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[Mintea]

I have been reading a lot about natural progesterone compared to synthetic progestins. It seems that micronised natural progesterone is very beneficial to health in lots of ways whereas synthetic progestins aren't. I am taking Evorel Conti which has a synthetic progestin and so am obviously concerned about this particularly as I tried Utrogestin but it didn't seem to work as I bled really heavily and felt depressed. I was advised to take EC by an NHS BMS specialist and it seems to have helped a lot with joint aches and pains but I do feel a bit foggy and irritable which I think is probably due to the progestin.
I am wondering whether to continue with this or if any one has any alternatives to suggest. I dont want a mirena coil.
I'm also wondering if the benefits of Hrt on heart health, bones etc are less when taking a synthetic progestin and if the increased risks are justified by the other long term health benefits. Sorry about the long post and I realise there are a lot of conflicting  views on this but it would be interesting to hear what others think.

[Hurdity]

Hi Mintea

I would always want to take the most "natural" hormone replacement product ie ones that are biologically identical to those our body produces. It is not surprising that such hormones are beneficial in more ways. eg synthetic progestogens are only chosen for their effect on prevent uterus lining from being stimulated to grown and thicken under the influence of oestrogen - and they may or may not have beneficial or less desirable effects on other parts of the body. Some of these have been studied although I don't think results are definitive - eg effects on brain, breasts etc. I'm just groping in the depths of my memory here ..... but there will be plenty of studies out there - sorry I've no time to look up  any.

As with all things you need to weigh up risks and benefits, and taking into account your family history, age, general health, how long you want to stay on HRT, quality of life vs unquantified nebulous small increased risks....etc

Cardiovascular health and bones - as far as I understand it is oestrogen that is the crucial hormones here though there have been some studies re progestogens and bone taken in conjunction with oestrogen but I cant recall the outcome! There s some info on this website - check out the main menus and news sections.

Sorry this probably isn't much help at all....

Hopefully someone else might be along....

Hurdity x

[Wrensong]

Hi Mintea, no time to reply at length this morning, but just to comment on your concern about bone health & progestogens.  I believe the Norethisterone in your Evorel Conti is thought to contribute to bone health.  Have trawled briefly this morning for research to back this up & best I can find being short of time is this, which is an old paper & small study, but perhaps might be a little reassuring:-

https://pubmed.ncbi.nlm.nih.gov/8287582/

MPA seems to be the progestogen to be more wary of as regards bone health, though from memory deleterious effects are thought to be offset by the presence of sufficient oestrogen.

Like you, I can't tolerate Utrogestan & in fact struggle with all forms of prog, but need HRT for QOL (& osteopenia) & bottom line is I'm better with than without.
Wx

[Mintea]

Hurdity
Thankyou for your reply. It has definitely been helpful and is always good to read your well informed posts.
 I also would prefer to take the most 'natural' hrt but sadly dont seem to be able to.
I suppose I'm trying to work out if the  negatives of taking a synthetic progestin outweighs the positives of the estrogen. So far for me the EC has helped with joint pains, VA and  libido which as well as preventing osteoporosis, were the main reasons for taking it. However, I still have irritability and brain fog to a degree which I dont like. I find it hard to get my mind to come up with names of things which I am sure I know. I dont think I had this problem before.

Mintea x

Wrensong
Thankyou for your reply and link which I've read. The study does find a strong beneficial link which is encouraging. I am searching for that elusive QOL but it doesn't seem to be as easy as it sounds as an improvement in one area seems to mean a deterioration in another!
In my case,  although my aches, pains and VA are better my mental state isnt and that is so important.
I'm wondering whether to take a break for a while as it's hard to remember exactly how bad i felt before starting on this journey.

Mintea x

[Wrensong]

Hi Mintea, I sympathise with your situation as I'm also still trying to find a better fit & like you have felt disappointed I've been unable to tolerate Utrogestan, especially given it seems to be the preferred option of menopause authorities & discouragingly for those of us who can't take it, often appears in articles comparing the synthetics unfavourably.  I also don't want an IUD, which seems to be the 2nd most favoured option,  as it seems too risky to have a device implanted that I can't remove myself when its very obvious my body really, really doesn't like prog.

That you are considering a break to see how you feel without HRT seems very sensible.  I also wonder though, if you haven't tried FemSeven, whether the Levonorgestrel in that might suit you better than Norethisterone, which a lot of women seem to feel bad on.  Perhaps an option for the future if it feels right to taper off now to assess how you are without HRT.  There's also the Femoston range as the Dydrogesterone in that has a more favourable profile than the other synthetics & is considered a gentler form of prog, but that's oral so you may prefer to give that a miss.

