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[Mary G]

GPL, I am with you all the way on this and completely agree that the progesterone part of HRT is over prescribed.  When you are intolerant to synthetic progesterone, it is horrendous and the side effects are life ruining and unless you have experienced it yourself, it is difficult to imagine just how bad it is. 

It is actually impossible for all women to need exactly the same dose of this progesterone, it just doesn't work like that, nothing ever does.  If you lined up 10 post menopausal women, all without underlying health issues, and gave them all identical amounts of oestrogen and synthetic progesterone/Utrogestan, they would all have very different levels of symptom control, side effects, levels of oestrogen in their blood and different womb lining measurements.

Like I said before, if the bar is set too high, women will either cheat (done it myself loads of times) and skip part of the progesterone dose or come off HRT altogether and then face a whole host of other health problems.  The only way round it for those who are severely intolerant to synthetic progesterone/Utrogestan is to take a low dose and then arrange to have a scan straight after a period - probably best to do a few months before the scan.  That is the only way to find out for definite if you are taking enough and of course there is always a chance that you will be unlucky and need to take more but at least you will know where you stand.  You might have to pay for it yourself but what are the alternatives?

[GypsyRoseLee]

Thanks again Niamh

I never tried Utro vaginally, but it sounds like the best method for someone like me?

I don't expect any regime to be perfect, nothing ever is. But I just can't stand 14+ days of progesterone intolerance like this each month, it's just inhuman.

[GypsyRoseLee]

Thank you MaryG

It's something that has bugged me for quite some time, this 'One size fits all' slap stick approach to progesterone. After all, progesterone is a powerful hormone, with known highly negative side effects for some women (my new GP admitted that certain synth progesterone 'can send women psycho'). Yet, doctors just don't make any distinction in dosage of it.

It just seems ridiculous and incredibly heavy handed. I suspect that thousands of women, who desperately need HRT, give up on it because they just can't tolerate such high doses of progesterone for half the month. God knows what they suffer? Or do they just end up on ADs instead?

There's no point in the NICE guidelines suggesting HRT as the first line treatment for peri mood swings/anxiety/depression, as opposed to ADs - when the HRT itself may well exacerbate these symptoms for half of each month.

If a peri woman is struggling with hormonal mood swings and anxiety then it is very likely she is progesterone intolerant. So dosing her with high levels of progesterone for half the month is just, frankly, stupid, pointless and potentially dangerous.

[Mary G]

GPL, well said and my thoughts exactly.  The guidelines for HRT were wrong for years and have recently been changed so now is the time to look at the guidelines for synthetic progesterone.  A flexible approach is needed together with solutions for women who are severely intolerant. 

[Night_Owl]

GRL, progesterone intolerance is a really big issue for some women (myself included as I'm highly prog intolerant and struggle with taking Utro 100mg v-route x 12 nights every 6 or 7 weeks - it is a real battle mood wise/depression whilst taking it and then afterwards with the withdrawal.  Even on estro only, I'm not that good in terms of a stable, content mood.)

You probably know this:  The Panay Meno Clinic told me that prog intolerance is the main reason women give up on HRT - roughly 20% of women who take HRT are prog intolerant and within that category, roughly 10% are *highly progesterone intolerant*.  In the case of prog intolerant women, they are/were intolerant to their own natural prog, when they produced it, in their fertile lives.  In my experience, GPs don't seem to know much about prog intolerance.

As suggested by the Clinic - a hyster - I would not want to have this just to be able to take estrogen only - there's also no guarantee that taking estro only would be the answer.  Nor do I want the Mirena, for various reasons, apart from the prog intolerance.

You make a really good point - HRT as a first line treatment - but the progesterone only exacerbates the symptoms of mood swings/anxiety/depression.  Vicious circle.

You may find these articles of interest:

http://writehealth.co.uk/hrt-progesterone-intolerance/

http://writehealth.co.uk/hrt-and-me-utrogestan-vs-cyclogest-natural-progesterone/

On this long HRT road, I've often felt that same - I've had enough of trying different types of HRT.

So much trial and error is truly exhausting - you have my sympathies. 

I hope you find a way forward.

[Lizab]

My experience with Mirena (years ago for contraceptive, not menopause) is exactly why the gyne and the midwife wouldn't offer any hrt for me now. They said I was too hormonally sensitive and throwing more hormones in will unbalance me even more. But I had to try something. The Prometrium (Utrogestan) is not too bad for me. The first day or two I wake up groggy, then I'm ok, then I'm bitchy. In some ways I think I'd be better off taking 100 every day instead of 200 cyclical. But then I remember how the Mirena only turned bad for me after about a year when I guess it had really built up in my system. I think I'd rather deal with the cyclical ups and downs of it than deal with what I had from Mirena. Like you, I get a few good days here and there, just enough to remind me that I could feel well and there is indeed something off. Is there a bio identical progesterone cream available you could try?

