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[Hurdity]

Yes I am like that with it too Stellajane!! Very weird isn't it? I have just finished a course of it (200 mg x 12 days vaginally) - and this time did not get a headache, nor migraine nor even the head fog! I just got the usual morning fatigue where I had to peel my eyes open, and also the bladder irritation at night - but these are minor inconveniences!

I know I have to be careful with alcohol - and I would suggest anyone taking utrogestan - orally or vaginally - try to avoid alcohol while taking it or make sure you drink 2 hours before bed and if you've had any at all before then drink loads of water for the rest of the evening.

The other thing I do is make sure my vaginal tissues are plumped up beforehand (I take utrogestan vaginally) - so I use lots of Vagifem during the week leading up to my utro cycle, as well as trying to during (in the morning) the cycle. My theory is that less is progesterone is absorbed systemically if tissues are plumped up. I have no evidence for this and I am just extrapolating from what is known about oestrogen systemic absorption (ie less absorbed from plumped up tissues) - so it could be complete baloney - but I do it anyway!!!

Unfortunately most women do not go back to how they felt before menopause - but a darn sight better on HRT than not - which is the important thing - and that should be how you judge whether HRT is for you (having given it time of course).

I agree with Dancinggirl that you should not do a long cycle without supervision. Are you under a gynae who would give regular scans?  After all you are already using less than the licensed dose -  if you are using 12 x `100 mg per month - which I am sure is fine with only 1 pump of gel - but to go two months may well be pushing it.

Hurdity x

[meno2016]

Hello everyone. Right now, I´m not sure which is better, with or without HRT. This new treatment with Oestrogel + Utrogestan is better but just in the sense that I don´t have breakthrough bleeding for so many days in the cycle (along with severe period symptoms). But I do feel a lot more tired, sleepy and zoombi daily. No energy whatsoever, so I feel like having 40% or less of my physical and mental capability than before. I don´t have one day when I feel alert anymore. In the mornings, I need to wake up early to prepare and take my kids to school and I´ve been finding it extremely difficult to get into the rhythm needed. Plus playing with them and doing what needs to be done with kids and house routine. I´m not working right now and I can´t imagine me coping with work/home routines if I was. That is a major problem, because I want to go back to work. How do you all cope with work/kids and menopause? Plus no one in my circle is going through any of this, so I´ve been finding it hard, as they all seem to have loads more physical and mental energy than me. I exercise, I believe I eat well, although not perfectly. I take Utrogestan orally. To take it vaginally would be an inconvenient for me. How can you function when you have ups and downs with HRT so often? I think I´ll wait 6 weeks only, then, to take the Utrogestan again, instead of 8 weeks, as per your suggestion. I´d like to take it as far apart as possible, as taking it 12 days a month means 12 days of bad symptoms than maybe 10 going back to normal, than normal for only a few days than 12 days having bad symptoms again. How can you live like this. Plus to think that I won´t ever go back to my previous energy level is just terrible. Right now I feel like having someone carrying me all the time. Do you think it could be due to the low Oestrogel dose?? If I increase it, am I likely to feel more energetic? I don´t feel any hot flushed with the doses I´m taking (1 pump and 1/4), but I don´t sleep well and I´m always very tired (meaning exhausted).

[Hurdity]

If you are post-menopausal and that young age then that is definitely a very low dose of oestrogen.  Re the tiredness - could be low oestrogen, but you could also ask for your testosterone levels to be tested, The utrogestan may cause temporary tiredness. Also thyroid function. Have you had blood tests recently - I would definitely go to the doc and ask to be checked.  There are also other causes of tiredness eg iron deficiency, and some vitamins. How is your diet?

Maybe as you are so young you would be better off either with the Mirena coil ( delivers most of the progestogen locally to the uterus to protect it) - and then you could try different levels of oestrogen for trials periods of say a month. or the birthcontrol pill - there is one with bio-identical oestrogen (estradiol) called Qlaira http://www.menopausematters.co.uk/contra2.php (scroll down) which has only 2 tablet free days, if you tolerate synthetic progestogens. Alternatively if utrogestan is really affecting you, perhaps try the tablet Femoston 2/10 for example and see how you feel - the progestogen is very close to our own but because it is more stable in the body, smaller doses can be taken so there is not so much of a hit of progesterone!

