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[Sunnydays]

Hi,
Following my recent appt with gynae, I have made the decision to move from Evorel conti patches. Whilst being on a low dose, over the weeks i felt the negative effects of the progesterone outweighed the benefits of the estrogen (I may of course find out later this wasn't actually the case!)

So I have just popped on a 25  mcg Estradot patch (aren't they tiny compared to Everol) and have Provera tablets to take in 3 months time (the gynae said even 4 months would be fine) one 5mgs tablet 3 times a day for 14 days.

Any guidance/reassurance anyone can give about what I might expect using this type of cycle? I wondered if I'd have any withdrawal from the progesterone in the conti regime but maybe its too low a dose?

The gynae was really helpful and has sorted my down below problem but I'm not sure how clued up he is with hrt! He suggested Premarin for the estrogen but I didn't want a tablet and as I'd heard this was regarded as an older one I thought I'd stick with a patch.

Thank you

[Dana]

"one 5mgs tablet 3 times a day for 14 days" - that's 15mg per day which sounds like a very high dose. Is that correct?

I use the 50mcg Estradot patch and I use the Provera on a cycle, and I only take 1 x 5mg per day. I realise that you're going to do a 3, perhaps 4, month cycle, but you are also only on a low dose patch.

Like you, I just had a very unsuccessful trial of using the conti patches, but continuous progestin/progesterone is always my undoing. Prior to that I was doing a monthly cycle with the patches and provera (my doctor said 10 days x 5mg per day is okay), but I'm going to try 6-8 week cycle so I will take it for 14 days (x 5mg per day).

Anyway, I like Provera. I prefer not to use Utrogestan, and Norethisterone doesn't give me a decent enough bleed on a cycle for some reason. I don't seem to have any problems with the Provera on a cycle.

[Dancinggirl]

Dana and Sunnydays - The high dose of progesterone for 14 days is because of the longer cycle.  It is very important that the womb lining is protected, so to make sure it sheds completely this high dose for that long is vital. Provera into not as harsh as the synthetic progesterone in Evorol and if one only has to put with feeling a bit rough for a couple of weeks 4 times a year it's worth it for the good times in between.

Sunnydays - I'm pleased you opted for the patches - much better way to go. Many women seem to do well with Provera so I hope this proves true for you. You are using a lowest dose of oestrogen so you will probably fine but you might find you get some spotting being on oestrogen alone for so long but I wouldn't worry at this stage as I'm sure your gynae will do a scan after 6 -12 months to see how things are.  Do keep us posted about how you get on.   DG x

[Sunnydays]

Thank you both.
Yes he did say 3 times a day. I thought it sounded a bit much but as you say DG it has a job to do. I am going to clarify with him though - ie does the amount of provera change based on a lower dose patch or if I try going just 8 weeks before taking it. I must admit to feeling quite scared about the progesterone phase as if it's going to like a dreaded thing coming up!
Dana - when you say about not getting a decent bleed; how do we know what is decent and not decent?

[Dancinggirl]

Sunnydays - the gynae I'm seeing privately specialises in treating the meno and he warned that trying a longer cycle can cause breakthrough or erratic bleeding.  He explained that it is often the length of time you use progesterone that determines whether the lining will shed properly or not; your gynae has decided you need 5mg 3 times a day for 14 days every 3 months which sounds logical to me.  If you look under 'Treatments' above you'll find the section on progesterones which shows that, used on a monthly cycle, one should use 10mg for 14 days search month - so for you doing a 3 month cycle that slightly higher dose would probably be appropriate.   The amount of oestrogen you use on a daily basis may not be significant but the longer you go without a bleed the more the lining will build up so. 
I think what you are trying to achieve is to have and benefits of the oestrogen with minimal side effects from the progesterone.  As I explained before, Provera is not as hash as the progesterone you were using before so you may find you are fine using it or at least not as bad as with the other, more synthetic, progesterone in the Evorol. I think ou would still need this higher dose even on an 8 week cycle.
It is difficult to determine what is a good bleed or not, that is why a scan is often necessary to see whether the progesterone is sufficient or not. It's all trial and error as we are all different. DG x

[Sunnydays]

You're quite right DG. That is what I'm trying to achieve. I guess having my cake and eat it! I'm always wary of trying different things but the support on here is helpful and reassuring )

[Dana]

Yes, I understand about the longer cycle, but 15mg per day still seems a lot for someone on a low dose. TBH I think that would be too much for me to take, so I certainly wouldn't be considering anything longer than a 2 month cycle. However, if that's what the doctor has prescribed I guess that's what you should take.

