Thanks everybody.
I want to start by saying that compounded hormones aka BHRT or bespoke hormones are not available on the NHS and are not mainstream HRT. To that end, they are only suitable for a minority of women who are post menopause, have tried conventional HRT and/or progesterone intolerant and need a bespoke progesterone dose. So compounded hormones should not be your first port of call and should only be considered as a last resort ie if you are facing having to have a hysterectomy to combat progesterone issues or you are having to ditch HRT altogether because you have not been able to find a suitable form of conventional progesterone.
I am probably an unusual case because I can't tolerate any form of synthetic progesterone including the Mirena coil or Utrogestan at any dose or in any combination. Like GRL, I had been successfully using the low dose 100mg 7 day Utrogestan regime for a number of years but I got to the stage where I literally could never take Utrogestan again because it unbalanced my hormones to the extent I was having continuous silent migraines. I was staring down the barrel of a hysterectomy.
I decided to have one last attempt to find an alternative before opting for a hysterectomy when I came across bespoke progesterone. I decided to consult my migraine specialist again and she said I had to stop having a cycle and needed a balance of body identical progesterone, oestrogen and testosterone every day without any fluctuations. We delved further into my migraine history and she concluded that my migraines started in peri menopause because of the lack of progesterone which, during my reproductive years, had acted like a protectorate and prevented my having migraines because it was balancing out the oestrogen (preventing spikes) hence no migraines until my progesterone levels dropped dramatically. This also explains why I was able to take the contraceptive pill and have a Mirena coil without migraines pre menopause. It is possible that a hysterectomy would not have worked in my case.
Armed with this information and on the back of a recommendation, I found a clinic in London who specialised in bespoke hormones. The dcotor (who also works at an NHS menopause clinic in London) read the report from the migraine specialist, went through my endless pages of blood tests results and agreed that I desperately needed hormone stability and prescribed 50mg progesterone every day alongside 1 pump of Oestrogel and testosterone. I was horrified, not least because of my problems with Utrogestan but also I had to stop using the Lenzetto oestrogen spray which I loved - she said it is a good product but not stable enough for migraine sufferers. She assured me that my experience with the progesterone lozenge would be nothing like vaginal Utrogestan. I was not convinced and told her I didn't think it would work and that I would only agree to it as long as I could use 2 pumps of Oestrogel every day. We had a deal. I went away thinking I would give it a try but I was not confident. I am pleased to say I was completely wrong!
That was over 18 months ago and it has been brilliant with no side effects, no bleeding (consistent womb lining of 3.3mm) no breast pain (something I have always experienced with all types of progesterone) no PMS symptoms or any side effects at all. I feel as good as I did on the oestrogen only part of the cyclical regime.
I was using a split dose of Oestrogel, 1 pump in the morning and 1 pump in the evening and I had a migraine during the afternoon so I have since reduced to 1 pump of gel in the evening which rectified the problem and didn't notice the difference. The migraine specialist said that the migraine was caused by the extra pump of gel in the morning which threw my hormones out of balance - my migraines are caused by oestrogen spikes.
To pick up on your point Stellajane, these clinics are very closely self regulated and you have to jump through hoops to get a prescription. At the initial consultation, I had to take all my blood tests results, latest transvaginal uterine scan results and I took a copy of my latest breast ultrasound scan. For the follow up consultation a year later, I had to produce a new set of blood test results, new uterine and breast scan results and I gave them my DEXA scan results. I would not have been able to get a repeat prescription without providing these test results. So it is not possible to cheat the system and pretend to be toeing the line because you have to provide proof and they need to see that the regime is working properly.
I should point out that this regime would not have worked for me 10 years ago. My oestrogen levels are consistently about 270-300 pmol which would not have been anything like enough for me before and I would have been constantly sweating buckets. I imagine the body changes over time and perhaps it is possible to be symptom free on a lower dose of oestrogen. Who knows.
Of course this regime will not work for everyone, there is no such thing as an HRT regime that works for everyone. However, for women who are having extreme difficulties with progesterone or perhaps those who have stopped using HRT and struggling to cope with the symptom or even those who don't want to bleed for the rest of their lives and can't stand Utrogestan, this is definitely worth considering.