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[andius]

 I have been taking oral progesterone 100mg nightly (prometrium) for about 6 mo with a 50mg estrogen patch which is 2x/wk. After about 3 mo I felt that the progesterone was building up in my system with symptoms such as a hangover headache in the am lasting thru the day and maybe some depressive feelings with not wanting to go out or interact with others. Also, I think I get a feeling of  all over itchy,****ly skin related to heat episodes only (outside in sun with sweating and in hot shower) with progesterone buildup that relieves if I cool down. I also have more VA symptoms during patch change day as the estrogen levels wane.

 Since January, I have left off the progesterone for 4 days at the end of the month and used half of the estrogen patch (25mg) during those days. The headache goes away and I feel great on just the estrogen at that time regarding my VA/bladder issues. I always seem to get a really nasty pimple on my face about a week after restarting the prometrium. By the end of the month, the headache and down feelings seem to come back as well as the ****ly skin related to heat exposure, and the more sensitive VA/bladder issues. No other issues taking the prometrium this way. I am 6 years without a period and have never had any spotting or bleeding since even though I have tried many types of HRT, always continuous type since I don't want to have periods.  I have tried 200mg prometrium daily also and all of these symptoms are present all the time.

Last month after 27 nights of  100mg prometrium, I got a blood level drawn before stopping the prometrium for 4 days.  It was 6.2 ng/ml or 19.716 nmol/l. I had taken the prog about 11pm and the blood was drawn in the morning at 10 am. For some reason, I am remembering that a level of 4 or 5 ng/ml (12.72 - 15.9 nmol/l) is needed to prevent endometrial thickening but not sure from where or if that is true.

My QUESTIONs:  Does anyone know what the progesterone level is that is needed to prevent endometrial thickening?

                          Could I possibly just leave off 1 prometrium the night before I change my patch either once or twice weekly instead of 4 nights at the end of the month?

                          Does anyone take less oral progesterone every night than 100mg or does anyone skip doses on purpose regularly?

I do not have the above symptoms when using an equivalent combo patch with norethisterone, but I gain weight and my hair falls out which doesn't happen with progesterone. The estrogen gel seems to amplify the headaches and doesn't last as long (runs out before next dose) as the patch so I prefer not fiddling with it daily.

[elizabeth64]

Hi
My feeling is that you should cycle the prometrium. It's not natural to take P all the time like that.

I only take P for 12 days of the month and I don't get a bleed as I keep my oestrogen (estrogel) fairly low (because I used to have endometriosis and taking too much is is gonna kick that off again)

But E is the cell proliferator, the hormone that builds your body up, thickens your vaginal wall, keeps your skin plump, builds your endometrium, thickens your hair… and P is the hormone that breaks it all down -  breaks down your endometrium, breaks down tumours, breaks down too much hair growth …

so you need the yin and the yang…. build up the E, and then break it down with P

If you are using P all month it is going to be problematic

these are my experiences, hop this is useful in  some way

[elizabeth64]

I use progesterone - USP Crinone, vaginally for 12 days and I deal with it much better that way. I pretty much feel fantastic apart from my too dry lady parts

[Lizab]

I think I agree with Elizabeth that you should talk to your doctor about long cycling with the Prometrium. If I remember correctly, my doctor wanted me to long cycle with 200mg 14 days every 3 months. I opted for a monthly cycle to start, as I had just finished a couple years of extremely heavy bleeding and was afraid a 3 month cycle would give me heavy periods. But if you're 6 years without a period, I don't imagine you would have that problem.

[andius]

Thanks to all for your replies.

I am afraid to use 50mg patch by itself. On days I change my patch, it seems to give me foot/ankle pain, upper back tightness and keeps me awake so I think it may be more than I need.  The progesterone seems to relieve this due to its opposition effects.  When I cut the patch to 25mg and don't take the progesterone at the end of the month for 4 days, I am fine.  If I use 25mg all month, the progesterone is too much for this lower estrogen dose and VA/bladder symptoms come back. Using 37.5mg patch has not been enough with every night progesterone either.

