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[SusieJ]

Hello All

I joined this board in the hope that you can offer me more insight than my doctors! Many apologies for the length of what follows, but as you'll see - this is rather complicated!

I am peri menopausal, in my early 40s, and single. I've been on HRT for a couple of years and like many here have struggled with progestins: I didn't cope well with Elleste Duet, switched to Femoston 1/10 (sequi) for 18 months which was OK but led me to have uncomfortable physical side effects (bloating, cramps, etc) and a slightly depressed mood. I was seen in a specialist menopause clinic and prescribed utrogestan and oestrogen. I was really optimistic about this being the ideal solution. But - after just two days of taking 100mg Utrogestan at bed time, I felt nauseous, exhausted and dizzy all day. By day four I was completely sedated: disconnected, no memory or concentration. Work became impossible - I had to lie down in a meeting which would have been embarrassing if I wasn't too stoned to care! I lasted seven days before realising it wasn't getting any better.  However, despite all this I felt physically better than I have done in years which is so frustrating as it suggests that the Utrogestan is a good match in other ways. My doc told me to stay off the utrogestan for a few weeks, then try again. I've now started again. Again, after two days I was suffering with exhaustion, dizziness, blurred vision. I decided to take utrogestan vaginally instead, which I have done for the last two days: I still feel tired and not quite myself but a bit better. So - I'm now wondering about whether this is sustainable and can work with my life, and would be so very grateful for your advice.

Firstly: I'm really worried about how the vaginal route will disrupt my life. I'm young (ho ho) and single and need a sex life! I can imagine this being easier to negotiate if you're in a stable relationship - but what if you're not? Are any of you in this position, and how do you manage it?

Secondly, do the side effects of utrogestan get any better? I persisted for seven days the first time because I hoped like other forms of HRT the side effects would lessen, but they just seemed to get worse. Should I give it longer? Do you build up a tolerance to this stuff?

Again, I'm so sorry for the length of this - but any advice/experiences would be so gratefully received. Looking at the sparse bit of medical guidance available I sometimes think that the assumption is that women who take HRT do not have sex lives - or any kind of lives...

THANK YOU so much all!

Susie

[CLKD]

   you need some HRT cover to protect heart and bones ……… have a read of the menus, top of screen and I'm sure that someone who is taking HRT will be along with advice! 

[SusieJ]

Hello CLKD

Thanks - yes, I've been taking HRT for over two years and will continue to do so. Any advice on the issues relating to utrogestan would be hugely appreciated!

Thank you again

Susie

[CLKD]

If you use the 'search' button you'll see the relevant threads 

[SusieJ]

Hi there
Yes, I know the forum well and I am very well aware of how it works. I have read all the pages very carefully over many months and am very grateful for the experiences of others which have been very helpful to me. However I haven't found the answers to the two questions I have raised here. (I've also read every academic paper I can find and have a relatively good understanding of the research). I've been really struggling to find answers to the questions which are affecting my life so severely and as the real experts are the people here who are so generous with their experiences, I would be hugely grateful if anyone could let me know how they have experienced these issues - do the side effects wear off? And if you use the vaginal route, how do you manage this in your everyday life?
   
Thank you very much!

Susie

[Night_Owl]

Hi SusieJ

Sorry that you're struggling with the Utrogestan.  Some of us do struggle with it.  A lot.

I can only relay my experience of it and taking HRT for c. 8 years - as we know, we're all different - I'm what is known as 'progesterone intolerant' (and attend a menopause clinic) so my view is from that perspective.  Hopefully others who have better experiences will comment too.

Firstly: I'm really worried about how the vaginal route will disrupt my life. I'm young (ho ho) and single and need a sex life! I can imagine this being easier to negotiate if you're in a stable relationship - but what if you're not? Are any of you in this position, and how do you manage it?

Is this something you can discuss at your next appointment.  No denying it, v-route is going to be somewhat inconvenient in a new relationship, especially if Utro oral route is worse for you.  Not sure how v-Utro would affect a condom - or if inserted after intimacy, would it be as effective.  All questions for the clinic.   I hate Utro and struggle to take it, v-route at about 7pm, trying to avoid the inevitable grogginess / sedation the next morning, when I take it later than this I'm much worse the next day - so I'm on a tailored long cycle low dose regime and only take it every 6 weeks, 100mg x 12 nights - during this time, intimacy is avoided.  I met my partner when I was about one year into early-ish meno and tearfully spilt all the beans about it after about a month - fortunately he didn't run off.  At the time I was on Evorel Sequi patches - the progesterone in those patches norethisterone is evil stuff.