All the different preparations are listed under Treatments/HRT preparations on the menu above.

How old are your kids? My youngest was probably about 11/12 ( and next one up about 13/14) when I started peri-menopausal - but I didn't feel tired  - just had the awful flushes and sweats. I was working almost full-time then. I do sympathise - you do need loads of energy with young children!

Hope this helps

Hurdity x

[Lizab]

Hi meno2016. I have some similarities. I am 39, but had terrible prolonged bleeding before starting hrt. When periods finally stopped, everything became unbearable. I am on an estrogen patch and Prometrium (Utrogestan) 200mg 10 days. The first time with the progesterone, I felt drunk through the morning and hungover through the afternoon. Each month it did improve. After my 3rd month, I started a little stronger dose of estrogen, and now I actually feel best during the progesterone days. I do think you might try another pump of estrogen. I was hesitant to increase as well, as my hot flashes had become tolerable again, and I was having such anxiety problems and the occasional headache which can be a sign of too much estrogen. However, when I did bump my dose up, everything improved. I am sitting here now questioning if this is good enough or if I should try for more estrogen, as I still don't have my energy like I had even only a year ago.

[meno2016]

Thank you so much for sharing! My kids as 6 and 4 years old. When I had my last period, my youngest was 9 months old. I was pretty much getting out of the postpartum when I became menopausal. Tough. I will increase Oestrogel to 2 pumps as os today as today was the first day in more than a year that I felt light hot flushes. Hopefully, my sleepiness and fatigue will improve. I has blood tests done some 5 months ago, and it was all ok. Is 10 days a month enough for Utrogestan 200mg? I had read somewhere in a study that 10 days were not enough, it had to be 12 days. But I don't know about the dosis of Oestrogel. When my box of Utrogestan 200mg finishes, I'd like to take the 100mg capsules (orally). What would be the minimum number of days to take the 100mg capsules with 2 pumps of Oestrogel and not have any period? So, if postmenopausal a woman requires more hormones than if peri? And as the years come, postmenopausal women tend to need to increase the dosis, than decrease later? How does it work? I'm on the Oestrogel only for the past week, so I don't think it's the Utrogestan. Mirena coil no, thanks.

[Lizab]

I wondered about that too, as most women seem to be on 12 or maybe even 14 days, but my doctor said start with 10 and see if I get any bleeding problems. I get a period from it and no irregular bleeding, so it seems this is sufficient for me. I think if you do the 100s, it has to be 25 days and no bleed, I'm not sure. My little one just turned 4 as well. It's definitely tough going through this. I'm not sure how it works as far as reducing dosage later. I'll cross that bridge later.

[Hurdity]

meno2016 The licensed dose or Utrogestan is  200 mg orally for 12 days per 28. However it is given as a one size fits all - so maybe too much, maybe too little depending on the dose of oestrogen and the individual woman.

What is known as that the research from a study ( I think Studd's work)  showed that 12 days was sufficient to reduce the incidence of endometrial hyperplasia to zero, 10 days it was low, and 7 days meant it was higher - maybe 4 % or something ( can't remember the figures) and that would have been for a given dose of oestrogen.

The licensed dose is set to minimise the risk of women developing endometrial cancer but how you respond is unknown.  When I used Cyclogest pessaries as progesterone I was always prescribed it for 11 days per 28. Also if you use it vaginally you will get a higher dose - although 7 days may not be sufficient in terms of time, to ensure that the whole of the oestrogen-primed endometrium (as it is known) is converted into secretory tissue ( which is what the progesterone does) so that it will all be shed when the progesterone is withdrawn. Does that make sense?

Intuitively you would need a lower dose of utrogestan for lower doses of oestrogen but it's not an exact science. If you're with NHS GP then best to start with the licensed dose and take it from there, if you can tolerate it ie 12 days x 200 mg per month orally. Ideally if you vary this (due to severe progesterone intolerance) then you would need your docs approval and regular scans to check the lining was shed each cycle.

