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[SueLW]

Hello

I've been taking various forms and doses of BHRT for about a year now.  Never quite managing to catch and keep the elusive rare moments when it all works and I feel good.  Most of the time I don't feel good.

I recently switched to the oestrogen patch, which I do really like.  It has stopped all the up and down roller-coaster emotions.  But my levels remain low on the 50mcg patch and my doctor is worried that my progesterone levels just don't want to come up with creams or even with the lozenge I have been using.  So she gave me Utrogestan to try and told me to up the patch to 75mcg which I did.

It took just 3 nightly tablets of 100mg to turn me into a weeping, suicidal zombie.  I was not expecting that at all.

Day one I felt very tired and ill.  Day two I was lethargic and finding it hard to do anything.  Day three was off the scale - just couldn't do a thing.  Not even read.  I just stared at the floor or the wall or cried.  I took no more after that awful day.

Has anyone else experienced this?  It seemed so extreme.  it also made me bleed and feel anxious and agitated.  Almost the opposite of what everyone says this medicine can do.  I'm not sure how the increase in eastrogen patch affected things either.  I came off the progesterone and reduced my patch back to 50mcg as I needed to return to a point of stability.

I would love to hear what others have experienced with  this drug and how they got around it if they too were zombied like me.  I don't know what to do next.

[Mary G]

SueLW, a lot of women have horrible side effects with Utrogestan and synthetic progesterone.  How did you take it, vaginally or orally?  I find it has fewer side effects when used vaginally and it also works better at lining clearance when used in this way. 

You are on quite a low dose of oestrogen which might not have helped because the Utrogestan would have lessened the positive effects of the oestrogen and caused the low mood. 

Are you progesterone intolerant and how well do you get on with the synthetic progesterone products?  I can't take them at all but perhaps you would tolerate them better?

I take as little Utrogestan as possible and often increase my Oestrogel dose to try and compensate for it during the part of the cycle. 

[SueLW]

Hello Mary G

I took it orally as prescribed.  It was supposed to be taken continuously!

I don't think I'm progesterone intolerant because I've not had any issues with the creams and lozenges, they just don't seem to absorb well enough.

I had a Mirena coil for many years until about 2 years ago.  I did have side effects from that, not that I realised it at the time.  I don't want to go back to a synthetic progesterone.

You think my oestrogen patch is a low dose at 50mcg?  But I had actually increased it to 75 at the time I tried the progesterone caps.  I'm perimenopause evidently even though I've not had a natural period since the Mirena coil was removed.  My own oestrogen is still spiking which is undoubtedly making things worse for me.

One thing I just don't understand and can't seem to find clarification on is, what makes use bleed on HRT?  Is it too much estrogen or too little or too much progesterone or too little?  I'm trying to be period free, continuous BHRT.

[Mary G]

If you didn't get on well with the Mirena coil, then synthetic progesterone is not a good idea for you.  I had a Mirena coil too and always had breast pain and relative low mood but once menopausal, I started having silent migraines so I wouldn't have another one either!

If you are progesterone intolerant, continuous combined HRT is something of a challenge.  None of the progesterone products used in HRT are anything to write home about and nowhere near as good as the oestrogen products available.  They all seem to have side effects and although Utrogestan is closest to the type of progesterone you produce yourself, the end product is not the same and the dose is too high for some women even at 100mg. 

Re bleeding, if you take progesterone all the time, it keeps the womb lining permanently thin hence no bleeding but if you use HRT cyclically, the womb lining builds up during the oestrogen only phase and needs to shed so once you stop the progesterone phase, you get a bleed, there is no way around that unfortunately.

This is a difficult one and a problem many women face - progesterone is the achilles heel of all HRT preparations.  If you don't get on with any of the progesterone products available, you might want to try using Utrogestan vaginally for a few days each month and see if you can put up with a monthly period.  There are fewer side effects when it is used vaginally and you can get away with using less of it because it is localised and works better at lining clearance/thinning but I can't promise you won't have any side effects at all.

I take 100mg Utrogestan vaginally for 7 days but I do have regular uterine scans to make sure everything is OK.  This could be an option for you to run past your doctor?  I don't have a choice, it's either that or a hysterectomy for me. 

[soniad]

You think my oestrogen patch is a low dose at 50mcg?  But I had actually increased it to 75 at the time I tried the progesterone caps.  I'm perimenopause evidently even though I've not had a natural period since the Mirena coil was removed.  My own oestrogen is still spiking which is undoubtedly making things worse for me.

Hi Sue,

One thing I have discovered through reading hundreds of forum posts from this website and others is that it's not uncommon to feel WORSE when you start hrt or when you change your existing doses. Remember, you increased your oestrogen at the same time you started the progesterone so it may not actually be the progesterone alone that is causing the problem, but the change in doses.

The general consensus is that when you change your dosage (or switch from one type of oestrogen/progestin to another), to give it at least 3-4 weeks for things to settle.

Still, I totally understand your feeling of desperation. When we feels awful we just want it to stop don't we?

I wish you all the best and hopw you find a solution.

[Dana]

A 50mcg patch is not a low dose. It is regarded as a medium dose, and a common dose used in post-meno. 75-100mcg would be regarded as higher doses.

It's a good idea not to make too many changes at the one time because you won't know what's causing what.

Estrogen is sometimes difficult to get right because having too little or having too much can give the same side effects. Give yourself a bit of time on the 50 patch to see if things settle a bit. Then you can tackle the prog, knowing that whatever symptoms you get won't be caused by the estrogen.