Secondly, do the side effects of utrogestan get any better? I persisted for seven days the first time because I hoped like other forms of HRT the side effects would lessen, but they just seemed to get worse. Should I give it longer? Do you build up a tolerance to this stuff?

Just my experience.  No.  The side effects are rubbish and get me every time.  By day 7, I usually get a migraine too, just to add to the mix, nice.  Also feel cr@p when I come off it too, takes a week or so to normalise and get it out of my system.  I start off sort of okay - then by day 4 the rot sets in.  Exhausted, dopey, vile mood, depressed, snappy.  Progesterone interferes with neurotransmitters, even if taken v-route.  This must be due to the cumulative effect.  There has been much discussion about side effects on here - try searching 'progesterone intolerance' top, right hand side box.  When I use it, it's always bad, just sometimes much worse!  I've never developed any tolerance to it. But that's just me. Some women are fine on it and take it every day.   In the past I tried the full spectrum of progesterones available and each time the result was the same - intolerance - eventually I came back to Utro again as it's the least androgenic (kinder to hair).  When, I've been particularly bad on the Utro, I may miss one night then continue but still take the full 12.

Sorry not to be more positive or have solutions - just saying it how it is. 

I hope you can find a way forward, it's all trial and error in this HRT game.

When is your next review appointment at the meno clinic?

[Night_Owl]

ps - when I'm on the v-Utro 100mg (every 6 weeks - so I do have a substantial gap, 'estrogen holiday') I do try and take extra care of myself with diet, exercise (brisk walk), drink more water, good quality vits, magensium, inositol etc etc - just to try and support my poor bod in the onslaught.

Just a thought - Utrogestan contains soya - are you you okay with soya re: allergy?

[GypsyRoseLee]

Hello

I am on my first month of Estradot patch and 200mg of Utrogestan taken orally. Just finished my 12 days of Utrogestan and waiting for my first bleed now. Luckily I didn't seem to react much to the Utro, possibly more sleepy during the evenings but this was good as I had nasty insomnia before starting HRT.

Anyway. Just had a thought regarding using it vaginally whilst also trying to have a sex life.

If you have sex during the day through to early evening (not constantly obviously) then you could just insert the Utro at bedtime. No issues. If you have sex at bedtime, then you could always douche afterwards to remove any semen, and then insert the Utro?

[Kittyjay]

Hi SusieJ- I read your post with interest as Im similar age to you and take 100 utrogestan nightly vaginally (for 6months now) and the worst side effect for me too is massive massive tiredness....i do think using it this way may reduce the nausea etc you mention though - fingers crossed for you!! Re sex ... If i know I'm going to get lucky  then I take the utrogestan orally just for that night. I know its not ideal and does kind of take spontaneity out of intimacy but it's an option!

[Cassie]

Night Owl on that routine, do you have to get checked out regularly to see how your uterus is looking?

[Night_Owl]

Hi Cassie - Yes, I have twice yearly endo scans - all has been okay for some years now.

I'm on a very low dose of estrogen - HALF of 25 Estraderm patch (the lowest dose patch, cut in half) twice weekly - and Vagifem 10mcg twice weekly.  Utro every 6 weeks, 100mg x 12 nights.  Reason for extra caution is that I had endo build up in the past on this low dose.  I have only have partial symptom control on this low dose estrogen - but if I went higher then I'd have to take more Utro - when I was on higher in the past I didn't have that much better symptom control - plus as I'm now 8/9 years post meno, I don't want to be on an artificially high dose, as one day I would LOVE to come off and never have to take Utro again!  Other advantage is that on Utro withdrawal I don't have major cramps / bleed on withdrawal of Utro, as I did in the past on 50, 75 and 100 patch.  It's not a great regime and others wouldn't consider it as the dose would be too low. 

Do you take Utro, Cassie?

I wonder how SusieJ is doing on the Utro ....

[Hurdity]

Hi SusieJ

 

I don't think I can be of much help even though I have been using Utrogestan for 3 1/2 years and only vaginally - because I have been in the same relationship for 38 years and have no libido whatsoever so intimacy occurs rarely! I take it 12 nights per 5-8 week cycle (usually 6-7) and it is easy to avoid the act during this time! Sometimes it has taken place after insertion of the utrogetsan but no untoward bleeding occurred. I wouldn't think it was sustainable long term though if you wanted to indulge fairly frequently especially in a new relationship. It might be OK to insert it after sex though but some of the prog may trickle out along with the semen. I can't imagine wanting to douche though  !!