Many women early in peri-menopause, and also younger women who start menopause early need higher doses of oestrogen both the keep symptoms at bay and to feel good. Remember that the average age of menopause is 51/52 so up until then you would normally (if fertile) be having a higher average amount of estradiol through the month. Starting HRT in late peri and when older - it is often possible to feel a lot better on just a low or medium dose - although some women need to increase temporarily about 2 years after menopause (or when it would have been) because oestrogen will have dropped off by then ( although I read that it takes about 7 years or something like that for all activity to cease completely!).

Unfortunately each time you decrease, symptoms can return for a while if the body is sensitive. eg I have been on 50 mcg for years but tried to reduce to 37.5 mcg but flushes came back. I must say I couldn't be bothered with this or seeing if I could ride them out (need to work after all) so went back to 50 mcg where I am still at age 63!

Hurdity x

[meno2016]

I´ll do 200mg for 12 days 6 weeks after taking it for the last time, this time, and see how it goes. I have another question... if I went into the menopause at age 39, which is 10 years earlier than the average age, does it mean that my menopause years are increased by 10 or does it mean that I will stop having the symptoms 10 years earlier than the average. Or there is no average?? Is it 7 years? Thank you!

[Dancinggirl]

meno2016 - Nobody can answer your questions!!!  Every women is different and the symptoms will be different - nobody can tell you how long meno symptoms will continue after stopping HRT. The important thing is to have a good level of oestrogen until at least 50, although between 55-60 would be a better time to stop HRT to really get the full benefits in the longer term.  DG x

[Hurdity]

The 7 years I was referring to is the time following the last period when hormonal activity pretty much ceases. According to the STRAW criteria this takes between 5 and 8 years - so I wasn't talking about peri-menopause nor even menopausal symptoms which as Dancinggirl says are unpredictable and individual!
http://www.imsociety.org/downloads/email_downloads/2012_02_16_1773491/straw10.pdf

Clearly the earlier any woman goes into menopause - the more years she will have post-menopause and be subject to oestrogen deficiency - with associated long term symptoms and potential knock-on health problems.

Hurdity x

[meno2016]

Hello everyone. I was on 1 pump of oestrogel + 12 days utrogestan 200g until las month. But I don't feel normal when I take the Utrogestan, with headaches, like a zoombie. So this month I'll be trying the 100mg dosis. I'd like to know what would be the least number of days per month that I can take the Utrogestan 100mg with 2 pumps of Oestrogel daily. Does anyone know?

[Hurdity]

How long is a piece of string? You could only answer that by getting your doc to agree to an annual scan so that you can work out what's right for you. Less progesterone is absorbed when taken orally than vaginally.

If you are peri-menopausal and early peri then you may well be producing regular progesterone of your own if you still ovulate most months - so it may be less of an issue. Some gynaes seem to be OK with taking less in these circumstances.

The amount of prog needed to protect the womb from too much oestrogen is dose and duration dependent. The fewer days per month that you take it the increased risk there is of endometrial hyperplasia - which in some cases can lead to cancer. Can you discuss with your doc slightly stretching your cycle to one calendar month and then perhaps taking it only for 10 days? If your own cycle kicks in thought you might get a bit out of sync? Also if you take it vaginally you will reduce the side effects.

Hurdity x

[meno2016]

Hello! I have changed my treatment from oestrogel 1 pump daily + 1 capsule of utrogestan 200mg for 12 days every 5 weeks to oestrogel 2 pumps daily + 1 capsule of utrogestan 100mg for 10 days every 4 weeks. I would like to know if that is acceptable. After I stop the utrogestan, I have 2-3 days light bleeding. I'm going for my third month on the latter regime. Unfortunatelly, I've been feeling exhausted and with light migranes daily, also feeling like a zoombie and not having deep sleeps. Brain fog and memory issues. Some nights I'm having imsonia. I'm POSTmenopausal. At 39 my periods had stopped completely, I went into another hrt treatment at 41 and I'll be 43 in a month. Any idea as to why this regime is not working well and what I should try? Thank you!