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[karin]

hello wonderful women!
I'm about to start month 3 on  Evorel sequi patches and as I've mentioned, I'm finding the progesterone part tough going. Emotional symptoms have abated which I m so pleased with but I'm getting nightly  insomnia and I also seem to have suddenly shed a lot of head hair. To be honest I'm in the edge of stopping and taking a few months out to rethink my personal position on HRT- my GP is supportive of any decision but not terribly forthcoming with solutions. Thing is, If I stop the patches will I trigger more hair loss or will the lack of progesterone start to slow down the loss? have any of you had a similar problem and did you mange to overcome it> thank you x

[Hurdity]

Hi karin

Here is some information on the different progestogens:

Progestogens which can be used cyclically are of 3 main types:

    Testosterone derived - Norgestrel, Norethisterone acetate and Levonorgestrel.
    Less testosterone related - Medroxyprogesterone acetate(MPA).
    Least testosterone related - Dydrogesterone and Micronised progesterone (Utrogestan).

Side effects are often experienced during the progestogen phase of treatment and can be reduced by using a product containing a different type or route of progestogen.

http://www.menopausematters.co.uk/perimeno.php

You will see that the type you are on is testosterone derived which I understand has an androgenic effect which can lead to or exacerbate hair loss.

Unfortunately both the HRT patches contain a testosterone derived progestogen (Femseven contains Levonorgestrel) so if you want one that isn't you can only take Utrogestan - which is micronised progesterone (mostly taken orally) - and is the most "natural" ie identical compound to our own progesterone.  You would use this with oestrogen only patches. This is the regime I am on.

Is the insomnia affecting you are any particular point in the cycle? Most women find that HRT helps with insomnia if only because it reduces night sweats - but some progestogens also affect the bladder so increase nocturnal bladder emptying which doesn't help with sleep!

Hurdity x

[karin]

Thank you Hurdity
I sleep beautifully until about day 3 of the progesterone added patch, then its 6-7 nights of not being able to drop off. bladder-wise no problems and also the sweats are pretty well gone, but I must admit to being upset about my hair. I had hair loss issues 3-4 years ago but managed to stabilise it with iron supplementation, but within about the last  3 weeks ( literally between photographs! ) my scalp is now peeping from every angle. add in weight gain and I'm not sure if the benefits outweigh the disadvantages personally. I realise I've probably got used to the flushes going and that will be a shock to have them back, but I'm at an impasse. I have never wanted to take HRT orally. Can you or others advise? Does anyone take anything herbally or otherwise which helps increase oestrogen ( which my body likes) but doesn't contain progesterone ( which it doesn't!) I know HRT - WISE I need both as I have a uterus 

[Hurdity]

Do not despair!

Like you I have always been nil-by-mouth for my HRT - and wanted to get it into my body by the most natural route, and not having to deal with by products from going through the liver.

I really do suggest you try oestrogen patches  - I use Estradot because they are so small and stick well - but if you want to keep with what you know for the moment go for the Evorel 50. For the progesterone ask for Utrogestan capsules (possibly in the doc's book as micronised progesterone). You would take these for 12 days per month. Hopefully you would not get the same insomnia - norethisterone in the Evorel can cause all sorts of unwanted side effects in some women. Progesterone has more of a sedative effect for many women.

Unfortunately the correct peri-menopausal dosage of 200 mg Utrogestan has been discontinued but you can still get 100mg capsules so you just need to make sure they know to double up the quantities on these.

Only oestrogen replacement will help with the problems you describe - and in any case if there was something that increased oestrogen sufficiently to eliminate symptoms then it would have an effect on the uterus and progesterone would still be needed.

Hope this helps and good luck with the doc!

Hurdity x