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[Katie1980B]

Hi all

Hoping someone can help as I’m at my wits end. Following advice from my GP, I switched from taking utrogestan 200mg 15 days on, 15 off, to now taking 100mg daily. I feel absolutely awful. My anxiety is through the roof and I just don’t know what to do. I spoke to another gp yesterday and she has prescribed Escitalopram, but I’m terrified to take it after a bad experience with AD’s last year (terrible side effects).
Has anyone else had this issue, and would switching back to 15 on/off be a solution? Has anyone else done this and if so, how?
I’ve been on hrt for over 18 months, so I don’t think it’s a reaction to progesterone as previously had no issues.
Why oh why must doctors mess around with doses etc. I’m kicking myself for changing it.
Please help 😫

[DottyD68]

Hi Katie1980B,

Were you still having periods when you started HRT?

How old are you?

Reason for asking is that I was 53 and still having periods when I started on sequi gel and utrogestan (14 days at 200mg). It wasnt brilliant but alleviated lots of symptoms, but due to my own fluctuating hormones I never got the balance completely right.

After a year, due to my age and assumption I had reached menopause, the GPs wanted me to go to a conti regime (utrogestan daily at 100mg). After a couple of weeks I could not bear it so went back to sequi (200mg for 14 days). The GPs werent happy with this as the guidelines are that there is a higher risk of endometrial cancer if post menopause on sequi regime. I have tried conti regime again recently (gel and utrogestan) and dont get on with it so now trying Evorel conti patches. Only 10 days in but feeling ok so far so praying this works.

For me the balance between gel and daily utrogestan (100mg) didnt work. I think its getting a balance of the progesterone vs ostrogen dose alongside your own fluctuating hormones.

It maybe you are not ready to go to continuous progesterone?

Hope this helps x

[Katie1980B]

I’m 43 and still having periods although they’re just beginning to stretch out a bit rather than being every 24ish days.

How did you switch back from conti to sequi? Did you stop utro for a time and then restart or did you just up your dose to 200mg?

Thanks so much for responding x

[Arya Underfoot]

Hi Katie

I take progesterone 100mg continuously as well, but have been doing so for 3-4 years and have no problems. I find the 200mg dose too high. Is there any reason why your dose was changed? With any change in HRT there is a period of 2-4 weeks where you'll experience symptoms, hopefully they settle down but if they don't you may need to try something else. I think we need to listen to our bodies rather than relying purely on medical opinion, so if you felt good on your previous HRT regime maybe go back to it if the change is too distressing. In terms of your anxiety, have you tried any natural medications? I take CBD oil and it does wonders for anxiety without the side effects or withdrawal. Find what works for you. 

[Katie1980B]

Honestly I have no idea why it was changed. It’s been nearly a month and not feeling any better since changing.

Took an additional utro about 2 hours ago, and already feel a bit better. I think 100mg every day just isn’t meshing with my own hormones and the sequi works better.

My other half mentioned Cbd. Which do you take?

[Hurdity]

Hi Katie1980B

Sorry to hear about your issues.

First re escitalopram - the doctor should not be prescribing anti-depressants for menopausal  symptoms when HRT is the first line of treatment and especially as you had bad side effects when you took them previously. OK you are on HRT but it is far more important to try to tweak the HRT first, than just give you another drug to try to make you feel better, when it could well be the HRT regime that is causing your anxiety.

You say you're still having periods - but if you're on sequi HRT it can be difficult to tell whether they are natural periods or the expected withdrawal bleed, though you should perhaps be able to tell depending on whether the bleeds etc are variable in when they have been coming (as you say - if they have "stretched out a bit") and how heavy they are?

Also more to the point what your periods were doing (how regular, cycle length etc) before you went onto HRT and what the symptoms were that led you to start HRT?

You are still very young at 43 and if you are still peri-menopausal then you should still be on cyclical HRT.

In addition as progesterone has a sedative effect and can cause other undesirable side effects (think permanent pms as in the second half or last part of the menstrual cycle) - many women find the build up of progestogenic side effects to be too much, and remain on cyclical HRT even when post-menopause ( like me) though that's not your situation. I am 70 and still taking cyclical HRT.

Personally I would go back to cyclical HRT, or even maybe try the gentle contraceptive pill (QLAIRA or ZOELY) which contain bio-identical estradiol (or close to it with ZOELY) which will even out the hormonal fluctuations of per-menopause but give you the estradiol which on average begins to decline as you get further towards menopause.

Hope this helps

Hurdity x

[Katie1980B]

Thank you Hurdity…I really appreciate your expertise on this.

So I’ve had perimenopause symptoms since I was around 38. Finally went on to hrt in summer 2022, and have had some tweaks. Until the beginning of Feb, I had been doing really well on Estrodot 100 patches and cyclical utro 15 on, 15 off. Only other meds I’m taking is Fexofenadine for my super itchy skin, and 1 magnesium tablet at night.

My periods have been pretty regular, but heavy. Generally they’re every 24/26 days regardless of the utro.

My main peri symptoms, and the reasons for going on hrt were the usual hot flashes, terrible night sweats, rage etc.

Interestingly the GP that prescribed the ADs isn’t my usual GP, otherwise I don’t think they would’ve been given.

In terms of switching back to cyclical utro, what’s the best way to do it? Should I stop taking 1 tablet and have a break, then restart in a week or 2 weeks?

