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[possum]

Hi all

I have just started cyclical HRT Estraderm 25 patches + Prometrium 100mg x2 days 1-12. I'm 51yo and went a whole 52 weeks without a period ... but then got one on week 53, so that was a good bottle of champagne wasted. My symptoms were relatively tolerable until then -- the usual hot flashes, aching joints and worst of all, fuzzy brain and lack of energy -- but they seemed to worsen after (esp my mood!).

I'm only on day 6...days 1 and 2 were great, within a few hours of using the patch I felt an improvement in mood, energy levels, and mental clarity, but day 3 was horrible, complete inertia with bonus bloating, sore boobs and abdominal cramping.

Since then, I have reduced the Prometrium to 1x100mg, and I feel much better. But I'm not sure if that's enough to protect the endometrium...I figure the estrogen dose is low, so why not the progesterone too? I've been researching around to find out if this is a fair enough assumption and not really found much.

But I did find this forum! Wondering if anyone has any experience or advice on this issue?

Thanks so much!

[aspie65]

I had this dilemma.  My estrogen dose was low enough I didn't get a period despite 12 days of 100mg utrogestan.  My doctor wasn't worried but I went for a vaginal ultrasound to reassure myself and all was fine (4mm).  I am planning to take less utrogestan next month as a result which is what Prof Studd prescribes his patients anyway.  So basically it is a case of trial and error with doses and a scan can give you a conclusive answer if you are worried.

[Dancinggirl]

Hi and welcome possum

I assume you are in the USA? Prometrium is called Utrogestan here in the UK.
The HRT regime youbare on is getting very popular here but you have been given very different instructions.
You are on a very low oestrogen level and 50mcg would probably be a better balance. The regime her in the uk is: days 1-16 oestrogen  only and add in the progesterone for 12 days. The progesterone taken orally should be 200mg but if you use it vaginally, then you could just use 100mg. 
You are technically still peri menopausal so need to use a sequential HRT regime and this will normally bring a bleed after finishing the progesterone phase - this why it's strange that you have been told to start the Prometrium from the outset!!! 
All progesterones can give side effects but Prometrium taken orally can bring strong sedation and low mood.
If you have regular scans then you may get away with only having 10 days of Prometrium.
But this must be under professional medical supervision
Sore breasts and period cramps should settle - your body is reacting to the hormones and waking up. DG x

[Mary G]

This comes up on here a lot because so many women don't get on with the progesterone part of HRT, not just because they are progesterone intolerant, but because they find it undermines all the good work the oestrogen is doing and in some cases makes HRT unviable for them.

There is absolutely nothing wrong with trying to tailor your progesterone dose to suit your personal needs and this option should be open to all women who have problems with it.  I am on the Professor Studd regime (100mg Utrogestan for 7 days each month although I take less than that under supervision due to severe intolerance) and have never had a problem with low dose progesterone (confirmed with regular uterine scans) and most women don't but obviously there will always be some women who do. There is only one way to tailor make your HRT regime and be sure you are getting enough progesterone and that is to have regular uterine scans.  That way, you will know for sure if you are getting enough to keep the lining thin.

As you quite rightly say, you are taking a very low dose of oestrogen so you should be able to easily do the 100mg vaginal Utrogestan regime and get good lining clearance.  Give it a try for a few months and then have a scan to make sure everything is OK.  If you are in it for the long haul there is no point in taking too much progesterone for years on end and ruining your HRT regime when you don't need to.   

[possum]

Thanks so much for the replies, you guys are the best!! It takes me back to the last time I was involved in a forum, which happens to be when I was having trouble falling pregnant...seems there is nothing like hormones to send you running to the arms of cyber buddies...

Thanks for the info re Prometrium/Utrogestan DG, I am in Australia.

I was prescribed the Utrogestan for oral use but do you all use it vaginally? And is it just the same little capsule as I'd be using orally? Maybe if I'd better give that a go then? Thought the days of cyclically sticking products up there were over...

Will take all your advice and do a couple of cycles with the reduced progesterone...maybe 10 days worth orally/vaginally (seems like another investigation to be had ) and see my dr to discuss + request scan.

Don't know why I was given the progesterone days 1-12 instead of 17-28...suppose it's the same nett result...feel a bit ripped off that I could have had 17 glorious days of estrogen only before i knew the full story tho!!

[luna66]

I am on the Professor Studd regime (100mg Utrogestan for 7 days each month although I take less than that under supervision due to severe intolerance) and have never had a problem with low dose progesterone (confirmed with regular uterine scans) and most women don't but obviously there will always be some women who do.

I'm also a patient of Professor Studd's and have been taking HRT for just over three months. He started me out on 7 days of 100mg of Utrogestan but at my three month check he raised this to 10 days stating that 'recent research' confirmed that this was a more suitable dose. So, for what it's worth, it looks like he may have shifted his general recommendation on this.

luna x

[Cassie]

I take 12 days of 100mg Utrogestan use them vaginally works very well.

[Dancinggirl]

The private specialist gynae I saw told me that recent research showed that 10-14 Days of progesterone seemed to be needed to protect the uterine lining. He explained that the right dose for enough days was needed to ensure a proper shedding of the womb/uterine lining. So doing anything less than 10 days per month would be more likely to prove problematic and result in eratic bleeding (with increased risk of uterine cancer) and on a longer cycle 12-14 days was necessary. DG x

[Mary G]

Professor Studd hasn't increased my progesterone dose because he knows I have regular scans and get good clearance on a very low dose but obviously everyone needs a different amount.

