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[Keep On Swimming]

Hello everyone,

I hope you are all well.

Please can someone help me!

Quick background details: 48 yrs old, night sweats started at 46, became horrendous (accompanied by palpitations, insomnia, nausea+++, crippling anxiety and very low mood) in March 2022, started Estréva (estradiol - oestregen) 0.1% gel 3 weeks ago and after 5 days my symptoms are MUCH IMPROVED, almost disappeared! I'm on a progesterone-only pill because I have adenomyosis so have no idea where my hormone levels are at.

So, this is the problem: I was prescribed the (wonderful) gel by the other gyne in the practice because mine was on hols. Mine just sent me an email to say, please come and see me to discuss your treatment. Managed to get her on the phone and she is not in line with the fact that her colleague prescribed me the gel with my progesterone-only pill. She says I should be given the Mirena coil for the progesterone part, but I tried a coil years ago and it was awful (contractions).

If I was at home (I'm in France) would they give me oestrogen gel + the progesterone-only pill? I'm totally freaking out she's going to take the gel off me if I don't get the coil put in (not an option)... Is there anything else I could take for the progesterone part? I totally love the pill I'm on though (Optimizette).

Has anyone any information about this? I'd like to be able to take a reference document from the NHS for example, saying that HRT + POP = ok but I can't find any online information.

I'm seeing her on Monday, any help would be much appreciated!

Thanks and bonne soirée !

[Keep On Swimming]

Ok, I just saw that Dotty wrote this to me a few weeks ago in another thread (thanks again Dotty!)

"Hi yes you can be on hrt as well as the mini pill, but would still need to take progesterone as part of your hrt as there’s not enough in the mini pill."

Ok, so now I'm getting it - is my gyne going to add progesterone to my regime? Is that "micronised" progesterone? I've seen so much bad press here about progesterone that I'm worried. Will it be everyday? Gel?

Sorry to be bombarding everyone with questions but I'm clueless about the whole HRT thing and I want to make sure I know what's going on before I go in there.

Thanks for reading my messages!
xxx

[Taz2]

You could use Utrogestan as the progesterone element I think. This can be used alongside the gel and the progesterone only pill so you keep your contraception method. The pill alone doesn't give your womb enough protection as you are adding in oestrogen. I think that's correct.

Taz x 

[Keep On Swimming]

Hi Taz2

Thanks so much for explaining!

But Utrogestan has such bad press from a lot of ladies on here, right? I'm really worried now. Can anyone tell me how much I should be put on? What form (gel, tablets?) etc. and how often in the month?

Time for a glass of wine, I think 

[Keep On Swimming]

Sorry, me again...

Can you get just vaginal progesterone? Would that work?

Right, I'll leave everyone alone now and go and have that glass of red...

xxx

[Keep On Swimming]

Ok, so I've been reading up about progesterone and it seems that the only bio iodentical type is Utrogestan and that's in tablet form. And the vaginal and gel types aren't as efficient as Utrogestan in protecting the womb lining.

Does that all sound right? Does anyone know if the gel/vaginal form are prescribed?

So, given that the coil gives me contractions, my only choice seems to be Utrogestan. And the whole issue for me is that oral tablets (antibiotics, stomach meds, whatever) mess with how I absorb my thyroid meds (I'm really sensitive) plus from what I understand you only take Utrogestan 12 days in the month and my poor thyroid meds need the same thing every day.

Feel like I'm stuck... But I deffo don't want to give up the oestrogen gel now I know how beneficial it is!

Any advice would be very welcome. I'm so annoyed I have to add another thing to the mix and mess up my already-messed up thyroid meds dose (= makes me feel weak, shaky, dizzy). I mean, how can the other gyne have forgotten the progesterone part of my treatment?
 

[Wrensong]

Hi Keep On Swimming, no time for much this morning so please forgive the abruptness of this post. 

1) Many women on here use Utrogestan vaginally to protect the endometrium whilst reducing the side effects of progesterone.

2) I hear you on the thyroid meds issue - I'm also hypothyroid & find HRT affects my thyroid levels.  Oestrogen can effectively reduce active thyroid hormone availability, though it's said more likely to be a problem with oral oestrogen.  There is also a smallish study that found that conversely, progesterone can potentiate thyroid hormone.  A number of hypothyroid women on here have found our thyroid levels affected even on transdermal HRT, but my impression as a long term forum member is that it seems to be those of us who require a T3 component to our thyroid replacement regimen rather than those on Thyroxine alone.  I think more research is needed for hypothyroid women on HRT!

I saw one of your other threads the other day & meant to post on it but have been short of time.  Sorry &  !

[Keep On Swimming]

Hi Wrensong!

THANK YOU THANK YOU THANK YOU!

I can now go to my gyne here in France on Monday and say please give me the VAGINAL progesterone. I just don't want to add anything oral in with the thyroid meds. I'm ultra sensitive and therefore really hard to dose.

