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[Dandelion]

A bit of history first

Sorry for the ramble - I hope it makes sense. I have tried to keep the contents of this post relevant.

I started peri 14 years ago, I am 56, I currently take 25mcg evorel and 200mg utrogestan, 100mg of which is oral, the other, vaginal.

I was put on sequential HRT in 2013.
I've been dependent on diazepam since 2016. I have been weaning off diazepam since 2016 under medical supervision. I was on a huge dose, 75mg, now down to 15mg.

In 2016 when I was still in peri, taking sequential hrt, 200mg orally, on the days I was not on the utrogestan, my mental state deteriorated, badly, I am autistic and had violent meltdowns.
I found the cause of my reduction in mental health was due to the progesterone.
There are ladies on a well known  benzodiazepine support forum who have had real hassle with progesterone, given that it's metabolites act on the GABA receptors, causing chaos for them, with natural cycles and endogenous progesterone and also HRT/Contraceptive pills.

This is not something I would expect my psychiatrist and Gynaecologist to know about, and they didn't, I was only through my own deterioration in mental state, plus the chaos the benzodiazepine dependent women on the well known benzodiazepine forum, plus several on here have had.

I have to keep my GABA receptors as stable as possible, and, so, I have to stay on the utrogestan.
My GP and gynaecologist have been informed about the interaction between progesterone metabolites and GABA/benzodiazepines, as neither consultants were aware.

In 2016, I decided to take 100mg utrogestan daily, without seeing my doctor, and my psychiatric nurse noticed that my mental state improved greatly.
In 2018, I started bleeding though, and was scared to see the GP in case they wanted to change me back to sequential utro as I was peri back then.

After months of bleeding, at the end of 2018, I did notify my GP, who kindly let me stay on daily utrogestan, then referred me to gynaecology to deal with the bleeding, it was then, that I notified the gynaecology consultant of the diazepam/progesterone hassle.
I was on 100mcg Evorel at the time, and,  under medical supervision, I had scans, hysteroscopy, reductions in evorel, and am now on 25mcg evorel, which is not quite enough, I need a fan in bed all year round, I think the lack of oestrogen has made me more anxious and depressed, but no more red blood and clots. 
I have also been in touch with Dr Currie, during this time, and it was she, who suggested I add another 100mg utrogestan vaginally, which my GP and Gynaecologist know about.

I also have other, ongoing, circumstantial stress, since 2010, regarding property and finance, which I cannot do anything about right now.
You know the morning anxieties associated with peri?
One morning, in 2010, I woke with an anxious thought, familiar in peri, about my property fear, and when I "checked-it-out-to-make-sure-it-was-just-anxiety" I found that the fear was related to a real issue.
I did not know, in 2010 I was in peri, it started in 2009. I put the flushes, increased anxiety and depression, etc, down to other stuff as I thought I was too young at 42 years old to think of menopause.

I have a brown discharge on and off for moths, and I have had that much gynaecological hassle, that I can't face notifying them about the discharge, as I am not worried about it being cancer.

My GP seemed less keen on me taking utrogestan vaginally, as it's not licensed that way, Dr Currie suggested vaginal administration, as the progesterone goes straight to the site, to stop the bleeding.

The progesterone metabolites are the only problem in my diazepam taper.
To stabilise myself more, as the progesterone has a shorter half-life than the valium, I would like to start taking one 100mg utrogestan orally in the morning on an empty stomach, and one at night, before I go to bed, I am just a bit paranoid that the bleeding would start up again, given that I cannot take any other progestins, and the gynaecologist said, in September 2021, before the brown discharge started up again, that I would need another hystericscopy, and I am fed up of the inside of my local hosptal, in addition to the property financial stress, as I have been there for other things, and the possibility of having to explain, over again, the progesterone metabolite relationship with the valium.
Going onto all oral utrogestan would be better for me mentally, as it goes through "first pass" liver stage, but going back onto vaginal, would cause mental health problems, because, although vaginal utrogestan still circulates around the body, it does not go through first pass liver.
The gynaecologist and a GP and Dr Currie suggested mirena, from these forums, I see how mirena has lowered mood/libido etc, which I cannot afford, as I am supposed to be an artist/singer/poet, who has not been doing much art/singing/poetry as she might do, given mood mood improvement by favourable change of circumstances and getting off diazepam and ultimately utro and coming through meno properly.

I am just paranoid I would bleed again on all oral.

[sheila99]

What a nightmare, it's so difficult when you don't fit the 'standard mould'. I don't think you should read too much into the mirena experience on here. You could be one of the few with problems but many thousands (millions?) more are happy with it so it's far more likely you will be too. And there's nothing better for sorting out bleeding/thickened lining problems. On the other hand 200mg utro orally *should* be enough. Presumably you are meno now so this is double the dose for a conti regime, but we all know there are some who will bleed even with this dose. I guess it would be a matter of try it and see though I can see why they recommend the mirena.
I don't quite understand why you think changing 100mg to oral will help though? I thought the idea was to wean off it over the long term and this will increase your dose?

[Dandelion]

What a nightmare, it's so difficult when you don't fit the 'standard mould'. I don't think you should read too much into the mirena experience on here. You could be one of the few with problems but many thousands (millions?) more are happy with it so it's far more likely you will be too. And there's nothing better for sorting out bleeding/thickened lining problems. On the other hand 200mg utro orally *should* be enough. Presumably you are meno now so this is double the dose for a conti regime, but we all know there are some who will bleed even with this dose. I guess it would be a matter of try it and see though I can see why they recommend the mirena.
I don't quite understand why you think changing 100mg to oral will help though? I thought the idea was to wean off it over the long term and this will increase your dose?

The mirena coil would mean messing about with my progesterone intake, which I cannot do while addicted to valium, due to metabolites of progesterone and valium being cross tolerant.
I was talking to a woman addicted to valium who ended up bed ridden after trying to come of progesterone, other women have had problems when changing progesterone, for instance, sequi hrt, like me, mental instability when not on it when I was on sequi.

My mood is that low, I find it hard to get out of bed as it is and adding a coil is just too much of a risk for me.

As for taking all oral, I don't understand how that would increase dose, because vaginal utro circulates around the body, unless I am mistaken.
Some women get sleepy after vaginal utro, I don't.

Since making this post I talked to a woman on a well known benzodiazepine withdrawal support forum who is bedridden and trying to taper off the US version of utrogestan, it's called Prometrium over there, she ****ed a hole in the side of the capsule and took a tiny bit out.
Ingenuis way of trying to taper a capsule, I hope they dissolve in oil and I can reduce that way, although the oil would mean greater bioavailability of the utro.
Better than ****ing a hole in it for me though.
Why do women take it vaginally?
I took it vaginally, because, at the time, I thought, rightly or wrongly, vaginal means less chance of bleeds.
I was prescribed 200mg in peri, but as it's cross-tolerant with valium, and I was going a bit nuts on the days I wasn't on it in peri, I decided to take 100 a day, and I bled.
I am undecided whether to take it all orally, I don't want more bleeds.
I have a brown discharge for the last few months at least, which I ignored, as I got fed up of going to and from the hospital with it.
I wish I never started progesterone, but needed it, to offset oestrogen, which I couldn't have managed without, I used to need 100mcg, my flushes were crazy hot, a friend even said I felt "warm" thankfully, I only need 50mcg, but take 25mcg and put up with night sweats, as I bled on 50mcg.
I wish I could just swap a progestin, but seeing the nightmares other benzodiazepine dependent women have had with progesterone, put me off.