[possum]

So interesting, thanks again for the replies.

I tried the 100mg vaginally, makes so much more sense, seems to be a better result.

I'm now hoping for some advice on the following plan...

I'm thinking that:

a) The 7 days worth of Utrogestan I have taken to date should be more than enough for this cycle, given that it was started alongside (low dose) estrogen at the outset, and I have had one period in 15 months...like, surely my endometrium is not in danger of growing wildly out of control at this point?

So b) I could now do 18 days of estrogen only and 100mg Utrogestan vaginally (and hopefully not feel so crappy) for 10. And then get a scan after I do/don't bleed.

It seems logical to me, feel a bit silly seeking reassurance, but also know I'm strongly biased to get off this bloody Utrogestan ASAP so maybe not making sensible decision. Fark it's so confusing...this is one of the reasons I didn't start ages ago when I was first prescribed. I like to keep my life simple. But then nothing was simple about unmedicated menopause either.

[Dancinggirl]

I doubt any of us on this forum are doctors ( however there are members that have a good science background eg Hurdity so she gives excellent advice)  and only your gynae can truly sanction any HRT regime you follow BUT if you find the 25 patch is helping meno symptoms then you may get away with 7 days of  Utrogestan used vaginally each month if you have regular scans. As you are clearly post meno, you may have reacted more severely to the Utro as you started taking it from the outset without building your oestrogen levels first. You may find you get fewer side effects once your oestrogen is at a better level and if you use it vaginally.
What I would suggest - and this is just my suggestion, based on my personal experience of using a wide variety of hrts over 25 years (due to premature meno) and seeing many different doctors and specialists for advice:
Stop using the Utrogestan for the next 3 weeks - this will allow your body to build the oestrogen and adjust to the hormones. Many gynaes suggest that patients who are post meno, so have very low oestrogen, start with this longer time on oestrogen to allow a gradual build up and to start to feel the benefits before adding progesterone.
I would suggest you then try 10 days of the Utrogestan vaginally to facilitate a proper shedding of the womb lining - the bleed should arrive a day or after you finish this progesterone phase.
I would then go back to a monthly cycle of 18 days of oestrogen only, then add Utro for 10 days and do this for the next 2-3 months - again to allow things to settle. Go back to your doctor and tell them what you have been doing, request a scan and then discuss your options regarding a longer cycle. If the oestrogen  level is enough to give symptom relief then you ask your doctor if you could stretch the cycle to perhaps 3, maybe even 4 weeks, of oestrogen  only with 10 days of Utrigestan  - so this would be a 6 week cycle.
As you are using such a low dose of oestrogen, you may get little or no bleeding and you may want to increase to 50 anyway to feel full benefits and to give greater protection for your bones.
I must urge you to consult your doctor when experimenting with HRT - what others do or suggest is not necessarily right for you. 
I hope that helps DG x

[Hurdity]

Hi possum I've replied with studies on your other thread.

It has been known for years that the progesterone dose needed to protect the womb is dependent on dose of oestrogen - but of course also on the individual woman. You won't need a scan after one cycle - it tends to be cumulative ie a gradual thickening over time - if it is going to hapen. I would wait at least 6 months on a particular regime.

The rsearch into the amount needed was done years ago - by Studd himself amongst others, when it was established from studies that (other things being equal) 7 days per month increased risk of endometrial hyperplasia, 10 days vastly reduced it and 12 days eliminated it (in that particualr study).  This formed to basis for all HRT prescriptions as I understand - and also taking into account the properties of the particular progestogen used (and its efficiency in protecting the endometrium).There may have been more research recently too. I haven't looked at any papers recently!

Hurdity x

[Dancinggirl]

Thank you Hurdity - as always, good proper information that is really helpful.

Hi again possum.  -
 Studd's 7 day Utro regime is usually for those with severe progesterone intolerance and will involve regular scans.  Utrogestan is actually not as stable or effective at protecting the uterus than most other progesterone types and many women do experience problematic bleeding ( I certainly did when using Utrogestan). I found using it vaginally really irritated my ‘lady bits' (most find it OK used sequentially) and taking Utrogestan orally made me feel quite ‘high' and spaced out!!!!!
You must bare in mind that Prometrium/Utrogestan may not be right for you and there other progesterones to try.
Medroxyprogesterone or Dydrogesterone are good alternatives. DG x

[weathergirl]

I'm not sure if the Estraderm 25 patch is the same as the estradiol (Minivelle) 0.025 patch available here in the US?  I believe it is the equivalent.

If so, my very conservative GYN authorized me to only use 10 days progesterone every other month.  For me (emphasis ), she said this tiny dose of estrogen does not warrant monthly 10-day progesterone use.  In fact, in the U.S. this patch is not even prescribed for relief of menopausal symptoms (only for maintenance (not even growth) of bone density).  It is not indicated for symptom relief.

This is also based on the fact that when I had been using the 0.025 mg/day patch, I was getting next to no bleeding after my monthly 10-day progesterone cycle.

[Dancinggirl]

Weather girl
I think there is an ultra low oestrogen patch available in the US that we can't get here in the uk unfortunately, so the 0.025 patch you wre using sounds like this very, very low dose - I'm not surprised you didn't get much of a bleed.
You wouldn't need much progesterone to protect your womb lining in this dose. DG x