Menopause Discussion > All things menopause

Progesterone intolerance OR not enough estrogen? Advice please!

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Misstowers:
Hello, I'm looking for some advice/experiences please, this website has been so helpful to me..

I'm perimenopausal at 42, have been for a few years now, I thought I was getting dementia before realising it was perimenopause, so in some ways a big relief to know the problems I was having were hormonal. GPs were useless but I managed to get referred to a menopause clinic at my local hospital which was great (sadly due to lack of funding it has now closed so I'm back to GP). The consultant put me on the contraceptive pill to start with but that didn't work so moved to Sandrena gel sachets (2 x 50m) and 12 days of utrogestan 100mg.

On the whole I feel better and like my old self, but there are times in the month that I seem to slip back to being very depressed, forgetful, tired, angry and lose my sex drive. I feel like a gloomy shadow of my 'normal' self, and that I'm on the brink of losing it. I just read a post on a website called writehealth (which is about menopause health) about progesterone intolerance and it makes a lot of sense to me, as I think my low mood coincides with the days I take utrogestan. (I will start to keep a diary I think...) In the post I mention above, she talks about progestrone suppositories and says that the Utrogestan capsule can be used as a suppository in the vagina,  and that this avoids it going into your system so much, as it goes directly to the uterus...

So, I'm wondering if anyone has experience of progesterone intolerance, what they did about it, and if anyone has used Utrogestan vaginally or has been prescribed a progestrone gel or suppository instead of pill form... has anyone taken Utrogeston that way? I wonder if it would be as effective in terms of the lining of the womb etc, and if there are side effects 'down there' of suppositories...

Thanks!

Dancinggirl:
Hi and welcome to MM Misstowers

If you were truly intolerant of progesterone you would get far more sever PMT and other symptoms - most of us find progesterone challenging one way or another. 

Though Utrogestan isn't licensed to be use vaginally here in the UK, for some strange reason, nearly everywhere else it is, so I would suggest you try it vaginally to see if it makes a difference. I believe using Utrogestan vaginally is actually more effective at protecting the womb lining and many women find they get fewer problems with erratic bleeding when they use it vaginally. Some women actually like how they feel on progesterone as it can have a sedative and calming effect!!!
I have to say that some PMT is quite normal on the progesterone phase of any HRT and in fact PMT is common for many women during their reproductive years - I think it is unrealistic to expect to feel good every day of the month.
In your case I wouldn't be tempted to move to a continuous HRT regime to avoid having monthly bleeds - it is fine to keep using a sequential HRT regime well into post menopause - it's just a nuisance to have the bleed every month.  Once you are well into post menopause you could possibly extend your cycle (under professional supervision) so you have a bleed every 5-6 weeks to give you longer on oestrogen only.  I had an early menopause and I did a slightly extended cycle from my mid 40s(once I was truly post meno) - so I did 24 -26 days of oestrogen with 10 days of progesterone BUT don't do this unless you get advice from a meno clinic or gynaecologist.

There will be some ladies on this forum who will tell you it's fine to use Utrogestan for just 7 days each month(they are probably seeing a specialist gynaecologist privately) but this MUST ONLY BE TRIED WITH MEDICAL SUPERVISION as there is a good chance the lining will build up and this can result in erratic bleeding requiring investigation.     

Do try using Utrogestan vaginally - it can cause a bit of irritation around your vaginal area but if you use some intimate moisturiser ( SYLK or the YES products are the best and you can get these online ) this may help.  I suspect trying Utrogestan vaginally might well help you generally.   Good luck and keep us posted.  DG x

SueLW:
Hello

I use Utrogestan vaginally.  I'm post menopause so I use 1 x 100mg capsule every night continuously and it's fine.  It's the same small round capsules that you would swallow.  Just be sure to get into bed and then push it up as far as you possibly can.  if you pull on your vaginal muscles when you run out of finger length it will go right up out of reach. 

I've never had any irritation from it.  I see a private specialist and she is more than happy for me to use it this way.  She says it's more effective for protection of the womb than swallowing it.  When you pass something like this through the liver a lot is lost.  Her view is 100mg vaginally is equivalent to 200mg orally.

Give it a try.  I keep a pack of wet-wipes on the bedside table to just wipe my hands on after I've inserted it.

Hurdity:
Hi Misstowers

 :welcomemm: from me too.

What the others have said!

It is not usually used as a suppository, but as a pessary - ie vaginally. Yes research shows its more effective at endometrial protection (stopping womb lining growing too thick or thinning it when used as part of HRT).

There can be more adverse side effects from oral use of progesterone because there are many more metabolic by-products as it has to be digested and metabolised through the liver. In fact also the licensed dose for cyclical use of utrogestan is 200 mg - but as SueLW says on average you can use half the amount of progesterone vaginally then orally to have the same effect. This has a scientific basis - I have posted abstracts from scientific papers on here several times which summarises this research.

Depending on how regular your periods wer ebefore starting HRT you might be able to get away with less than the licensed dose ( if you are still ovulating reguarly and therefore producing progesterone every month from the ovaries). As ovulation becomes less frequent it is more important to get closer to the licensed dose and as Dancinggirl says - only under medical supervision deviate from this to ensure your womb is protected.

Hurdity x

Ladybt28:
Hi Misstowers - I have taken my progesterone orally and vaginally and vaginally is way better for me!  I am post meno and take it 12 days during the month with a bleed - I tried continuous and couldn't cope.  I really don't like the progesterone part but I have to have it I have a womb. I am trying to balance what I do but it is trial and error - I think it is like that for many women here which is why they are posting.

Reference what Hurdity just put in her post here (sorry dont know how to copy the sentance out of the post?) I take 200mg for the 12 days vaginally  - she said "200mg is the licencensed dose orally... but as SueLW says you can use half the amount vaginally rather than orally for the same effect"

So can I cut my 200mg vaginally to 100mg vaginally for 12 days?

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