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[lucie79]

Hi

Looking for advice please.  I'm 43 and peri-menopausal.  Have been skipping periods now and then plus  very up and down with brain fog / anxiety.

Last November I started Utrogestan (200mg for 14 days) and 50mg Evorel patch.  Because I had side effects from the Utrogestan the GP advised me I could take 100mg every day for 25 days with a three day break.

I have been doing this but have experienced some really painful and heavy periods although last month was very light.  Apart from pretty horrific periods I've been feeling OK and definitely better than before.

I read online that this regime is only recommended for ladies who are post menopausal.  Just wondering if anyone else has experience of this regime in the peri-menopause stage and did it cause any period problems?

I had convinced myself that the estrogen had triggered endometriosis flare up because I've had so much pain.  I had a pelvic scan recently and they said everything looks fine.  I have been given a prescription for amitriptyline for pain but waiting to see what next month is like before I take it.  I had endometriosis diagnosed via surgery for fertility investigations in 2013 but never had too much pain till I started HRT.

Just wondering if anyone has any thoughts or has had similar experience

It says Utrogestan can cause abdominal pain so maybe this is what I'm been feeling?  It's all very confusing so appreciate any thoughts or help

[Sarah48]

Hi Lucie,

You can take Utrogestan, as you are, with a three day break even if peri menopausal.   You can take Utrogestan continuously, with no break, if you haven’t had a period for 12 months or more.    As I also take the mini pill my consultant said I don’t have to have a break either, even though I am peri menopausal.  It’s all so confusing!!

I have had dull stomach ache since starting HRT 4 months ago, but it is only mild.    I think oestrogen can encourage fibroid growth and they can cause heavy bleeding and pain. 

Amitriptyline can make you feel quite sleepy, but worth taking it if it could help.   

I would suggest going back to your GP and asking about Fibroids being a possible cause.  A colleague of mine had the exact same symptoms as you do and when she had a scan they discovered multiple fibroids.  She is having a hysterectomy as got really fed up with the pain and bleeding.

Hope you get some answers x

[joziel]

If you have/had endo, you should be on a continuous progesterone regime !!!!!!!!  Yes, even during peri!!! So that first protocol you were on was totally wrong for you.

I'm so shocked to keep coming across women on FB or other places who have had endo and are on sequential!!!

Estrogen (without progesterone) WILL FEED YOUR ENDO!

Moreover, it can be challenging to get the progesterone right to suppress the endo - and take some expert advice and knowledge. If your doctor doesn't even know not to prescribe sequential HRT to a woman with a history of endo, they probably don't have the knowledge to help you navigate the progesterone.

Often utrogestan isn't sufficient by itself for endo sufferers, to suppress their endo. I am 44yo and have been on Cerazette/desogestrel mini pill for 9 years before I started HRT (it was making me symptom free from endo) and I decided to try stopping the Cerazette at the same time I started HRT.

I was on continuous utrogestan 100mg. After 5 weeks, I got back all the old familiar endo pains in all the same old places. So I re-started Cerazette alongside the HRT and all is now fine. I want to at least try, at some future point, switching the Cerazette for 200mg of continuous utrogestan... but I know it might not work.

Which is all to say, it is very likely that 100mg of utrogestan isn't going to be enough to control endo symptoms. It doesn't stop ovulation. Your ovaries are still functioning and at ovulation estrogen floods the abdominal cavity... For me, endo control means stopping ovulation and trying to provide stable and consistent hormones without big fluctuations.

You could ask to try doubling the utrogestan to 200mg continuously. If even that doesn't work, then you could go back to 100 continuous but add in a mini pill (as I've done) - Cerazette is the mini pill which stops ovulation consistently so the one most often used. Alternatively, you might need to try some of the synthetic progesterone HRTs because often those control bleeding more. Femoston Conti with dydrogesterone is often recommended for endo sufferers and I've heard from a few people now that it has been good for them - although some people need more estrogen.

