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[Felix]

Hello Everyone,

My long, and so far mainly unsuccessful journey, with HRT continues I would really value some help with understanding which Progestogen might  work with for me?

I'm 59 and so far have tried:

Evorel Sequi patches - which was fine but I was advised to change to Conti due to my age.

Evorel Conti patches- started in June 2019.  Unfortunately, I had intermittent side effects with the Conti, these included joint pain in hands and feet, a feeling of having a raw mouth, feeling tired, painful boobs. So I stooped this in Sept 2019. I can only assume that my body didn't like having the Norethiserone for 28 days as opposed to the 14 days I got with the Sequi patches. So in October stopped using the Conti patches and came off HRT.

I was struggling with sweating, feeling anxious and painful sex so in April 2020 I was prescribed Estradiol gel daily and Utrogestan tablets days 15 - 26. However, I could not get on with the utrogestan and I concluded I must be progesterone intolerant. I felt awful, very tired, unhappy/no joy and emotional.

By June I tried taking 2x Utrogestan tablets  vaginally on days 15-26 to see if that resulted in fewer side effects - it didn't and I was having short but very very heavy periods.
I then tried taking 1 tablet of Utrogestan every night but this resulted in me feeling very low, critical & achy joints.

In October 2020, due to the side effect I was having I decided come of HRT and stopped the utrogestan and started cutting back on the Estradoil. Cutting back on the Estradoil caused me to have silent migraines. By the end of October I was off all HRT.

In January 2021 I Was really struggling with painful sex and the menopause clinic prescribed Intarosa tablets again, however I found that after about 9 days of intrarosa I was moody and critical and unhappy so I stopped them.

My conclusions are, and they could be wrong, is that I struggle with the  Progestogens I've had in the HRT I've been prescribed namely the:
Norethisterone - for 28 days in the Evoril Conti (I was OK with Sequi)
Utrogestan - either orally or vaginally
Prasterone dehydroeprandroserone DHEA - in the Inrarosa vaginal pessaries.

So helpful Menopause Matters Buddies I'm asking for any advice you might have about what if any Progestogens might work for me. I'm struggling with hot flushes at night proceeded with a horrible aura/surge of feeling anxiety and doom. I feel I've lost my va va vroom and have lost my joy somewhere. I feel flat and low so I've decided to try HRT again.

My doctor at the clinic has suggested I could try Femseven Patches - this has 7mcg Levonorgestrel so is a different Progestogen and I'm wondering if my body might tolerate this?

(Also I have been taking Imvaggis since August and that has really helped with bladder control however sex is still very painful. I might ask if I should increase the pessary to 3 per week rather that 2 to see if that makes a difference. Imvaggis is easy, if a bit messy so I wear pants at night when I use it.)

Any advice please on what HRT might work for me would be very welcome.

THANK YOU

Felix

[Mogster71]

Hi Felix

Sorry to hear you have been feeling so rough - I too have had a bit of a journey with HRT and especially the progestogens.
I found the kindest one for me via tablet has been Femoston (which is dydrogesterone). The only reason I came off it was another jump up in headaches, which had been the main symptom throughout for me. Femseven sequi patches weren't available at the time I eventually switched to transdermal HRT, so went on to Evorel sequi. It did take quite a while to settle though and weirdly enough I feel better on the progesterone bit now!

Femoston does a conti version so that may be worth a try but this is tablet form so if you prefer patch then I think the Femseven are the only option which isn't norethisterone.

I hope you can find a solution and feel better.

Mog x

[sheila99]

As you got on with evorel sequi why not go back on it? There's no medical reason you have to use a conti regime. Some women who can't tolerate utro are OK with provera. Or perhaps a mirena.

[Hurdity]

Hi Felix

Sorry to hear you;ve been having problems with progestogens.

Just to add that DHEA is not a progesterone nor a precursor of one - and it would be unlikely that your symptoms woud be due to the tiny amount absorbed systemically from vaginal use so I owuld suggest you can probably discount that as a problem.

The other thing is - great to try the other suggestions - but also I have never wanted to take artificial progestogens myself as my regular HRT so my compromise is long cycle HRT and I grin (more usually grimace!) and bear it despite being late 60's.

This is off licence and under medical supervision having found out how my uterus lining reacts to normal cycles - and also on a medium dose of oestrogen, and post-menopause. So I take 200 mg Utrogestan vaginally for 12 days per 6 weeks which means that for more of the time I am experiencing the benefits of oestrogen only. That's the best I can hope for and also the same for some women who also don't like the soporific, depressive effects of progesterone.