Thus, I think I could probably get away with 25mg all month without progesterone (would be willing to try), but am frightened to use 200mg progesterone for 14 days as to what it will cause with the VA. One doctor put me on 200mg nightly all month with the 50mg patch and I suffered terribly until I stopped it. If I use 100mg progesterone for 14 days, I may not get a bleed on that regimen, correct?? Interestingly, I have stopped the vagifem for the last 3 mo. due to burning the day after I use it and I seem to be fine without it so far. If I drop the estrogen dose of the patch to 25mg, I suspect I may need to start vagifem again which has always caused me problems even though it helps.

I don't see my doctor until mid summer. My daughter is getting married at the end of May, and I plan to keep my correct regime until after the festivities are over as I don't want to have that horrible VA/bladder symptom during this time.

I like the idea of Crinone, do you use the 4% or the 8% gel, Elizabeth?? Stellajane, I am in US and we don't have femoston.  We only have combo products with the androgenic type progestins which make me gain weight and lose hair, both the patch and the pill combos, but I may consider these again after this wedding business is over. What doses of estrogen do you think you are getting with your estrogen?

How I would love to quit everything!  However, last time (2 yrs ago) that I stopped hormones, I was fine for 3 mo, then the VA struck relentlessly and it took 4 mo to get back to a comfortable level. Vagifem was useless as was the estring.  I had to go back on the patch and progesterone to relieve it. After suffering in peri and early meno for years with VA/bladder atrophy with stupid doctors who had no idea what it was, I am reluctant to revisit those horrible years.

[Lizab]

How about the Vivelle Dot at 37.5, with a cycled Prometrium 200mg? If 50 without prometrium is too much, and 25 isn't enough. 37.5 with cycling, maybe long cycling progesterone could work. Also, I cycle monthly with 200mg Prometrium for 10 days. It was a lucky guess that my doctor put me on this, as 10 days does give me a period, but I don't think I could handle taking it more than 10 days. I start to get a heavy-headed dull headachey feeling by the on 9th or 10th day of it. So, you could possibly experiment with a shorter course of Prometrium if your doctor is on board with it. There are some on the forum that take a small dose for 7 days, but go for regular ultrasounds to check for lining buildup. Sorry this is a ramble, I'm sure there's a solution and trying to brainstorm.

[andius]

Lizab

Do you cycle with 200 orally or vaginally?

What about cycling with 100 orally for 14 days....is there anyone on this board that does that?  Of course, that would be with 37.5 or probably 25 patch....I would not want to do this with 50mg patch.

[Lizab]

I cycle monthly 200 mg orally 10 days. I can't remember who else on the board is on alternative doses. If your doctor will monitor your lining and you get a sufficient bleed from 100mg, I'm not sure why you couldn't do that. Maybe Hurdity will jump on here with some actual data about alternative dosages and why or why not.

[elizabeth64]

Hi
Can you do the 50 patch but do 12 -14 days of progesterone?

It is so hard to find the balance. I personally would hate to have 2 hormones in one patch as then you can't adjust just the one.

I am using crinone 8 - we couldn't get the lower one but this is fine. I hated it the first month as it made me so sluggish but now it's fine.

It gives me such a flat tummy! After 2 weeks without it after the first night the next day my tummy is so flat. And I get sexy dreams!

But oestrogen is the hormone to make you sleep. I think the patch can rev you up but low oestrogen is the cause of insomnia in meno.

P makes me sluggish but does not make me sleep.

I find I prefer estrogel as on the patch my breasts swell like crazy, and my tummy, but with the gel I can lower the dose to ease it whereas with the patch I can't . Also the patch gives me such a weir claustrophobic feeling - and the Vagifem did the same - unbearable for me

[andius]

Thanks for all replies. I will be well prepared as to what options I want to try when I next visit my doctor.

As this is the 15th of the month, I am tempted to stop progesterone and see what happens while continuing the patch for the rest of the month...but alas I am too chicken at this time since I haven't spoken to my doctor and my appt. is still several months away.

Also, I really don't want to change things up until after this wedding in late May for fear of new issues developing with new HRT regimes.

I have been reading through the long thread on estrogel and utro. support and saw these references that Hurdity posted a while back which could be of interest to some of you.