[CLKD]

 

[joziel]

Yes, welcome, sorry if I was a bit negative there. I am just shocked  at all the misinformation around. I'm not a medical professional and in trying to figure out endo/HRT I feel like I now know more than most doctors about HRT(!!!). I've even done the Louise Newson Confidence in the Menopause online course(!!) for GPs! I still feel like I'm stumbling around trying things out because there isn't enough experience/knowledge/research out there to guide complex situations yet. I feel like if you're not Ms Average with nothing else going on, good luck(!).

If you scroll down to my 'endo and HRT - a trifecta' post (can't remember what I called it!) you'll be able to read my story with endo/HRT if any help.

I am in a holding pattern now, waiting for estrogen to stabilise and palpitations and estrogen side effects to go away, then I might try switching Cerazette for 200mg utrogestan.

[lucie79]

Thank you so much @Joziel and @Sarah48 for the advice.  It's really useful.

Can I ask when you say continuous HRT do you mean even without the 3 day break?  Or 25 days on 3 days off?

In 2013 I had a lap and they said I had moderate endo with patches on bladder, pouch of douglas ovaries encased etc.  They gave me laser treatment and that was that.  This was all about getting pregnant though and thankfully I never really suffered with pain.  I never had any treatment or follow up about endo after my baby was born as I wasn't in pain.

Post starting HRT I had convinced myself that the pain was endo and I'd probably have another operation so was surprised when they scanned me and said I'm totally fine... carry on with the HRT.  Last month I had virtually no period only spotting - I assume this would have been a month when I skipped a period before HRT.  It's hard to be pushy with the doctors not knowing how I'll be month on month.

It's hard to know what to do!  I asked if I can be referred to a menopause clinic and they said no need.  I feel like now I've had a clear scan it's like I imagined it all

[joziel]

The 3 day break idea is a bit old school. It's not really used anymore. You're either on progesterone for half the month (sequential) or always (continuous). Having a 3 day break doesn't do anything positive and just upsets your hormones and makes it more likely you'll bleed. Unfortunately way back at the beginning, it is what was used when they first tested things and in the research - so some doctors who are behind the times still use it.

So I'm on continuous, meaning always....

Snap on lots of counts there -I also had my lap in 2013 but only had mild endo. It was on top of my bladder, bottom of my uterus and right pelvic wall. Everything else including ovaries was fine. It was also layered off. I didn't know the importance of trying to get it excised then, but I think the bladder endo might have been hard to excise as the bladder is v sensitive anyway.

I was on desogestrel POP just before that surgery and remained on it for 9 years. It suppressed my endo but it also gave me migraines. I know it was the POP for sure because I stopped it for 10wks when I started HRT and I didn't have a single migraine. I restarted it 2 weeks ago after endo pains came back and I've now had 2 migraines in the last week. It is known to cause headaches for some people. I think it also disguised my peri menopause or maybe hastened it - it causes a low estrogen state by keeping your ovaries in the early follicular phase.

If your problem is heavy and painful periods, have you considered the Mirena coil? This is known to be ideal for that. I don't want the coil but many people swear by it. Whilst they are happy to give it to women with endo as the progesterone for HRT, without anything else, since it is supposed to act only locally and since endo can be anywhere, you could also continue the utrogestan at 100mg to suppress any endo deposits.

[Hurdity]

Just to add that the Mirena coil does provide some systemic absorption of levonorgestrel - but just minimal in comparison with contraceptive pills contains the same progestogen, but I've no idea whether this would be sufficient to suppress growth of endometrial deposits.

Hurdity x

[joziel]

Just to add, if it's any use... I had a follow up today and the next plan of action is for me to try stopping the Cerazette again and switching it for 200mg of utrogestan, to see if that will be enough to keep my ovaries dormant 

If not, I go back to 100mg and re-start Cerazette and then the choice will be either to stay like that until menopause (when hopefully the ovaries will be dormant by themselves!) or I'd have to completely change regime and try a different synthetic progesterone....