In terms of side effects - it does seem to vary for me slightly each cycle. Sometimes I don't notice it until about Day 5 and then get progessively more tired/fatigued and foggy headed. Sometimes get a migraine. Last time I got a migraine quite early on after 2-3 days. I don't seem to get withdrawal migraines (ie after stopping the utro) like I used to when taking progesterone pessaries ( Cyclogest) some years ago. Sometimes it doesn't affect me hugely apart from a bit of tiredness. I always need to pee more in the night while using it vaginally. I don't think you build up a tolerance to it - you just have to grit your teeth and bear it!

If you are under a specialist menopause clinic then you could perhaps negotiate a shorter progesterone course per month in return for their agreeing to monitor your womb lining ( ie scan) annually to ensure it doesn't thicken? As with Night_Owl some gynaes will greatly vary the standard regime for progesterone intolerant women.

Hurdity x

[SusieJ]

Dear All

I've been away for a few days and just found all your lovely, helpful and supportive messages! Thank you all so very much - I can't tell you what a help it is to hear all your experiences, even if they are horrible ones.

Night_Owl, it sounds like you've been having a really tough time on this (and Hardily, you too...) and I'm so sorry - but actually I find it really reassuring to know. My GP has no experience of utrogestan and all the papers I've been able to get hold of about it say that it has minimal side effects and is really well tolerated, and causes no tiredness the next day! I was starting to think that I was making it up, or making a fuss and I can't tell you how much it helps to know that I'm not the only one going through this. It's also useful to know that this isn't something that simply gets better, as I need to decide whether I can put up with it before it takes up huge amounts of my life.  Sadly - it is the HRT as I'm fine with soya (but thank you for thinking of this). I think your suggestions of seeing if the clinic can do anything more creative is a really good one. The last dr I saw there wasn't exactly brilliant (she was a very new trainee and got all my prescriptions wrong...) but I've now made a new appointment and asked to see someone with more experience, so we'll see. I'll keep you all posted on what they say...

And thank you all for your honesty about how you manage a sex life with the vaginal route. Kitty jay - I'd thought I might do as you do as well, and it's good to know this has managed for you so far. I've always wanted to take oral HRT for just this reason and I am wondering whether it might be a deal breaker for me and utrogestan. I also wondered whether it's safe to use it vaginally if you have a partner - very possibly a stupid question, but do you know if your partner can absorb it through their skin if they come into contact with it? I'd want to know all the risks on both our behalf...

I'm back at the clinic in 10 days time and I'll let you know what they say. I am still holding on to the hope that there's a perfect solution...

Until then, THANK YOU all again so much for all your help and honesty. It has helped me so much.

Susie J

[SusieJ]

PS: Oh dear - so sorry: Hardily = Hurdity. Autocorrect strikes again! xx

[SusieJ]

Hello All!

An update. I'm just back from the specialist menopause clinic and saw the top consultant there. She was really thorough - and very clear: and there are no easy answers...

The key message was that most women seem to tolerate utrogestan better than any other progestin, and for someone who is sensitive to it like me it is worth persisting with. She thought I might not be on a strong enough dose of oestrogen (I'm on 1mg) and that upping it to 2mg might make a difference to the effects of the utrogestan, but suggested changing only one thing at a time - which is sensible. She said that women really vary in their response to utrogestan, and in whether their side effects wear off or not. She said that women often feel tired for all kinds of reasons during the menopause and it's difficult to untangle what is caused by the drugs -  I found this a bit annoying, as it's quite clear to me that it's the utrogestan having the effect and it isn't causing tiredness as much as feeling like I've been given a massive dose of sleeping pills! (Sometimes I feel my doctors think I am a bit dim and don't actually know the difference between normal tiredness/ stress and sedation/ massive chemical mood swings....)

But she was also very relaxed about playing with the dose a little. She wanted me to take at least 200mg for 14 days every six weeks on the whole (or for 12 days if I'm taking it every four weeks), but that I could manipulate my cycle and make it slightly longer or shorter according to what is going on in my life - she said I could take it for 14 days  even every eight weeks on occasion if there's something big coming up at work where I can't risk being exhausted. The increased risk is so small in my case not to be significant (though of course everyone is different - I have a very low risk family history and lifestyle, and others may have different advice...). She also said that utrogestan isn't licensed for vaginal use in the UK but she was happy for me to take it this way if it caused fewer side effects. The dose is slightly stronger if taken vaginally, but not enough to make a significant difference. She said I could swap about using different routes during a cycle if I wanted to.

So: I felt quite reassured that it might, possibly, perhaps get better... I also liked the idea that I could be a bit more flexible with it than I thought. So I feel determined to stick this out for a bit and see if I can make it work... I'll let you all know!

In the meantime, I just wanted to say thank you again for all your understanding , advice and support. You are all amazing!

Susie