[Mary G]

SueLW, the only way to find out if you are getting enough oestrogen from the patch is to have a blood test.  This is what I did (several times) and it confirmed that I was not getting anything like the right level of oestrogen from it.  In theory, a 50mcg patch is the equivalent of 2 pumps of Oestrogel but, in my case, it is nothing like the reality.  I get far higher blood oestrogen readings from 2 pumps of gel than I did from a 100mcg patch let alone the 50mcg patch and I feel a million times better with no menopause symptoms whatsoever.

From my experience, if you are constantly suppressing that level of oestrogen with continuous progesterone, you will probably have side effects. When I used a 50mcg patch with a Mirena coil, it was so ineffectual, I might as well not have bothered and the 100mcg patch was hardly any better.  I think the Oestrogel might have worked better with the coil but I didn't get the chance to try it and would no risk it now because of my migraines.  I did try a continous combined regime of oestrogen patches and Utrogestan and failed miserably.

I can only give you my own personal experience from the many different combinations of HRT I have used.  I have only ever felt good on high doses of oestrogen and very bad on high doses of progesterone but of course you could be different.  You need to find out what makes you feel good but I does sound like you could be progesterone intolerant.  I am intolerant to all types of synthetic progesterone and to high doses of Utrogestan but not my own progesterone - I never had any problems with PMS or periods so it doesn't necessarily follow. 

[SueLW]

Thank you ladies. 

I'm still puzzled over the bleeding though.  I am using the 50 patch and taking a compounded progesterone and testosterone lozenge twice a day, plus a squirt of progesterone cream.  So I still don't understand what is making me bleed.

My last blood test, a few weeks ago, showed my oestrogen level was low (hence trying to increase to 75mcg) and my progesterone was also low.  I've gone back to the 50 patch and feel better in myself today, but still bleeding.  My hormone doctor says "stop everything until the bleeding stops" but if I do that I go completely crazy.

I realise I made a mistake increasing the patch and starting the Utrogestan at almost the same time.

I had one wonderful day after stopping the progesterone capsule.  The Monday after the weekend from hell.  I felt great that day.

I have tried the gel, but my doctor was telling me to use just 1/2 squirt a day.  I understand that they start low, but that seems very low.  It made me feel very up and down all the time.  The patch removes that up and down feeling.  I just need to stop the bleeding somehow.

[dangermouse]

Oestrogen stimulates the lining to build and then progesterone supports and nourishes it and stops it from breaking down. Once progesterone levels fall, after pregnancy hasn't occurred or when you stop taking it, the lining falls away and you bleed.

Hence, it must be that the progesterone is too weak against the stronger oestrogen, especially if you're having natural oestrogen surges on top of the patch.

[Dana]

Compounded progesterone (either lozenges or cream) isn't recommended to be used as part of an HRT routine where you have to oppose the estrogen. It's simply not proven to be effective or strong enough to protect the uterus. Certainly keep using the estrogen patches, but no medical or menopause authority will endorse the use of compounded progesterone for uterine protection.

[peri]

I've never heard of the testosterone lozenge SueLW where did you get that from and have you had any side effects with it?x

[Dana]

It will be a compounded testosterone.

[Hurdity]

Hi SueLW

 

I presume you are not in the UK because you are not taking a standard type of HRT and certainly not recommended by NHS? As Dana said - compounded stuff and especially progesterone is not recommended for endometrial protection. You can get all you need from your GP (or equivalent in US/Aus wherever you are based) - as estradiol (tablet, patch or gel) and micronised progesterone capsules. These are bio-identical in exactly the same way as so called (and much hyped) "BHRT" - which is a commercial con! I have almost only ever used "BHRT" - but not in the way it is sold in US/Aus - all my bio-identical hormones are on NHS. Testosterone gel can also be prescribed by your doc (in UK) for libido although this is unlicensed. Some women have to go to private doc first for prescription but then can get the actual medication/hormones on NHS.

I must say the instructions from your doc sound really weird - squirts of this and that here and there - I would defo go to a regular gynae/GP and get proper prescription of HRT as above ie either gel or patch + micronised progesterone (Utrogestan) - but not available in Aus I don't think.

When you say you haven't had a natural period since Mirena removal - what HRT have you been using since then? If you have been on HRT you don't know whether you are peri or post-menopausal.

If you are still peri then you will get bleeding on a continuous combined HRT especially with low dose progesterone, so would be better off with cyclical prog and regular withdrawal bleed.

Hurdity x

[andius]

How do you know that it wasn't the increase in estrogen from 50 to 75 that caused your symptoms?? Too much estrogen makes me feel like a slug and I get weepy too.

Could you possibly try a prog capsule 1 night on 50 patch and see what happens?

Too much estrogen can make you bleed. If you are perimenopausal 75mg could have been added to a natural estrogen spike from your body.

The bleed from Progesterone comes after stopping it...hence withdrawal bleeding.

[Lizab]

Beginning estrogen patches and again when bumping the dose I felt weird and drugged to the point that I backed off too, but when trying again a few days later I didn't get any side effects. Progesterone also took some getting used to. At first it was nearly unbearable, with time it only made me sleep well, and now it doesn't seem to affect me at all. I don take it daily though, so I can imagine your worry about having to deal with the effects on a permanent basis. I only had to focus on getting through the 10 days each month. I think some of us(most of us on the forum?) are super sensitive to hormonal changes, but if I were you I would give it more than 3 days to level out, changing one thing at a time as others have said.