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[Nettie3070]

Hi All...Im on continuous combined HRT...2 pumps gel 100mgs nightly of utro...i was advised to go on this regime to help with my pms like mood swings on cyclical however I just feel 'flat'..no motivation, no enjoyment.Im sure its all hormone especially the progesterone related.I wake up feeling sad.Has anyone had this and did you change your regime?

[Nettie3070]

Can anyone help?

[Sammiejane]

nettie3070

how long have you been on this regime as it takes some time for levels of estrogen to rise and a good 6 months for things to settle x

i've been on estrogel and have recently stopped it but only because of hair shedding which is still happening so i may be looking at combined regime x

[Shannonplussed]

I know that flat feeling!! When I can't so much as smile when my favourite song comes on. No spark of joy in anything. That's my hormonal upheaval feeling (often paired with an incredibly short fuse). That is why I also take continuous instead of cyclical. I started continuous and then tried cyclical, and I'm happier with cyclical. The ups and downs are no good for me (or my family or coworkers!). Maybe you're not having the right dosage of estrogen, or the right ratio for you? Now that I've had things settled, if I feel like that again, it's usually just before some spotting or bleeding; something is clearly in the works.

[Ladybt28]

I cannot take progesterone continuously, Nettie.  It starts off making me flat and tearful, everything you describe, and by the time it has built up over a couple months I am pretty suicidal!  I now use it on a cycle and yes I get a bit "dippy" around the cycle but now it has settled it is quite manageable, I know what is happening which makes it easier to deal with and I know in my head it will soon be over.  It did take a while for the cycle to adjust and the flat feeling to lessen on the cycle.  The symptoms even on a cycle took about 6 months to form a consistent pattern.

I tried 6 types of hrt and found out that the progesterone part is a problem for me and also the type of progesterone.  After much trial and error I use utrogestan for 12 days but I am like a couple of ladies on this forum I extend my cycle slightly.  I run 28 days gel and 12 days utrogestan.  I have to bleed (which some may think is awful and some GP's think unnecessary at 58) but it is a very small price to pay for feeling vaguely normal and it has been the only thing that really works for me.

[Ladybt28]

How much utro Birdy and are you running a normal 15 day 12 day cycle?  Sorry to ask again and I know you have said but I can't seem to keep the different posts in my head.
I run 28 days gel, 12 day utro at 200mg vaginally but I am on higher levels of gel 3-4 pumps.  If you are down at 2 pumps then I believe Hurdity and others have said 100mg may be sufficient.  Your bleed is scant because you are not building up any womb lining it is remaining thin, which is a good thing.

I extended my gel days because on 15/12 (which is the normal prescription), the last days of withdrawal kept coming too quickly.
I think Hurdity runs a 6 week cycle as do some of the other ladies (maybe stellajane???)

[Ladybt28]

100mg Utro is borderline on 3 pumps of gel and I'm sure Hurdity would say the same but it is continuous so that balances it out, but if you are having your womb scanned or monitored and the thickness doesn't build up then there are ladies who do that with the proper monitoring.

You are on your testosterone blob every day.  Try going every other or twice a week?

I found in the early days taking the progesterone caused cramps and restlessness at night and for the first 4 months of the cycle it was like having PMT and then it all settled down.  I don't get any issues until day 8 of taking it and then I get "flat and a bit teary issues" during the bleed but that's it, it goes away after that.  As I have said before it took a full 7 months before all the pieces of the puzzle fell into place and everything levelled out.  I still get those issues get the dodgy "period week" but I know its coming and I know it will go.  I know its hard to "have faith" whilst it sorts itself out. If you have been chopping and changing which you have looking for answers then things will go "up the left".  Keep persisting with what you are on and hang on in there for at least 12 weeks (3 months).  If you find you are getting worse with the depression side then it's continuous progesterone, I'd lay my life on it.

You still go the problems on the cycle but that takes even longer to settle but if you could ride it out if the above doesn't work then you ay well find it settles fine it's just whilst you are feeling so unwell, you just want a quick fix.  You know what I say about it...if you are sick without hrt and still suffering 6 months after the only thing you can do is really keep going because, giving up often isn't an option either.  cc

[Ladybt28]

You might need high oestrogen Birdy some of us do. I think Sgtvhilts shows high oestrogen on testing but still has to use high amounts to keep her levels right.  You are just going to do what you are doing and wait....patiently   rubbish I know..thinking of you cos I remember those feelings all too well.

[Hurdity]

Hi All...Im on continuous combined HRT...2 pumps gel 100mgs nightly of utro...i was advised to go on this regime to help with my pms like mood swings on cyclical however I just feel 'flat'..no motivation, no enjoyment.Im sure its all hormone especially the progesterone related.I wake up feeling sad.Has anyone had this and did you change your regime?

As the others have said - if you are taking progesterone continuously this can lead to the flat feelings as it is a sedative. Sadly we can't have it both ways on HRT - either we have (to put up with) the cycle which means we go up and down with the prog as we have to take it regularly, or we have it all the time which keeps us more on an even keel - but then there is the depressive effect.