Sunnydays I have just copied and pasted some notes I made some time ago from various papers. I haven't re-read them before posting. I'm sure there are others too:

http://www.ncbi.nlm.nih.gov/pubmed/22321028'

Endometrial response to concurrent treatment with vaginal progesterone and transdermal estradiol.
Fernández-Murga L1, Hermenegildo C, Tarín JJ, García-Pérez MÁ, Cano A.
Author information
Abstract
ABSTRACT Objective To describe the effect of the intermittent administration of vaginal progesterone and a low-dose estradiol patch on endometrial stability, as assessed by the rate of amenorrhea and endometrial stimulation. Methods This was an open study in which 64 moderately symptomatic, postmenopausal women were treated in the outpatient clinic of our University Hospital for different intervals up to 1 year. The treatment consisted of a combination of patches delivering 25 µg/day estradiol and intravaginal pills containing 100 mg of micronized progesterone. Patches and pills were administered concomitantly in a twice-a-week protocol. The endometrial response was assessed by endovaginal ultrasound completed with suction biopsy when required. Results Both cumulative amenorrhea and no-bleeding rates increased progressively and reached 88.9% and 100.0%, respectively, by the 12th month. Isolated or repetitive episodes of bleeding, bleeding and spotting, or only spotting were reported by three, four, and 12 women, respectively. Endometrial thickness remained unaltered. Endometrium was atrophic in the seven women in whom a biopsy was performed. Conclusion The substantially reduced progestogen load determined by this combination achieved an acceptable incidence of spotting or bleeding when associated with a low estrogenic dose. There was no apparent endometrial stimulation. Additional studies are required to confirm this observation.

http://www.ncbi.nlm.nih.gov/pubmed/15222511

Efficacy of oral micronized progesterone when applied via vaginal route.
Choavaratana R1, Manoch D.
Author information
Abstract
The aim of the study was to compare the efficacy of oral micronized progesterone when applied by the vaginal route. The comparative study of serum progesterone levels between oral and vaginal micronized progesterone administration was conducted in sixty female volunteers. The subjects were equally divided into two groups to receive the drug either via the oral or vaginal route. The subjects' profiles showed that there was no significant difference in general characteristics between these two groups. The blood tests for estrogen and progesterone levels were performed on all volunteers before and after the drug administration. The data collected from the experiment revealed that the serum progesterone levels achieved by oral administration (5.06 +/- 2.95 ng/ml) differed significantly (p < 0.001) from those achieved by vaginal administration (8.26 +/- 4.09 ng/ml). The data also revealed that the serum progesterone levels of the oral administration group (4.23 +/- 2.68 ng/ml) did not differ significantly (p = 0.925) from the other group (4.15 +/- 3.40 ng/ml) when the serum estrogen level was less than 30 pg/ml. On the contrary, when the serum estrogen level was at least 30 pg/ml, there was a significant (p < 0.005) difference in the serum progesterone levels between these two groups (6.32 +/- 2.99 ng/ml for the oral route and 9.76 +/- 3.23 ng/ml for the vaginal route).

http://www.ncbi.nlm.nih.gov/pubmed/20575654

Transdermal estradiol and oral or vaginal natural progesterone: bleeding patterns.
Di Carlo C1, Tommaselli GA, Gargano V, Savoia F, Bifulco G, Nappi C.
Author information
Abstract
OBJECTIVE:
To evaluate the effects on bleeding pattern of two different doses of natural progesterone (NP) administered per os or per vagina in association with transdermal estradiol in a continuous, sequential estrogen-progestin therapy.
METHODS:
A prospective, randomized trial was conducted on 100 patients randomized into four groups. Each group received transdermal 17beta-estradiol treatment at the dose of 50 microg/day. Groups A and B received NP per os at the dose of 100 mg/day and 200 mg/day, respectively. Groups C and D received NP per vagina at the dose of 100 mg/day and 200 mg/day, respectively.
RESULTS:
After 12 cycles of treatment, no significant differences were observed in endometrial thickness between groups, suggesting that all treatments are effective in balancing the effects of estradiol on endometrium. Regarding bleeding control, patients in Groups C and D showed a higher number of episodes of regular bleeding than patients in Groups A and B and fewer episodes of spotting. The better control of bleeding was associated with a higher treatment compliance in patients who received vaginal NP, with a larger percentage of women completing the study.
CONCLUSION:
Transdermal estrogen replacement therapy combined with 100 mg of micronized NP administered per vagina from the 14th day to the 25th day of each 28-day cycle leads to good cycle control and provides excellent patient satisfaction without serious side-effects. This therapy could be a treatment of first choice in early postmenopausal patients.


