Thanks for your replies. Since posting my questions I have been doing a bit more fossicking around and I have also been talking to an American friend who is using Prometrium every day. Her ob/gyn seems to be very bioidentical savvy and has told her she can just continue to take the 100mg every day, without a break. She takes hers orally and feels this is working well for her because it gives her a constant dose without any hormone spikes. She also feels taking it every day has helped a lot with her sleep, because when she was doing 14 days on and 14 days off, she always slept better for the 14 days she was taking it.
It is now 4 days since I stopped the Utro, and I've had my period now for almost 48 hours (it's reasonably light, so it's obviously not building up too much even after 2 months), so I feel I should be able to safely start taking the Utro again. I'm still having insomnia problems, so hopefully taking 100mg tonight will sort that out. Like my US friend, I think I will feel better if I have a consistent dose, rather than experience these peaks and troughs on a regular basis. So I'm undecided about the 3 day break, because on any other conti regime you wouldn't take a break at all, so maybe I'll just take the break every couple of months and see what happens.
I am a bit concerned about potential weight gain from taking Utro all the time. I already have a stubborn weight issue that I can't seem to shift no matter what I do, but I guess if I have to make the choice between insomnia and some added weight, I would prefer the weight...lol...
I'm still undecided about oral vs vag, but I'll start out taking it orally and see how I go with that. I can always switch to vag later on. I must say though that orally seems more convenient. I can just "pop a pill" without having to phaff around, but I guess like everything in life, it's trial and error.
For those interested, I found this info in Dr Elizabeth Vliet's "Screaming to be Heard", which I found very interesting....
I described in chapter 3 how estradiol produced before menopause is one of the primary hormones regulating the brain's sleep centre and facilitating the normal stages of sleep. When estradiol declines, the normal stages of sleep, especially periods of Stage IV deep sleep, are disrupted. So it is crucial for women to have adequate estradiol to regain normal deep sleep and muscle repair, but there are a number of metabolites of progesterone that have potent sedative effects, very similar to barbiturates and benzodiazepines.
Remember the compound I mentioned in chapter 3 called, 3-alpha-OH-DHP? It is about eight times more potent than the sedative methohexital, a potent barbiturate used for anesthesia. The liver provided most of the conversion of progesterone to these sedative compounds, so the sleep-inducing effects of progesterone will be increased if it is taken orally and goes through the liver “first pass†metabolism. So progesterone does have effects on brain receptors that help sleep, by acting like the medications you may already know like Valium, Klonopin, Ativan, and others in this group.
Progesterone's effect on sleep is quite different from estrogen effects, so just taking progesterone doesn't eliminate the need to estradiol to restore sleep pathways, as some books claim. Since progesterone can make you sleepy like Klonopin does, there may be times when it can be a useful addition to hormone therapy even if women do not have a uterus, but this has to be balanced against the unwanted, potentially negative metabolic effects of progesterone that I have discussed elsewhere.
Some of the metabolites of progesterone have greater sedative effects on brain receptors than Klonopin. If progesterone is used to improve sleep in women with fibromyalgia, I find that lower doses can be effective, provided estradiol has been restored to optimal levels. If you have a uterus, however, you and your doctor have to be certain that you are taking an appropriate dose of progesterone for the desired protective effects on the endometrial lining.
