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[Mary G]

Furyan, I just had a look and yes, 20-30 nmol is the level of progesterone produced by women in the luteal phase which is much less than 200mg Utrogestan.

For post menopause women on a continuous combined HRT regime, 50mg of progesterone every day should be enough for the majority of women (it definitely is for me) and at that dose, it's unlikely to cause side effects unless someone is progesterone intolerant.

That is why the Newson clinic prescribe 100mg Utrogestan every other day.  It is the closest they can get to the magical 50 mg every day and from years of experience, they know it's ample for most women.

Less dogma and more flexibility is needed.

[Furyan]

Furyan, I just had a look and yes, 20-30 nmol is the level of progesterone produced by women in the luteal phase which is much less than 200mg Utrogestan.

For post menopause women on a continuous combined HRT regime, 50mg of progesterone every day should be enough for the majority of women (it definitely is for me) and at that dose, it's unlikely to cause side effects unless someone is progesterone intolerant.

That is why the Newson clinic prescribe 100mg Utrogestan every other day.  It is the closest they can get to the magical 50 mg every day and from years of experience, they know it's ample for most women.

Less dogma and more flexibility is needed.

“Less dogma and more flexibility is needed” - absolutely agree with this Mary. For HRT and a great deal more health needs. Going through another turning point with my thyroid and it’s incredibly frustrating trying to have an informed conversation with medical professionals who stick rigidly to dogmatic procedures rather than seeing the broader picture. Not good that some professionals are heralded as gatekeepers to our health and well-being. For chronic health needs, this can end up doing more harm to the patient than good - going against the very oath they swear to 

[Tribbins]

Not just flexibility, but also the acknowledgement that the patient is the expert when it comes to their own body - how we feel, what side-effects we get, it's all subjective. Yet we are obliged to hand all our trust and power over to healthcare professionals, and hope we get one that respects that.

To answer my own question, no it hasn't got easier - I've struggled with Cyclogest, even 50mcg daily is too much after 5 days due to headaches, blurred vision, mood changes and fatigue. 100 mcg every other day results in feeling flat, detached, pointless on the 'second' day. Either way it undoes most of the positives that the oestrogen achieves. I've not even spoken to a GP for 3 months, they sent me a review date for next March. I was told by the receptionist when I asked for the Cyclogest prescription (I had to ask - they were quite ok to leave me on oestrogen only until I pointed out after 4 months that this wasn't ok) that if I didn't get on with Cyclogest then I had to stop the lot. Messages relayed by a GP via a receptionist.

I just feel drained by the whole experience, probably mostly drained by the progesterone actually. Having spent 40-odd years dreading periods and their onset, and saying 'roll on menopause' I've tried my best to get through it without HRT, but that resulted in me having to stop work for two years due to chronic migraine, and subsequently only being able to work limited hours due to absolute lack of energy as well. Oestrogen alone was good, migraines have lessened to such a degree and I started to get some energy back but at a cost of losing hair at quite a rate and then having to take progesterone which has just negated any positives. It even stops me being able to exercise, I just feel fatigued and breathless. I can't risk feeling so low, as I start thinking 'what's the point?' so I'm cutting down the Evorel and going to see if I can at least tolerate 50mcg Cyclogest every other day until I can speak to a GP.

[Mary G]

Tribbins, were you severely progesterone intolerant pre menopausal?  This really matters because if you were, I'm afraid the only real solution is a hysterectomy.  If not, you need to review your progesterone type and very importantly, dose.

From what you have said, your migraines are caused by low seratonin levels which are caused by low oestrogen levels.  I didn't really find 50mcg patches very effective and if you reduce your dose, I think it will make your migraines worse.  You need get a good dose of oestrogen into your system and you need to aim for a blood level of about 300 pmol to have any real effect on seratonin levels and to counter the ill effects of progesterone.  If you just bump along on a low dose of oestrogen, it's not going to do anything for you.  The fact that your migraines improved when you started taking oestrogen only is a strong indicator and your doctor should have picked up on that.

Obviously I'm not a medic but I'm convinced you need more oestrogen and probably a low dose antidepressant to get your seratonin levels up.  This should make the 50mg progesterone dose more tolerable.

Have you tried Oestrogel?

[Tribbins]

Mary G, I just don't know. I used to feel poorly before a period, much the same as I've felt on Cyclogest (headache, fatigue etc) then terrible heavy and painful periods  I felt pretty good when I was pregnant aside from fatigue and a few nasty migraines in the later months. In the couple of years leading up to menopause I was going bonkers before a period, and was prescribed Fluoxetine, which only made me feel worse. Like a lot of women on here, I'm really sensitive to medications. I took a combined contraceptive in my twenties, and coincidentally also had a lot of issues then with mental health, and headaches. Migraines only really got out of control around 9 years ago, coming up to meno and then afterwards. I found that they have decreased drastically with one and a half 25mcg Evorel patches, I had two in the past three months, as opposed to every week. I was increasing oestrogen but stopped as that would mean increasing Cyclogest as well and I just can't face it.
 

[Mary G]

Tribbins, I know how you feel, this stuff can really wear you down and in my case, it's been 19 years since the very start of the menopause.

It sounds like you could be progesterone intolerant but at the same time, you need decent levels of oestrogen to feel good and keep the migraines away.  Unfortunately, if you suffer with the same type of migraine as me, they do not improve post menopause and often get worse.  I'm not progesterone intolerant but I can't tolerate high or unstable doses and I also need a steady flow of oestrogen.  It's not easy though.

Why don't you provoke a bleed and then have a good long run of oestrogen only and see how it goes for a while?

You could try buying some 5-HTP supplements to try and raise your seratonin levels naturally and see if that helps.

Ultimately, I think I would be inclined to book a consultation with a menopause specialist who also has a good understanding of hormonal migraines.