I’m just so sick of feeling this way. I started this year on such a positive note, in its all gone wrong in a matter of weeks

[Hurdity]

Hi Katie

So were your periods starting to become quite irregular before you started HRT or were they 24/26 days regularly? I ask because if they were still very regular then all the more reason you should be taking cyclical HRT. Strictly speaking when periods are still regular peri-menopause (by the medical definition) hasn't actually begun and it is termed the late reproductive stage BUT hormonal changes have begun to occur and fluctuations can cause problems in some women as you have experienced, due to the hormones starting to go awry and maybe bigger fluctuations etc. Sometimes HRT doesn't work at this stage but with you it sounds like it did!

To go back to cyclical HRT I would wait for the first day of your next bleed (if you think this is your natural cycle breaking through) and count that as Day 1, stop taking the Utrogestan and restart on Day 15. Hopefully that will sync with your natural cycle and you will feel better.

All the best and let us know how you go

Hurdity x

[Arya Underfoot]

Hi Katie, I've taken various CBD oils, CBD 25 is the best place to start and then work your way up till you get relief. I'm currently taking Cannatrek 100 CBD (4 THC). Blended oils tend to work better than isolated compounds. My generalised anxiety just disappears for 12 hours. I take it daily because it's prescribed for pain but am amazed at how well it works on anxiety.
Hopefully once you're back to cyclical progesterone you feel better, if it's really stressing you out switch it earlier rather than waiting, got to take care of our sanity. My perimenopause started around 38 too, it's rough going through it so early, hang in there! 

[Katie1980B]

Thank you!

I went and bought some CBD yesterday (reakirio 500mg full spectrum), and took 5 drops at lunchtime and there was a marked difference in my heart rate and general feeling. Definitely left me feeling more relaxed and the racing heartbeat went away, however as you will probably see from the time that I’m replying, I’m back awake at stupid o’clock having been panicky most of the night. It’s my first evening not taking the utro, so think it’s a bit of that as well.

Going to see how long I can go without the utro - hopefully I will get to at least my usual period, in which case I can start again after that, however if I struggle, I’ll start it earlier.

I’ve learnt my lesson on this though, and next time a GP suggests changing anything I will certainly be asking more questions on the reasons for changing.

[Katie1980B]

I’m now day 4 of no utro and feel awful. I caved and started the Escitalopram last night as my anxiety is through the roof, and as expected, feel rotten.

Think I will need to restart the utro 15 day cycle tonight. I know it’s early, as my period hasn’t started yet, but I don’t think I can take another potential 2 weeks feeling like this. The palpitations from the anxiety and mental health is really wearing me down.

Will I be ok starting it again tonight?

[sheila99]

Anxiety and palpitations can be an indication that your oestrogen dose needs adjusting. You can get them from both too much and too little oestrogen, my anxiety was from too little. Just thinking that if you used to be OK off utro and now you're not perhaps the issue isn't the utro.

[Katie1980B]

I was ok on the utro 200mg 15 on, 15 off, but the issue seems to have started when I switched to daily utro 100mg with no break. Nothing else about my meds has changed, only that, so I have to put it to that for the time being I think.

I think I’m going to restart 20mg utro tonight and wait for my periods to catch up. I can’t go on feeling like I have been for the last two weeks or so.

I just don’t feel like Escitalopram is for me. Sleep was crap last night again, and it’s given me what I can only describe as a “fizzy” stomach, which is what happened in a different med last year. I’ve been a groggy mess all day.

Think I’ll get back on the utro tonight, hopefully get some sleep, and see how I feel over the next couple of days

[vikkiod]

Hi Katie,

Sorry, you are feeling so bad. Fingers crossed there are brighter times ahead.

I just wanted to jump in and give you some support. I am older than you (55) but was also very happy for about 5 years on my cyclical routine of 50 patches/200mg Utro at the back end of the month. The doctor has kept telling me to change to continuous I tried it once a couple of years ago and felt terrible. I have just been encouraged to do the same again with terrible results. I was bleeding more than ever and inconsistently. I am now again abandoning ship for my beloved old routine. I  love the sedative effect of 2 of those little round balls and don't seem to mind at all when the period begins. I am waiting for the 12th day after my period as I have a short 24-day cycle and then starting to take my Utro.  I am hoping that I have not confused my poor body any more than I needed to. I have also noticed more hair loss since I started the continuous and, as I am a Trichologist, my spidey senses were tingling! I was also considering upping the estrogen but to be honest, I want to wait and see if I can settle back into my lovely old familiar routine before changing anything else.

I also love the fact that Hurdity is still choosing this approach at 70. I think hell will freeze over before I try to go back to continuous. I think having a period keeps us young and our body seems to like it. There's an element of protection in shedding that womb lining.

Hope this helps somewhat and gives you the courage to challenge your Doctor if they come at you again to do the continuous routine.

Good luck with everything,

Vikki. x

[Katie1980B]

Vikki, thank you so much for your kind words and advice. The last 3 or 4 weeks have been hell and I won’t be changing my hrt again!

It’s interesting what you say about the hair loss, as looking back, I think I had the same. A lot more hair loss when washing for sure.

What other symptoms did you experience in changing to daily? Mine have been the palps, severe lack of sleep, terrible boob pain, and the anxiety has been off the charts (I’m catastrophising everything).

I took my first 2 utro last night and managed to sleep for 6.5 hours which is a small improvement compared to the last several nights.