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[LaoiseK]

Hi
I am currently on 100mg estradot and 100mg utrogestron every other night and on a continuous regime with no periods. I notice that I am significantly fatigued the next morning and day after a utro capsule which I take vaginally. Is this a side effect that other women experience ? Is there an alternative that people have found doesn’t give this side effect?
Thanks

[Hurdity]

Hi LaoiseK

Yes morning fatigue is a common side effect of progesterone even from vaginal use. I experience this and have never taken it orally, but there are other additional undesirable side effects that some women experience when taking it orally.

How long have you been on this regime and presuming you are post-menopause? If you are absorbing the oestrogen then that is a high dose and yet you are taking far less than the licensed dose of utrogestan to protect the womb. Even when taken orally that standard dose of progesterone is not guaranteed to be sufficiently protective of the womb when high oestrogen doses are taken.

Not wanting to be alarmist but do be vigilant about any signs of  spotting or bleeding which could indicate thickening of the lining or maybe the doc who prescribed this regime is your monitoring your womb lining regular and sending you for regular scans to check, which would be good?

Progesterone is a sedative unfortunately, but there are other synthetic progestogens which may not have the same side effects - Provera tablets or the Mirena coil. I am sorry to say this is a perennial problem discussed on here - many of us are seeking different progestogen products due to sdie effects from those available!

All the best

Hurdity x

[Gnatty]

How long have you been taking the utrogestan? For some women the tiredness settles down after a few weeks so it may be worth persevering with if you have only recently been on this regime.

[Furyan]

Could be that you need more progesterone to balance the effects of high oestrogen? I agree that 100mg progesterone every 2 days is maybe a low-ish dose of progesterone for that strength of patch, and it it isn’t balancing the oestrogen, this may bring about the symptoms you’re reporting. My question would be, is the oestrogen dose truly what you need? You may feel ok immediately after an increase, but something clearly isn’t right if you quickly go back to feeling rubbish again. Hope you find the answers you need x

[sheila99]

Sadly fatigue is a common side effect. I use long cycle (6 week) sequi to give me more 'good'  time.

[LaoiseK]

Thank you for all the replies.  I’ve been on HRT for 4 years starting off on the oestrogel 2 pumps, then 3 pumps and 4.  While I absorbed it well initially ( oestradiol bloods between 300-400),  over the past two years I’ve had to change to patches as I wasn’t absorbing the gel anymore.  Started on 75mg patch and upped to 100mg as bloods still showing levels between 100-200 and my legs fatigues so easily and had not motivation for anything. 

What levels would  oestradiol levels need to be to warrant 100mg a night.  I heard Dr Newson saying that absorption is greater vaginally and taking it this method every other night was sufficient, but she didn’t mention the oestrogen dose concerned.  I’ve also tried lenzetto where I only managed oestradiol blood levels of just 58 on three sprays. I can also feel  some vaginal cramps by day 3 of the patch - could this mean progesterone level could be too high at this time?

I haven’t great access to hrt advice from medics other than getting a prescription.  Would appreciate any advice. Periods stopped by 43, discovered oesteopenia and put on hrt 2 yrs later at 45 following a complete physical breakdown and been on it 4 yrs now.  Thanks.

[Hurdity]

Could be that you need more progesterone to balance the effects of high oestrogen? I agree that 100mg progesterone every 2 days is maybe a low-ish dose of progesterone for that strength of patch, and it it isn’t balancing the oestrogen, this may bring about the symptoms you’re reporting. My question would be, is the oestrogen dose truly what you need? You may feel ok immediately after an increase, but something clearly isn’t right if you quickly go back to feeling rubbish again. Hope you find the answers you need x

Laoise - just to say that when I posted earlier today based on what you said,  I agree with Furyan that you may need more progesterone to balance oestrogen but NOT because of symptoms. The balance is only necessary to protect the womb.  Insufficient progesterone won't give you any symptoms, and certainly not fatigue - as I said, quite the opposite. If you increase progesterone you may well experience increased fatigue - though maybe you qould just feel the same.

Having now read your latest post - it may well be that you are not absorbing oestrogen well despite your patch being 100 mcg. That being the case then that dose of progesterone may well be sufficient, as long as you are being monitored. Yes the Newson clinic recommends that, but it is half the licensed dose, and the manufacturer recommends taking the same dose vaginally as orally. While there is limited research showing that hlaf the amount of utrogestan can be used to protect the womb when taken vaginally comared with oral intake, this has only been tested using small studies and for up to medium doses of oestrogen - as I understand.

Progesterone should not cause vaginal cramps and I'm not sure even what these are or what could be causing them? Don't worry about progesterone being too high - it's not, but may be too low!

There is no correlation between absolute oestrogen levels and progesterone needed - it is purely a question of how your womb reacts to being stimulated by the oestrogen and how much it grows. On continuous combined HRT the two hormones need to be balanced so that the womb lining does not thicken at all which is why care must be taken when using less than licensed doses.

As per sheila99 I take Utrogestan cyclically to avoid the horrible fatigue.

I hope you are able to get this resolved soon.

Hurdity x

[Furyan]

I’d disagree with the idea that there is just one purpose for progesterone which is to balance the effects of oestrogen on the womb lining. There is a wealth of data on the multiple effects of progesterone, as there are receptors for it throughout the body as well as for oestrogen. The sources are too copious to mention but google it and you will see. Whatever effect oestrogen has, it’s friend progesterone is there to balance that effect. This indicates its broader impact on the mind and body than on just the womb. I personally do experience side effects (fatigue, weakness, palpitations) even if I am on an optimal dose of oestrogen yet not enough progesterone. Hence why I mention that the imbalance between the two may be what’s causing your symptoms?

I don’t think there is a ‘level’ of oestrogen (as in a number) that is optimal to warrant a certain level of progesterone, I believe it’s a general consensus that the progesterone required should reflect the dosage of oestrogen (of which you are on a high-ish level). The vaginal cramping needs looking into or time to settle down? I’ve had cramping ‘down there’ when my oestrogen was too high in relation to progesterone, I know this because tweaking the progesterone dose eased it. x