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[ljcybergal]

Hi - I'm 56, and for the last five years I had been happily taking an HRT regimen prescribed by a specialist at King's College Hospital. This consisted of oral HRT in two separate prescriptions, one for 1mg oral estradiol (Elleste Solo) continuously and one for 7.5mg oral medroxyprogesterone (Provera) for 14 days per month. It took a while to find the ideal treatment - initially I had been prescribed Femosoton 1/10, but didn't get on with it. Then I had gone up from 5mg to 7.5mg of Provera, as I was having a very long and heavy monthly bleed on the lower dose.

I've been very happy with this, and have extended my cycle to 3 weeks on/off so that I only have to deal with a bleed (usually quite light) every 6 weeks.

I recently went back to King's College Hospital for a follow-up appointment with a new specialist, as the previous one has now retired. I requested to continue with my HRT, as I have the feeling that underlying symptoms are still there and the HRT is keeping them under control - e.g. I continue to get occasional overheating / hot flushes. For the last few months I've also been feeling uncharacteristically tired, exhausted even, and have aching muscles.

So the new specialist gave me a new prescription to take back to my GP: 0.75mg estradiol gel twice a day (Oestrogel), 100mg oral bio-identical progesterone at night (Utrogestan), and 50mg testosterone gel in the morning (off-licence Testogel), all continuous. I have been struggling with this new prescription and could do with some advice please!

I'm all for the idea of gel instead of pills, a bit messier but apparently safer. The only downside is having to remember to apply the Oestrogel twice a day, whereas before it was a pill once a day. The Testogel is a bit of a faff, having to administer one sachet over 10 applications, not ideal, but OK.

But while I absolutely agree that it's preferable to have bio-identical progesterone, and I love the idea of not having a bleed anymore, the main thing I'm struggling with is the idea of continuous progesterone. Prior to menopause, even though I had been on the combined pill for over 30 years (!), I was one of the unlucky ones who had really bad PMS every month, and prior to going onto HRT, I was having terrible mood swings and anxiety along with hot flushes, bad skin, insomnia, headaches, etc. On HRT, things have been largely controlled, but the progesterone part of the HRT cycle has still been that time of the month when I have bad skin, get grouchy and/or tearful, and feel bloated. So my concern is: why would I want to feel that way continuously? Or is the continuous daily dose of Utrogestan so low that that is not supposed to happen?

But the main issue I'm having is that after one week I've had to take a break from the Utrogestan, as it was making me feel queasy and tired. I've confirmed this, as since stopping it, I'm no longer having those side-effects. Unhelpfully, the instructions say to take a pill on an empty stomach. This may be to increase absorption, but if one of the side effects is nausea, then that seems absurd, since most pills that could affect you in that way are not supposed to be taken on an empty stomach? (e.g. aspirin or ibuprofen). Also, if one of the side effects is tiredness, then surely that cancels out the benefit I'm supposed to be getting from the testosterone?

Any thoughts / ideas / suggestions appreciated! I know that some of you take your Utrogestan vaginally - is that safe, and will that at least get round the queasiness problem?

Thanks in advance 

[Hurdity]

Hi ljcybergal

 

Firstly although I am not a gel user - many women actually apply it all at once ie in the morning - the dose should even out as it absorbs into the layers of the skin and is held there for a while. It is not necessary to apply in two doses unless you are very sensitive?

Secondly yes I and many others use Utrogestan vaginally and this is to reduce sdie effects like nausea and dizziness. In fact the instruction to take orally on an empty stomach is actually to reduce not increase absorption, which is bizarre. Taking with food increase bio-availability of the progesterone. Using vaginally still has a sedating effect and sometimes other side effects but cyclically most of us grit our teeth and put up with it so we can have the benefits of oestrogen only. Although not licensed to use vaginally in UK it is on the continent and research shows it is more effective at the same dose when used like this. Perfectly safe - it is manufactured for both routes ( oral and vaginal ) - same product.

Thirdly - many of us depsite being post-menopausal opt to continue with cyclical HRT - I am nearly 66 and still do this! This is because we don;t like the effects of continuous progesterone as you don't either. Depending on how your uterus reacts to the increased dose of oestrogen from the gel - you might be a ble to stretch your cycle like you did with the Provera - but I would start off monthly first. Perhpas you can run this past your specialist - the idea of going back to a cycle? However if you were doing this before and no medical reason why not - then by all means say you want to do this again.

I use testosterone sachets as you do ( well I have tubes at the moment but these are no longer available). I used sachets for three years. You just squeeze out a pea-sized blob and then fold over the sachet with a paper clip.

Hope this helps and keep us updated

Hurdity x

[ljcybergal]

Thanks Hurdity

Just a couple more thoughts / questions: I read that fatigue is a common side effect of Utrogestan, and I did notice this on taking it (as well as the nausea). Given that I've also been prescribed the Testogel for tiredness, will this be a problem? Or will the testosterone benefit outweigh the Utrogestan effect? If I take the Utro at night, and the Testogel in the morning, will that give me the best balance (i.e. sleeping well at night, having energy during the day?).

I've also read that some women find the best solution to reduce the side effects of continuous Utrogestan is to take 100mg every other day instead of every day. I forgot to mention I already take Vagifem every other night. If I were to start Utrogestan vaginally, does that mean I can't or shouldn't do it at the same time as the Vagifem? If I adopted the approach above, could I alternate the Vagifem and Utrogestan?

Then to add a spanner into the works, for many years I've had interstitial cystitis (irritated, painful bladder). I've just been reading that Utrogestan taken vaginally can irritate the bladder, so now I'm wondering if I shouldn't even consider taking it this way. Does anyone know how common a side effect this is?