The other solution sometimes is to have a higher dose of oestrogen during the progesterone phase - which some women have reported can somehow override or counteract in some way, the negative effects of progesterone. This is only possible when you take separate oestrogen and progesterone so that you can tweak it yourself.

Hurdity x

[Felix]

Hi lovely people,
Thank you for your support, sorry I haven't replied sooner but I've been dealing with some other difficult life issues.
However,  after weeks of horrid hot flushes proceeded by awful feelings of doom I've decided I've got to try and find the right hrt for me.
I've been reading as much as I can both on this site and Dr Louise Newson's site.
I'm going to try the Estrogel  Utrogestan regime again BUT I'm going to try 1 100mg capsule vaginally every second night. With 2 pumps Estrogel daily.
I'm wondering if there are any of you who have tried this.
If this fails I might try asking for a long cycle similar to Hurdity.
Thanks again for your help with this. Such a great site and kind people 

[Felix]

Hello,
I started with 2 pumps estrogel every morning and 1 tablet utrogestan vaginally every 2nd night.

I started this last Monday so have had 5 days of it now.

On Thursday I started to feel a little bit like the old me,  more energy and not so flat, which is great.

However I'm still having bad hot flashes preceeded by waking up anxious. These can start anywhere between 1am and 3am and are very disruptive to my sleep.

Please could someone let me know how long it might take for the estogel to start working and the flashes to go  away.

Thank you 😊

[Hurdity]

Hi again Felix

Sorry to hear you are still suffering.

Usually those who use transdermal HRT find that flushes and sweats are the first to go - so you should begin to notice the effects of the oestrogel soon. Looking back at your earlier post when you said that "Evorel Sequi patches - which was fine but I was advised to change to Conti due to my age." - did your flushes subside or lessen on this regime?

There is no need to be on conti HRT at any age although there is a slight increased risk of endometrial hyperplasia etc  for those who remain on cyclical HRT - but this can be minimised through correct dosing of progestogen. You would also have to endure a withdrawal bleed if you could put up with that.

You need to be careful in any case with that reduced dose of Utrogestan and you may well get breakthrough bleeding.

In your position I would give it a few more weeks and hopefully the flushes and sweats will get less and less until you wake up one morning and think - ooh I haven't had one for a while....

WHen I started patches in my mid 50's (50 mcg) I was (probably very) late perimenopause and they worked like a charm and flushes and sweats have never returned except when I briefly stopped HRT once and also when I've reduced the dose ( and another time when I changed to gel).

It is possible you are not absorbing the gel so well but only time will tell.

All the best

Hurdity x

[Felix]

Hi Hurdity,

Thank you for your reply.

And yes for the last 2 nights I've only had a couple of hot flushes and they weren't proceeded by a horrid rush of anxiety. Goodness, it's such a relief to be sleeping better. I guess the Estradoil is starting to work yippee. I also feel far more like my old self and feel like I'm emerging from under a heavy blanket back into the world.

I've only been on this regime - 2 pumps Estradoil and 1 X 100 utrogestan vaginally every second night, since Monday 7th Feb but in the last couple of nights my sleep app has recorded that I've had some periods of deep sleep which I never got before.  The utrogestan does seem to help me relax, in this quantity anyway.

I've got a telephone appointment with my Dr  and Conifer House in Hull on Friday morning. She is lovely but I'm not sure how she is going to react to me taking Utrogestan every second day. I had some Estradoil and Utrogestan left from last time so I put myself back on this regime without her being aware - I couldn't wait until I could get an appointment - I was so fed up.  I had a scan a few weeks back because I'd had a very big bleed around October last year - they said my lining is normal but that I had some fibroids about the size of grapes.

From reading past posts I know there was a small study do in the past about taking utrogestan every second night and it does seem to be a regime some Drs will allow. I'm just wondering if you know any more recent studies I could point the Dr to  if she is unsure. I know it's early days but I want to keep with this regime for a while.

If I'm not allowed then I will ask about the long cycle such as you are on, I don't want a bleed but I'd put up with it if I had too

You asked about what happened when I moved from Evorel Sequi to Conti, I can't honestly remember, I don't think anything happened  with my hot flushes.

I've had no break through bleeding as yet but I am monitoring all my symptoms on Dr Louise Newson's Balance App.

I'm also wondering if I should perhaps start a new thread/post entitled 'Utrogestan alternative nights' to see how other members are getting on. The title of my thread /post is a little confusing I think?

Thank you for all your help Hurdity

Felix