it yet. I am also to add some progesterone gel to my daily routine to see if it helps with sleep and sweats?

Also recommended some 5HTP for the anxiety.

It really is a minefield out there and although I feel I've asked all the questions I'm always then left a little confused as more questions dawn on me latter.

Thank you all again.
 

[MicheleMaBelle]

Hello life at fifty- the bio identical hormones are readily available on the NHS ( oestrogel or equivalent and utrogestan) -they're not normally the first choice of most GPs - not sure if this is down to lack of knowledge or cost? Might be both.

If your friends struggle they could go back and ask to change. Many of the tablet formulations have bio identical oestrogen but many contain a synthetic progesterone, norethisterone which can cause problems. There is another formulation Femeston which contains a synthetic progesterone and this sometimes can be better tolerated if they don't fancy the idea of a Mirena.

Hope you find a regime that suits- hang on in there for a bit longer. And taking it vaginally is ok. It's licensed for IVF treatment vaginally but not for HRT although most consultants are happy for you to just shove it up there!

Let us know how you get on x

[lifeatfifty]

Thanks again michelemabelle

[Katia]

Hi Lifeatfifty, what is the progesterone gel you refer to?  A it the Crinone gel?  Ive been reading some posts that it is better tolerated, but I think hard to get it prescribed. I'm struggling with the depressive effects of the Utrogestan, but want to complete a month so that I've given it a fair go

[weathergirl]

Katia, I've wanted to ask about using Crinone gel.  It comes as 45 mg and 90mg. I believe the 45 mg would be used in HRT. Unfortunately, at least here in the U.S. it is not approved for use in HRT so I think insurance will not cover it and it can get quite expensive.  Why it is not approved, I have no idea. Doesn't make any sense to me!

[lifeatfifty]

Katia & Weathergirl.
I haven't received the prescription yet so not sure what the progesterone cream/gel is yet, but will update once I do.

I have used Progesterone cream in the past which was prescribed by a homeopath. Then the pharmacy stopped supply so she recommended Source Naturals which had the same %progest and was available on the internet - this is an American brand.

I used this for a number of years in my mid 40's in the second half of my cycle. I actually found this was very helpful with stress incontinence after I ovulated!

[Katia]

Lifeafterfifty, did the gel come from the GP/gynae or is it from a health shop?  I wondered about putting a Utrogestan into some cream and using it that way to see if it had less side effects, but I imagine it would be unclear if it would absorb, or how much of it absorbed.

Weathergirl, I believe it's not licenced for use in the UK for HRT either.  There is a thread on it where some ladies get it off licence. I'm looking to move back to the states.  you may have more progesterone choices than in the UK.

[Katia]

I came across a link in a thread yesterday which is about varying the dose of estrogen and progesterone not in accordance with how your cycle would naturally be. I can't for the life of me find the thread now, but it seemed an interesting idea.

[Jenna]

It's earlier on in this actual thread Katia - at the beginning of the lengthy post (4th July) from lifeatfifty. This is part you are looking for:


"Shortie - here's a link to the Wiley Protocol http://www.thewileyprotocol.com/about/
              Basically your estrogen is increasing over the first half of the cycle with it peaking, as it would in nature, at midcycle. You are given tailored
             doses to take on each day and if you don't know when your last cycle was you follow the cycle of the moon!

             I did ask my doc about this and she said she wasn't keen as the levels of estrogen taken at mid-cycle are huge (exactly as a 20 year old girl
             would).
             I have read many interesting reviews with woman saying how fit they felt. The premise is that you need the peaks and troughs to turn on the
             estrogen and progest receptors in the brain to trick it into remaining in homeostasis and the body healthy."

[lifeatfifty]

Hi Katia,
my cream was prescribed by a homeopath who was also a registered GP.

As mentioned there are creams available. Have a look at https://www.johnleemd.com/  who pioneered low dose progesterone in a bio-identical form.

However many "Uzzi Reiss" and many other 'experts' feel low dose is not enough...................so like everything there are complicating views.

I have used this in the past https://www.healthmonthly.co.uk/source_naturals_natural_progesterone_cream.

Hope that answers?

[Hurdity]

Lifeafterfifty, did the gel come from the GP/gynae or is it from a health shop?  I wondered about putting a Utrogestan into some cream and using it that way to see if it had less side effects, but I imagine it would be unclear if it would absorb, or how much of it absorbed.

Weathergirl, I believe it's not licenced for use in the UK for HRT either.  There is a thread on it where some ladies get it off licence. I'm looking to move back to the states.  you may have more progesterone choices than in the UK.

Katia - I sympathise with your struggles with utrogestan ( I am feeling very tired this cycle - I'm on Day 6 now) please do not put your Utrogestan into a cream because you're right - it will  probably not protect your womb when used like this! Even progesterone creams from compounding pharmacies (as mainly in US) are not standardised nor consistent enough for this purpose.

Hurdity x

[weathergirl]

It's a bummer that the OTC progesterone creams (Pro Gest, Smokey Mountain Naturals, Life Flo, etc) do not provide enough protection for those on exogenous estradiol via HRT.   
In the US there are compounded hormone creams but they're expensive, not covered by insurance, and potency unfortunately cannot be guaranteed, even though there are some very reputable compounding pharmacies that have been trusted by patients for years. 

If I were using compounded formulations, I would insist on regular uterine scans for testing as well as full hormone level testing.  On top of that, the potency can vary from batch to batch as it is compounded in smaller batches.  My doctor, who is generally, very open to most suggestions, does not advocate the use of any compounded hormones (at least in the U.S.) as they are not regulated and do not go through rigorous, strict testing.   I queried a compounding pharmacy on this and they told me that they do not even submit all batches for testing.  They are only required (at least in the state where I live) to submit a given batch quarterly, or thereabouts, for testing.  It just did not sound regulated or controlled enough to allow confidence.

Hurdity, I'm on day 10 of my Utrogestan and am tired, sluggish and my digestion seems to come to a crawl....ugh.   Will be so glad to be done with this cycle!!  You have my full sympathies!

Katia, hmmmmm.....there are no more options for gestagens here in the US than anywhere else, at least I don't think so.  We have natural progesterone (Utrogestan), the IUD (Mirena, etc), Provera (and mini pill), etc.  I'm not aware of better or more superior solutions here than what you have in the UK......