Dana - when you say about not getting a decent bleed; how do we know what is decent and not decent?

What I meant was the norethisterone didn't give me the same "quantity" of bleed as the Provera. On the provera I would take it for 10-12 days, and after about 3 days I would get a reasonable bleed for a few days, with a few more days of spotting, but on the norethisterone it seemed to take longer to start, and the bleed never got much heavier than just a few days of what I would call "heavy" spotting which I only really needed a panty liner for.

[Dancinggirl]

Dana - It is very important to share our personal experiences but we are all so different and we each have to follow the guidance of good professionals  - do bare in mind that each progesterone is given in different dosages because they will work in different ways and the positive and negative effects of a particular progesterone will vary from women to women. Using HRT on a long cycle can easily cause problematic bleeding as I have experienced so erring on the safe side and going for the slightly more substantial dose to ensure the lining sheds properly is sensible.
My understanding about the type and length of bleed each women gets will be different.  I am using a very low dose of oestrogen - far less than Sunnydays is using - and I still get a good build up of lining even on a 4 week cycle!!! How we absorb the oestrogen is probably significant - some women really need a lot of oestrogen as they simply don't absorb it well!!! The fact you get quite a light 5 day bleed does not indicate how well your womb lining has shed. I am using Utrogestan and was getting quite a heavy bleed for up to 14 days - which I'd never had before on synthetic progesterones - now this might indicate my lining was shedding better than when I was on the synthetic progesterones but according my gynae this isn't necessarily the case.  I had a scan last month at the end of my bleed and my lining, after 9 days of a good bleed, still had some to shed!!! I think the whole thing is very complex and variable and finding the right balance that will give you all the benefits of HRt whilst protecting your womb lining is quite crucial.

Sunnydays - I can understand your anxiety over the progesterone after your experience with Evorol but I still think you have been given good advice and could find you are OK with regime - well worth trying.  Do keep us posted.   DG xxxx

[Sunnydays]

What type of scan is the scan given to check womb lining? Is it ultrasound?

[Dana]

Dancinggirl - I think you have totally misinterpreted my posts. I have not in any way given any indication that someone should not follow a professional's advice. I merely wondered if the dose was correct, and it is always good to double check to make sure. She doesn't yet know how she will fare on that dose of Provera, and the attraction of having such a long cycle may not end up being worth it - but then again it might, so time will tell.

I also never said I had "quite a light 5 day bleed". I said I had a "reasonable bleed for a few days, with a few more days of spotting". "Reasonable" actually means "reasonably heavy" which is perfectly normal for me, even before meno.

I don't really wish to continue discussing this, as I sense it's going in a strange direction, and I certainly don't want to be responsible for taking focus off Sunnydays' thread.

[Dancinggirl]

Sorry Dana - didn't mean my post to sound so critical - rereading it now I realise it came across in the wrong way. I was just keen not to put Sunnydays off trying what her gynae had suggested.  Looking back at your posts I had misinterpreted things - so again sorry about that.  It is important we share our experiences. DG xxxxx

[Hurdity]

Interesting the discussion about Provera

As may have already been said - the standard dose of Provera is given as 10 mg daily for 14 days out of 28 - although no maximum dose of oestrogen is given for this to be appropriate. If you look at the treatments for peri you will see that Tridestra is listed which has MPA as the progestogen ( I've checked and it is the same one!) - given as 20 mg for 14 days per 12 weeks. This is for a daily dose of 2 mg oestrogen. Interesting that it is only double the quantity!

Oestrogen stimulates the endometrium in a dose dependent manner (more oestrogen = thicker lining) and progesterone works to change the lining also in a dose dependent manner. The amount needed is both dose related and time-dependent as Dancinggirl says. Clearly if you took the total amount in one go it's not going to deal with the lining adequately.

Different progestogens differ in their potency for keeping the endometrium thin and work generally the body in slightly different ways (re effect on other hormones and receptors).

I am sure that if you are in a very low dose of oestrogen you may not need such a high dsoe of Provera ie it is 3/4 the dose of Tridestra but the oestrogen dose is low. Nevertheless I can see why your gynae wants to be on the safe side because long cycle HRT has fallen out of favour with some gynaes because of the increased possibility of endometrial thickening and oestrogen breakthrough bleeding, as well as some increased risk of endometrial cancer.

The best thing to do is try it and see! The point is you will definitely build up some lining in 10 weeks, so a bleed is very likely. This is not necessarily the case for women on a 4 week cycle it seems - as I posted elsewhere the info on here states that 4 week cyclical HRT induces a withdrawal bleed in 85% of women - but not all. The amount of bleed is not necessarily the crucial factor - but the extent to which the progestogen changes and then sheds the lining. If it stays thin then the amount of bleeding is immaterial.