Like Ladybt says - I do a longer cycle like she does, so around 4 weeks of oestrogen only patches then the 12 days of Utrogestan vaginally. I am experimenting with lower dose of prog ( 100 mg) because I have been on HRT for 12 + years and have had various scans at various points so know how my womb behaves and my last scan ( before I started this) was 4.8 mm just after the bleed which is better than I could hope for! My oestrogen levels are also not very high. I put up with the prog and the withdrawal and the bleed because I know it's going to end and I have a few weeks of feeling good again - although I would say not with quite the same enormous zest for life that I had when fertile and my hormones were wonderfully high - that would be imposdsible to achieve if you still have a womb (due to having to take more prog!).

Once you are post-menopausal or even when late peri you could explore with the doc making your cycle a bit longer. Alternatviely you could increase your oestrogen dose (with doc's approval) to see if that is sufficient to lift your mood without causing breakthrough bleeding?

Hurdity x

[GypsyRoseLee]

Hi. I so recognise the progesterone flatness/nothingness. It's horrible. When I tried Femostan 2/10 as soon as I went onto the combined oestrogen/progesterone tablets I was nearly demented with how low I felt. I felt suicidal, and that's not something I say lightly. It was that extreme.

Luckily, I seem to tolerate my current Utrogestan regime, which is just 100mg x 7 days per month. The only side effects are that I felt very, very sleepy mid afternoon whilst on it. The only time I reacted badly to Utrogestan was the time I tried it vaginally. I felt awful within 24 hours, so low. Never again.

I think the reason I'm not effected by the Utrogestan is because I balance it with a high oestrogen dose of 4 pumps. I think I'm exceptionally sensitive to hormonal fluctuations, and especially progesterone. When I told Prof Studd about my history of severe PMS and PND he said that proved I was highly intolerant to progesterone. He admitted he'd known women commit suicide because progesterone made them feel so dreadful.

It's a very real problem and not to be dismissed as 'feeling a bit blue'. In just the same way that most of us can scoff a packet of peanuts without harm, but an unfortunate few only have to eat a grain of peanut and it can kill them. I 100% believe that severe progesterone intolerance kills women.

I know my Utrogestan dose is low, but I have yearly utertine scans and my lining stays nice and thin, and my withdrawal bleeds are very light and only last 3 days.

Have you considered upping your oestrogen to 4 pumps, which should be enough to surpress your cycle and should buffer you against the side effects of Utrogestan?

[Pinkjan4288]

thank you for starting this thread. I have been feeling what can only be described as apathy to everything. im tired and need a nap most days.

I take utrogestan for 25 days a month ( 100mg) and have 2 pumps of gel daily. I feel so flat. I changed my regime in summer because I cant sleep when I stop the progesterone for half the month.

I barely bleed when I have a break and its also takes ages to start any sort of period

[pants46]

Birdy, and others,
I'm only 2 months in to my hrt. 100 patches and 12 days of utrogestan 100.
I used the patches only for 6 weeks, never got my bleed. And didnt stary to feel great or anything. Then started using the utrogestan. I panicked about taking it orally, so used it vaginally. Didnt feel too bad on it. Then when I stopped I felt awful, for the whole time yntil I started again.
When I started again, I tried orally, but felt terrible after 4 days. So switched to vaginally for the rest of the 12 days. I felt ok ish after a few days using it vaginally. I've come off it, felt ok (almost good) the day after I stopped, then the anxiety has ramped up again.
I don't think I can go 11 more days until I start it again.
Given that I'm on high dose E and low dose of the U, do you think I can take the U for 3 weeks a month and just stop for a week to get a bleed ?
I'm not sure I like the idea of shoving it up there 21 days out of 28, but if it works, then I could manage it for a year or two.
What do you think ?

[Sgtvhilts]

HI,
I guess the answer lies in what works for you.  If you feel better on Cyclical etc.  Are you on enough Oestrogen though.  Also i feel a dip in mood when i am on the Oestrogen only part of my HRT.  I think it is quite common, no less pleasant though. About the old 'cost /benefit conundrum.
Me and progesterone are sort of life long enemies.  We hate each other.  I have found only one that dosen't risk me getting sectioned or vomiting my own stomach up,  that being dydrogestone.  Wierdly though, i do feel my mood is better when i am the progesterone bit of the hrt, Don't ask me how that works out.  I am an enigma.

[Mary G]

I agree that progesterone intolerance is very real and should be taken very seriously. 

Because I can't take any form of synthetic progesterone and suddenly hit the buffers with Utrogestan I (wrongly) thought I was progesterone intolerant but I had no history of PMS so I was somewhat baffled.   Like GRL, I successfully followed the low dose 100mg 7 day Utrogestan (vaginally), Oestrogel and testosterone regime with yearly transvaginal uterine scans and always had a very low womb lining measurement but the withdrawal bleeds were making me feel ill and I was suffering with silent migraines.  I was seriously considering a hysterectomy.

Basically, the Utrogestan was destabilising my oestrogen levels, causing them to spike which then led to the migraines so I had to stop using it.  I desperately needed hormone stability.   Perhaps these hormones spikes cause different problems with some women?

I never thought I would say this but for the past 15 months I've been on a continuous combined HRT regime and it's going extremely well but it's taken me a long time to get there and obviously it's only suitable for post menopausal women.   

[pants46]

Yep, Birdy. That's why I posted, cos I thought ..  hang on ... I'm having the same issues as Birdy. xxx
Although, I'm only 2 months in, so I guess it could settle down a bit. Or maybe that's just wishful thinking.
Anyway, I see my hormone man on 26th Jan. Hopefully he'll take some more blood to see whether I'm absorbing the E ok. And then I can talk to him about doing long cycle Utro.