I hope whatever you decide you soon feel better.
Wx

[Mintea]

Thanks so much for your reply Wrensong. It has made me feel a lot better already to read your suggestions which I will look into in more detail.
I should be due another telephone appointment soon with a menopause specialist so will probably discuss with her. I have a vague memory of hearing that Dydrogesterone was the safest synthetic in a fairly recent study but have been advised that transdermal is best for me.
I feel exactly the same as you about having an IUD.
I'd be interested in hearing about your experiences but will read your posts so you don't need to reply here unless you feel like it.
Mintea x

[Wrensong]

Hi Mintea, glad it helped a little to chat to someone in the same boat .  Please don't bother to trawl through my posts though if you want to know more about what I've tried - most are like War & Peace!  You can always PM me with any qs or if it might help to compare notes in more detail.
W x

[Quandry]

Can I also join this discussion, as I popped into the Forum today (after a LONG absence) to ask/research the exact same question!

For me, I've been on HRT probably about 6 years now and it has helped enormously with flushes, joint aches, restless legs, sleep and concentration. Despite being post-menopausal (I'm nearly 55) I've stuck with a low dose sequential regime -  Elleste Duet 1mg (or Novofem, which is the same, when there have been shortages) as I found that a continuous regime just sort of dulled me down and left me felt feeling continuously 'flat' and sad.

I've also read about the benefits of transdermal HRT and tried patches (Estradot) and Utrogestan, but I had such a terrible reaction to the Utrogestan - it gave me blurred vision, migraines and left me so knocked out at night that I ended up damaging my shoulder by sleeping heavily and awkwardedly on it.

I've recently started sleeping less well again and I wonder if I need slightly more estrogen sometimes? I'd love to manage this by using Estrogen gel, rather than simply getting a higher (double!) dose tablet.
Are there any other alternatives for the progesterone part, other than Utrogestan and Mirena (I really don't want the Mirena)? Can you get any other progesterone tablets to match with transdermal estrogen?

It's so hard to find any specialist healthcare people to talk to about this. The private meno consultant is £250 for an initial chat and £200 per follow up!

[Wrensong]

Hello Quandry

Can you get any other progesterone tablets to match with transdermal estrogen?

MPA (Provera) tablets are sometimes prescribed (my current prog) & norethisterone tabs can be taken with transdermal oestrogen, though I think you will be familiar with that progestogen from Elleste Duet?  You may want to research the MPA first! 

MPA is considered somewhat old fashioned & is not favoured by some doctors who consider it to have a less than favourable risk profile.  There is also some evidence that it's not beneficial to bone health if used long term (I saw 2+ years mentioned in one study), though I believe that's thought to be offset by the presence of sufficient oestrogen.  Some women get on well with it, some less so.  It has the advantage of coming in several strengths & seems to be pretty efficient at lining control, though that's just my personal impression on low dose oestrogen. 

In my experience, norethisterone tabs are also efficient in that respect, though again, I've only used them with a low dose oestrogen patch.  I found norethisterone tabs side effects too awful to continue with & I have to admit I also really struggle with MPA.

Some of us just seem to react badly to all forms of prog, but please don't let that put you off as many women find one they don't have probs with.
Wx

[Quandry]

Wrensong
Thanks so much for your reply. I think I've mostly managed OK in tolerating the norethisterone - at least on a cyclical basis. Are you saying that there may be an option to combine transdermal estrogen with a norethisterone tablet?

So many people seem so anti synthetic progesterone it worries me - I really need to read the research myself to understand the actual risks.

In an ideal world, I think I'd like to be able to vary my estrogen a bit, as necessary, but stick with a progesterone I can tolerate for 12 days of the month.

[Wrensong]

Hi Quandry.  Sorry to be so long in replying - was away from the forum for a few days.  Yes it is possible to combine norethisterone tablets with gel/patch/spray oestradiol.  Have a look at the Chelsea & Westminster Hospital leaflet link & relevant extract below.  I have used the tabs with Estradot patches, but only for one cycle as for me, MPA has been marginally more tolerable.  I completely agree & sympathise about the offputting negative press relating to progestogens, but many women do well on them.  If we can't tolerate Utrogestan, have uterus still intact & need oestrogen, it can feel like we're between a rock & a hard place .  At least on a cycle you're minimising exposure to prog.

https://www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause-and-pms-clinics/links/ProgestogenandProgesteroneRegimensinHRT130518AGREED.pdf

"When is a cyclical progestogen or
progesterone used in HRT?

If periods have not stopped for one year then there is
a risk of further menstrual bleeds occurring. To avoid
the risk of irregular bleeding on HRT a progestogen
or progesterone is taken for 12-14 days each month
and an artificially induced bleed will follow
discontinuation. Common prescriptions are:
• Norethisterone 5mg twice daily, for 12-14
days every 28 days
• Utrogestan 2x100mg capsules at night, for
12-14 days every 28 days"