Yes the scan to check the womb lining is initially ultrasound - I'm having one next week! If they want to take a closer look they will do a transvaginal scan - they put the U/S probe thing up your vagina and measure the endometrium thickness. If there are any abnormalities detected (as there were in my case) they will refer for hysteroscopy and biopsy (mine turned out to be a small fibroid but they couldn't tell from the scan).

Good luck with it all 

Hurdity x

[Sunnydays]

Thank you all very much for your posts. They've been really helpful during my 'needy' phase!

I've just re-read my copy of the the gynae letter to the GP and it says
 '...and every 3 to 4 months for 14 days Provera 5 mgs tds...'
Does tds mean 3 times a day?? If not, maybe the GP has got it wrong 

When giving me the prescription, the GP said he was giving me 2 months of Estradot, and when I collected from pharmacy he'd only given me 8 patches - I guess he didn't realise that they are twice a week. Groooaaan!

I've emailed the gynae for clarification, will keep you posted. Now i'm wondering if the dose of Provera will be too low............

[Dana]

Sorry Dana - didn't mean my post to sound so critical - rereading it now I realise it came across in the wrong way. I was just keen not to put Sunnydays off trying what her gynae had suggested.  Looking back at your posts I had misinterpreted things - so again sorry about that.  It is important we share our experiences. DG xxxxx

No problem. Thanks.



Regarding the issue with the dose of Provera, it is quite confusing. In doing some reading yesterday I've seen anything from 5mg to 10mg being recommended, but no actual dose of estrogen seems to be stipulated.

My doctor has prescribed "5mg for half the cycle", although she did say I could probably get away with 10 days seeing as I have an issue with progesterone, and I have been doing that since I started using it maybe a year or so ago. Now I'm unsure if I'm taking enough, although I do get a good bleed on a monthly cycle. I have increased it myself to 12-14 days, depending on how I'm feeling on it though.

Why can't these medical professionals and pharma companies make HRT a bit easier to understand? Next time I'm at the chemist I might check with the pharmacist to see if they can shed a bit more light, because I think sometimes they know more than the doctors about medications.

[Dana]

Just an update - I needed to go to the chemist to get some scripts filled so I had a chat to the pharmacist. She said that the dose that is "recommended" is a bit of a "to be on the safe side" kind of thing and that basically the dose of Provera is quite variable and is going to be very dependant on the woman herself and what kind of job it does. She said if I'm on a medium estrogen dose, and taking 5mg a day for half the month is giving the desired result (ie a good bleed with no negatives like breakthrough bleeding, bloating, spotting etc) then that would be an okay dose for me.

Seeing as my doctor is aware that I'm a bit sensitive when it comes to progestogens, she has obviously gone with this dose and will rely on me to report anything odd. The only time I've had any kind of spotting or breakthrough bleeding is during the 2 months I was trialing the conti patches, which ended up being a fail anyway. When I use the Provera @ 5mg for 10-12 days I've never had any of those issues, although to be on the safe side I will now use it for the full 14 days. I may also try to spread it out to every 6 weeks and just see how things go.

I have asked my doctor in the past about the scans, but she's never been too concerned about them. She said as long as the bleeds look normal (good colour, no clots etc), and there were no other signs like the breakthough bleeds etc, they usually aren't necessary. When I mentioned the scans to the pharmacist today she also said the same thing.

The reason I was being so concerned about the dose that Sunnydays was being prescribed is because she has already said she had progestin issues after using the conti patches. This is exactly the issues I've had too, and I know I certainly wouldn't want to be taking 15mg per day of the stuff. So I just wanted her to be cautious about considering such a long cycle and perhaps needing such a high dose each day.

So anyway I just thought I would post all this to help anyone else who may be a bit confused. Don't take too much notice of what dose others may have to use. Always look at the results you are getting as a guide to what is right for you. I think sometimes we just need to relax a little and go with our gut feelings about things. Sometimes reading a lot of stuff on the internet, and forums like BB, can make us a bit OCD about things. We have to remember that we are all different, and if something is working, and there doesn't appear to be any problems, just go with the flow (no pun intended..lol...). Menopause can be hard enough without making things harder for ourselves by reading too much about things that may never happen or may not apply to us.

Mind you, if the day ever comes when I can either stop HRT altogether, or even reduce the dose, I think I will be a happy puppy, because despite being a big advocate for HRT, and all the benefits it can bring, there can be a big downside too if you have progestogen issues.