[Mary G]

Night Owl, that is interesting and Professor Studd suggested I have a hysterectomy.  The strange thing is, I was never intolerant to my own progesterone during my reproductive years and never suffered from PMS but I am severely intolerant to all types of synthetic progesterone and also Utrogestan if taken in large doses.

[Kate50]

I've yet to take my 7 days of the dreaded U lol!  You aren't making it easy! ! Seriously though if this doesn't work for me I will be trying a homeopathic route I have used it in the past and it has worked for me.  It's a case of shedding the lining doesn't have to be progesterone that does it?? Correct me if I'm wrong.

[Tinkerbellj]

Meant to say as well I have beem going to reflexology and can highly recommend. My therapist is fantastic and I really feel it is helping. Def calmer!! Worth a try xx

[Briony]

Agh GRL, I wish I had read this before I pm'd you just now. I'm so sorry to read that you're having a rough time of it again. Your plan does sound really sensible to tide you though.


Re Utro - I had a terrible time when I took 200 mg for 12 days. The withdrawal afterwards was emotionally hideous. However, on 100 mg vaginally for 25 days, I am not aware I am taking it. My only slight concern is that it is affecting my bladder and making me a bit itchy?

Hang in there - not long till you see Annie Evans now x

[GypsyRoseLee]

MaryG it's definitely time that HRT is overhauled to make it more tailormade for individual women, especially the ones with severe progesterone intolerance. But I doubt it will happen because the industry is so male dominated. And to quote male GP I know 'The problem with gynaecology is that women's problems are just so boring'.

Thanks for that.

[Mary G]

GPL, women who are severely intolerant like us can only have tailor made HRT, nothing else will work.  The NHS should be offering regular scans to women who have to seriously limit their intake of synthetic progestins/Utrogestan - they seem happy enough to constantly scan pregnant women. 

There is a definite overlap between Family Planning Clinics and Menopause Clinics and I think they should merge.  With so many peri menopause women using the pill and menopausal women using the Mirena coil, it would make sense to put the two together giving women and joined up service.  These clinics should also offer uterine scans which all women should be routinely having anyway.  HRT should be offered to all women who are approaching menopause and the people administering it need to know what they are talking about so these clinics should have a gynaecologist who can do scans and fit coils etc. 

That was an extraordinary thing for the doctor to say when you consider there are so many areas of medicine where doctors are completely helpless and can do very little other than help someone die a more comfortable death.  A good gynaecologist like Professor Studd makes a difference and changes lives and can have a much more rewarding career than that individual ever will. 

[GypsyRoseLee]

Night_owl thank you for posting that link, it's a real Eye-opener. We just don't tend to discuss how dreadful progesterone can make you feel if you're one of the unlucky ones.

But clearly this is a real issue for many women.

I have been on a couple of blogs written by women who opted for a chemical menopause via prostap injections, because their PMS was so extreme. They had the injections for 6 months and refused any progesterone (just took oestrogen).

They said the results were amazing and life changing.

[GypsyRoseLee]

Hi Briony

You know it's always fatal to ever mention on here that you might be feeling better!

I looked back in my mood diary for last year when I took Utro. I seemed to have only taken it 3 times, for 11 days each time. Seemed to be fine whilst on it, and then only dipping a few days after stopping it. Bleeds were light and no pains, or anything. Symptoms were primarily the sudden very low mood coupled with anxiety. Is that how it affected you?

At least reading back in my mood diary has reassured me that taking Utro shouldn't pose too much of a problem, compared to how dreadful the synth progesterone makes me feel.

It's a wonder that I could have ever felt good whilst on the BCP, but I did do, for up to 3 weeks at a time. I can only think the much higher oestrogen in the BCP did much to combat the synth progesterone side effects?

I would still love to know why, in the end, I reacted so badly after taking the BCP continuously?

[Mother bean]

Hi GRL ,

I want to send you a virtual hug :

Good luck when you see Dr Annie Evans,  you will get on fine with her like I did, she is really lovely. One thing I wanted to suggest to you if  she does recommend the Utrostan that perhaps you split taking the daily dose of 200mg in two, i.e. AM before breakfast and PM at bedtime. I have been taking it like for a long time and find it good. When I took 200mg all together I woke up feeling really tired but by splitting I don't really find it that bad! Good luck sweetie! Ask her about the jittery feeling aswell, why do we get this on waking! Keep in touch!  xxx