I totally hear you re. research and thyroid meds / menopause... Are you dosed correctly? It took 8.5 years to get me dosed right (total bliss) for 1.5 years then menopause kicked in and it's been a roller coaster since March (hypo). Shakes, weak, dizzy, sea sick... Great stuff altogether!

Have a lovely weekend.

[Wrensong]

No problem  Yes, some women on this forum do use the oral 100mg Utrogestan capsules vaginally & there will be lots of threads discussing that if you want to do a search.  I don't know whether you may be able to get Cyclogest or Lutigest progesterone pessaries in France, so perhaps something to raise with your gynae, especially with adenomyosis in the mix, which must really complicate things for you & I imagine needs careful consideration as regards HRT?  I have no idea what may or may not be suitable for you in that respect, so please do discuss all this with whoever helps you manage it.

I think the lowest dose Cyclogest come in is 200mg as opposed to 100mg being the lower of the 2 doses for Utrogestan.  I have never taken the 200mg Utrogestan but I think these are in pessary form, though not sure about availability where you are.  I understand Cyclogest pessaries are waxy & can be cut if your gynae thinks a lower dose suitable, though I haven't used them myself.  I think a member called Kathleen has posted that she's used Cyclogest, so you may like to look up her threads or perhaps send her a PM.

Maybe have a look too, at the attached link from Newson Health, especially the para on page 2 headed "Local progesterone – released into your vagina or womb."

https://www.newsonhealth.co.uk/wp-content/uploads/2021/07/Progesterone-Intolerance-March-22-update.pdf

I found the perimenopause-chronic hypothyroidism combo very difficult, so I really sympathise with your situation.  I came late to HRT, not starting until several years postmenopause & balancing it with my thyroid meds is a work in progress .  In common with many women on here, I struggle with progesterone intolerance & have some stubbornly resistant menopause symptoms, so we are still trying to find my best fit.  I also take T3 as I'm a very poor converter of thyroxine, so it's proving a challenge to get the HRT-thyroid combination sorted & being on a cycle is not helping overall stability. 

Enjoy the rest of your weekend.
Wx

[sheila99]

There's only type of utro capsule  (100 or 200mg) and they can be used either orally or vaginally. It might be worth comparing the dose in your contraceptive pill to utro, I think there are some that do have enough prog but I don't know enough about it to comment. If you use the pill and utro you may find you have too much.

[Wrensong]

There's only type of utro capsule  (100 or 200mg) and they can be used either orally or vaginally.

  Thanks Sheila    I've used the 100mg orally & vaginally but when I googled the 200mg Utro earlier they are described as vaginal capsules!
Wx

[sheila99]

I think the 200ng are only licensed in the UK for IVF and they have to be used vaginally for that.

[Wrensong]

That makes sense.

[Keep On Swimming]

Hello Wrensong and sheila99,

Thank you both so much for your replies!

Wrensong, thanks for the link - it's really helpful. I'm sorry you are progesterone intolerant (I guess I'm about to find out if I am too...). How are you managing for the progesterone part of your HRT? As for Hashimoto's and menopause... I WISH I could find a Dr who could take both into account. Like a gyne/thyroid specialist. That's what we need! My gyne, thyroid specialist, and GP have all said to me since I was 46: "Oh, yes, a thyroid problem + the menopause is very complicated". But no one was helping me. Which is why I ended up here and found out that HRT can actually be given to premenopausal women (not the done thing here in France). My gyne told me she couldn't give me anything until I was through the menopause! Then I ended up seeing her colleague when she was on hols in Nov. Her colleague readily gave me the oestrogen gel but forgot the progesterone part, which is why I've been asked to go in to see my gyne tmw.

I'm really strugging right now with the mixture of the wrong thryoid dose (hypo) + adapting to HRT. On the positive side, the oestrogen gel has made such a massive difference to the meno symptoms, and very quickly. But I think I need to up the dose because the symptoms are coming back. I haven't had one day since March where I've felt well. I'm used to feeling rotten when my thyroid dose is wrong but the two combined is brutal. I waken up every morning feeling seasick/weak/tired, then I feel better after a swim/walk and my gel, then quite often late afternoon, or the evening I get hit by a spell of weakness/dizziness and just feeling really ill. I'm managing to work, probably because I work from home for myself. I can't work out if it's my thyroid meds dose or the fact that I need to up my oestrogen gel. And now that I'm about to add progesterone into the mix I'm really worried about it all. I'm going to do a TSH/T4/T3 tmw morning, even though I increased only 3 weeks ago. Far too soon for a reliable reading, I know but I need to see where I'm at before I see the gyne tmw evening. I just feel so rotten, even after 9 hours sleep!

Do you know what your set point is?

Sorry to whinge on about thyroid issues everyone. And thanks for reading!

Bonne soirée.
xxx

[Keep On Swimming]

sheila99,

Sorry, I meant to say that there's 0.075mg of progesterone per pill (it's called Cerazette or Optimizette) but I've no idea how much we need for the womb protection aspect of HRT.

I am worried about having too much, like you say. I should just trust the specialists, right? But given the fact that my gyne and her colleague don't agree on the HRT course I'm on, I'm not feeling too trusting...