Thanks again 

[racjen]

I'm wondering why this new specialist is messing around with your prescription, when what you were doing before seemed to be working? Did he explain why he was changing your regime? Speaking as someone who hasn't, as yet, managed to find anything that works in controlling menopausal anxiety and depression I'd say - go back and ask why you can't just stick to the old prescription....

[ljcybergal]

You make a really good point racjen, I'm starting to wonder that as well. I understood it was mostly because Utrogestan is bio-identical and ‘safer' (cancer and heart-wise) than Provera. But I certainly wasn't told of its own unique side effects!

To add insult to injury, yesterday afternoon I had an ocular migraine (just the aura, no pain involved, but I couldn't see properly for a good hour or so). I've only ever had a few of these in my life, so it's a bit worrying! I have read that sometimes the onset of menstruation is a trigger in some women (although that's never happened to me), and lo and behold, after stopping the Utrogestan after trying it for only 4 days, yesterday I was also having breakthrough bleeding! 

[solidgrounds]

That's very interesting ~ about the absorption of Utrogestan being increased when taken with food! I had always thought it was the opposite - and I soon switched to the vaginal route of taking Utrogestan (after consulting my Menopause Specialist). There was no way I would have been able to tolerate oral Utrogestan so this method has been ideal for me.
And in America, I have seen the advice being to take oral Utrogestan (the equivalent) with food so I was always very confused about this conflicting advice!

I have found Evorel patches to be the best form of estradiol for me overall - I began my HRT journey back in Nov 2017 having just reached the menopause. I began with 25mcg and gradually increased to 75mcg. I have tried some 100mcg patches but I seem to feel overall that 75mcg works best for me, all things considered.

However, I still think there is room for improvement; and I am open to non-hormonal meds that might help support me on my way.

I have tried Estradot (different dosages) but these patches really didn't work well for me at all, sadly.

I have tried some testosterone cream - teeny tiny doses - and although there were some definite noticeable benefits (eg well-being, energy, etc), this is not something I have added into my regular routine. I wish I had been able to tolerate this more easily but in the end, I stopped using it.

Finally, I am currently trying Estrogel and seeing how this works with my particular body chemistry!!
I am very sensitive to meds and supplements so it isn't always easy finding good compatibilty...my doctor (UK) says it is fine to rub in the gel (whereas in America, the product information says you must NOT rub the gel into the skin but leave as a thin layer that has been spread thinly over the skin!).

So time will tell ~ and minimizing any side-effects is always key for me. Ultimately, I know I can tolerate my Evorel 75 mcg patches absolutely fine - but that more could be achieved which I haven't quite found yet. Some supplements and other meds can help but something still feels lacking for me?

I have found that overall my weight is lower these days; and that my use of Evorel patches seems to work in favour of keeping my weight balanced and lower. I think I lost some weight (for various reasons) in the autumn of 2017 and just before and then around the time I first began to take HRT?only a small amount as I have no real weight to lose but the Evorel patches have certainly not caused any weight increases.

I hope this helps!

[Hurdity]

Thanks Hurdity

Just a couple more thoughts / questions: I read that fatigue is a common side effect of Utrogestan, and I did notice this on taking it (as well as the nausea). Given that I've also been prescribed the Testogel for tiredness, will this be a problem? Or will the testosterone benefit outweigh the Utrogestan effect? If I take the Utro at night, and the Testogel in the morning, will that give me the best balance (i.e. sleeping well at night, having energy during the day?).

I've also read that some women find the best solution to reduce the side effects of continuous Utrogestan is to take 100mg every other day instead of every day. I forgot to mention I already take Vagifem every other night. If I were to start Utrogestan vaginally, does that mean I can't or shouldn't do it at the same time as the Vagifem? If I adopted the approach above, could I alternate the Vagifem and Utrogestan?

Then to add a spanner into the works, for many years I've had interstitial cystitis (irritated, painful bladder). I've just been reading that Utrogestan taken vaginally can irritate the bladder, so now I'm wondering if I shouldn't even consider taking it this way. Does anyone know how common a side effect this is?

Thanks again 

I'm not sure how your body will react to taking utrogestan and testosterone every day! I wouldn;t want to take prog every day due to the sedative effect and this will still happen even if you take the T gel as it is a different sort of tiredness. With low T it is more of a general fatigue I find and especially a muscular fatigue after exercise - and uncharacteristic aches and pains after exercise - due to the effect of T on muscles ( or lack of it rather).

I use Vagifem and when I am on the progesterone phase of my (cyclical) HRT I do the Vagifem sometime during the day about 12 hours after the progesterone - so to some extent they are up there at the same time - although hopefully most of the prog is absorbed and then leaks out before I do the Vagifem. With Vagifem anyway the tablet sticks to the vaginal walls so hopefully continues to release estradiol even with the prog up there!!!

I agree with Stellajane re the bladder irritation - I have to get up in the night to pee when on the Utro part.

Have you thought of staying with a cycle ( or have we discussed this already?)?

Hurdity x

[Jeepers]

Hi

I take utrogestan orally every day, hurdity, so you think this is bad then?

I have been feeling dizzy and occasionally feel like I am going to faint, but I don't know if it's the utrogestan +which I take at night), or the oestrogel , 2.5 pumps in the morning, because I seem to feel dizzy etc in the morning, but by lunchtime it's gone away.

As for sleepiness, I don't have a problem, in fact I sleep really well at night, but I'm okay in the day time

Jeepers x

[Hurdity]

Hi Jeepers my comment was just an open question about what might be the effect of taking progesterone and testosterone every day  - which ljcybergal was thinking of doing. Lots of women take progesterone every day quite happily but she was talking about the one being sedating and the other energising and how this might work!

Don't worry!!

Hurdity x