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[Quandry]

After being on Elleste Duet 1 mg for about 2 years relatively successfully (apart from a few digestive issues at times) I decided to switch to a continuous regime.

Started on Estradot 25 and Utrogestan 100mg (for 25/28 days) just 11 days ago. Thought was fine at first, but for the last 3-4 days I have had just the most awful stiff neck with pain running up the left side of my face/ headache. It's worse when I first wake up, but yesterday and today it has left me in tears. I've never had migraines, but this feels like a lop-sided one!
After reading some comments on Menopause Matters I am sure this is being caused by the Utrogestan.

I can't tolerate this longer term, but I can't see a GP until next week at the earliest.
I'm not sure if I should just stop it to prevent any further build up in my system?
Anyone had anything similar / have any advice?

My GP is hopeless - just asks me what I want and looks it up on Google in front of me! If this isn't going to work for me te=hem I don't know where to go next in terms of continuous regime?
Perhaps I should just go back to Elleste Duet for a while?

[Quandry]

te=hem  = Longer term...

[Hurdity]

Hi Quandry - just had a quick look at the forum on my phone (not logged in!) and saw your post so had to reply straight away rather than let you wait!

Short answer is – yes it's fine to stop taking the Utrogestan until you see the doctor. It is highly doubtful whether you have built up any womb lining to shed – firstly because you are taking such a low dose of oestrogen and secondly because you have been on this regime for such a short time. If there was any residual lining that wasn't shed after your last cycle of Elleste then you may get a small bleed a few days after you stop. Two weeks of oestrogen only – especially on that low dose  - would be like cyclical HRT so no problem at all. I presume you started the conti regime after you finished the packet of Elleste and I presume you had a bleed as usual?

Now to Utrogestan – women who experience side effects from Utrogestan (headache, nausea, fatigue, dizziness) from oral use may take it vaginally – although in UK this is off-licence, unlike on the continent. (Research shows it works better this way for a given dose). Most women would not want to take progesterone vaginally on a continuous basis, and some not at all, so the other alternative is to remain on cyclical HRT – which several of us choose – especially on into our 60's or late 50's.

The other thing is that you are on a very low dose of oestrogen – is there any particular reason for this? The standard dose of oestrogen patch is 50 mcg. I started on this dose in late peri-menopause when I was almost 54 and have been on it ever since ( more or less) – aged 64. I take progesterone on a long cycle ( 6-8 weeks) and use Utrogestan vaginally 200 mg vaginally x 12 days and then get a short bleed. This would need supervision by your doc to check that your womb lining did not build up on this long cycle,

The other possibility is to have a bit shorter duration of progesterone (10 days – vaginally or orally) monthly – but would still need to keep an eye out for any suspicious spotting/bleeding as 12 days is the recommended duration. If you were using it vaginally cyclical then docs might agree that you can use 100 mg x 12 days for up to 50 mcg patch. It is partly a case of trial and error – under medical supervision. If you don't have any issues with your uterus then 50 mcg might be the way to go.

Also if you are using it vaginally make sure you are using a good dose of local oestrogen as well (just my own pet theory) as it might also limit systemic absorption of the prog and hence fewer side effects.

I still do get side effects from utro but nowhere near as bad as I imagine I would get from oral use – the number of metabolites produced from going through the liver are numerous and these are what causes many of the additional side effects whereas vaginal use is much gentler.

Longer term I would seriously consider opting to remain on a cycle as outlined above and maybe increasing your oestrogen dose ( depending on how you feel, and how old you are, or whether post-meno?).

Hope this helps and hope your headache eases - I know how this feels as I sometimes get migraines from utrogestan even when using it vaginally, and also I find it does not mix with alcohol - and can give a dreadful headache/hangover feeling even after one small glass of wine.

Hurdity x

[Quandry]

Thanks Hurdity - I'm really grateful for you taking the time to reply!

I'm 51 and about 2.5 years post menopause (I was a bit early...)

I started in Feb 2015 on the lowest dose of Elleste Duet 1mg and it seemed to be enough to get rid of my symptoms, so it stayed at that level.
When I switched to Estradot I started again at the lowest level , presumably because 'lowest' had worked before?
I don't know how the levels translate between a tablet and a patch though is  Elleste Duet 1mg tablet = Estradot 25micrograms ?

Yes - I started this regime after I finished the last pack of Elleste and I had a bleed which continued for the first week of the new regime. It was bit 'fresher' and heavier than usual, but nothing excessive.

I did consider using the Utro vaginally, but one of my menopausal symptons I was addressing was irritable bladder, so I'm loathe to go down this route as I've read it can exacerbate this.

Presumably I'd need to see a private specialist to get the kind of 'medical supervision' for the different regimes you're suggesting?
I've yet to find a local GP who knows anything about HRT 

That is so interesting about the alcohol! The two worst mornings/worst headache pain I've had have been after I've had a couple of glasses of wine the night before.

[Hurdity]

Hi there - you're welcome

Yes strictly speaking they are both low dose ( according to the menus) ie 1 mg or 25 mcg - but then 37.5 mcg is also classed as low dose. However the standard post-meno oestrogen dose is 50 mcg and this dose is licensed for prevention of osteoporosis. Any oestogen preparation will have some positive effect on bone but as it's dose dependent the higher doses will have a greater effect on a greater number of women than lower doses.

You are barely at the natural average age of menopause - note that I was almost 3 years older than you when I started 50 mcg - and if no reason why not I would try to aim for this dose. It may help lessen the effects of progesterone - but I would say still not enough to warrant taking it continuously given the side effects you have already experienced.

However if they were due to concomitant alcohol intake and you change the way you have this, then perhaps it might not be so bad in the long term?

I've posted elsewhere about alcohol and just found one of my posts: "My tolerance to alcohol completely changed when I became peri-menopausal and especially later on the progesterone part of HRT. I can have any alcohol now as long as I don't have it late in the evening - ideally with a meal and with copious amounts of water afterwards (at least twice the amount of water as wine and more if stronger alcohol!). Now, if I drink it too late in the eve irrespective of the HRT I am on at that moment) it can trigger a three day migraine. A small amount is sufficient for me to feel happy (!) and I rarely have more than two drinks eg a G&T and a glass of wine or something".

Maybe this might be something you need to do. No way could I have two glasses of wine later in the evening and expect to feel OK in the morning and not even when on the prog!

You should not need to go privately for this medical supervision but you must find a GP that understands menopause and HRT or else get a referral to a menopause clinic if there is one in your area. I have managed to have scans along the way from investigations of various things like pains here and there, spotting at the wrong time etc. I also paid for one last year because there was nothing wrong and due to my age I felt I should. You can get them pretty cheaply (around £100) although this should not be necessary and I don't like to advocate having to pay for scans as even this is out of reach of some women and it should be possible to get a treatment to suit you on NHS . The bleeds you have or not, and the length of them should give you an indication of whether your regime is keeping your lining thin enough (if you are on cyclical HRT). Also if you have a history of fibroids - these can be affected by HRT although doubtful at the low dose you are on and maybe not even on medium dose. My small fibroid shrunk over the course of two years on med dose oestrogen.


Hurdity x