E-mail from information manager at Ferring ( previous manufacturer of Utrogestan)

The product monograph talks of two trials of vaginal use as part of HRT – they're small patient populations – 20 and 30 patients in each.

One study used 100mg once daily vaginally for 21 days of 28 day cycle – the study lasted a year and was undertaken in 20 patients. Symptoms were significantly reduced, bone density remained and no adverse effects were seen. The endometrium was safely protected from the estrogenic effect of 1.5mg transdermal Oestrogel.

Another of 30 patients over 36 months studied the use of 100mg vaginal Utrogestan every other day. For most patients there was absence of bleeding and good patient satisfaction. There was a reduction in mean endometrial thickness and at the end of the study endometrial atrophy was seen in all cases. Five of the 30 women dropped out due to vaginal bleeding.

The references are:

Spritzer et al Exp Clin Endocrinol Diabetes 2003; 111 (5) 267-273

Vilodre et al Gynecol Endocrinol 2003; 17 (4) 323-328.

Hope this helps

Hurdity x

[Cathy9660]

Hi,
I am new to all this and my this is my first time posting. I am 47 and had my last period about 12 months ago and am now on cyclical HRT. I tried the everol conti but was wrongly prescribed as the combination gave me a lot of breakthrough bleeding. I also was curious to know how I would feel without the progestin 24/7. I am suffering terribly with joint/muscle/tendon pain and I am also on pregabalin. I am progressively getting worse with menopausal symtoms since Dec 2015 and now find my thoughts/focus are not as clear as they once were. Fatigue is another problem-can't over do it these days at all. Nothing is really working but I am new to all this and hopeful it won't go on for too long. I am finding my way around all this HRT business and persuaded my doctor to let me try transdermal everol 75 with utrogestan-just started this month with taking 2 NP orally-(on day 3 today). He has a preference for prempak c 1.25.

Elizabeth64 - could you tell me what dosage crinone 8% you are using and on what days? I would prefer to use something vaginally and know that I will be covered by using the correct amount of progesterone. I think the recommendations I can find online is always for the Crinone 4% (45 mg daily) from days 1-10 of each calendar month. So is it 22.5mg daily for the 8%? I think 1 utogestan vaginally might be OK with everol 50 but not sure about taking only 1 with 75mcg of transdermal oestrogen-whereas 2 orally seems to be recommended. As I said my doctor seems to prefer synthetic hormones but he is very HRT and open to working with me also.

[matildamouse]

Andius thanks for all the studies. Very interesting.

I am curious to find out what you decided in the end and how you are doing? I am in the wondering what to do stage myself...

[Hurdity]

Hi Cathy9660

 

The licensed dose of utrogestan used sequentially is 200 mg x 12 days orally. As you will see from the studies I posted (quoted by andius) used vaginally is fine to prevent endometrial thickening - but unfortunately there are insufficient studies regarding dose and it is dose dependent ie as you say, more would be needed to oppose higher oestrogen doses. However the results do indicate that lower doses of vaginal progesterone can be used compared to oral progesterone.

Through your doctor, I would say that 200 mg utrogestan used vaginally for 12 days per month should be adequate to protect your endometrium - but you would only be able to ascertain this if your doctor agreed to scan your uterus to check.

I use 200 mg utro 12 days per two months for 50 mcg oestrogen and that is fine (doc is fine with this) - scans have shown this - but we are all different and also if you have small polyps or fibroids, this can also affect the outcome.

There are very few Crinone users on here past or present - so it would be interesting to hear about this! From what I remember the 4% isn't available any more but I might be wrong, and also I don't know why it is not more widely used - but it doesn't seem to be licensed for HRT in UK anyway.

Hurdity x