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[lizzy76]

Hello,

This is my first post. Looking for some advice on progesterone intolerance and Bijuve.

I have just been prescribed Bijuve by NHS menopause clinic. I am 2 years post menopausal at 47.

I have tried Oestrogel and oral utrogestan 100 every night
Oestrogel and vaginal utrogestan 100 every night
Oestrogel and vaginal utrogestan 100 every other night
Oestrogel and 1/2 a cyclogest every other night rectally (prescribed by Newson clinic)

Each time, I become very PMT like and have to stop when my mood becomes unbearably low. This goes very quickly when I stop the progesterone.

I had similar problems taking oral contraceptive (apart from Dianette) and have a history of fairly severe mood related PMS. I didn't have post natal depression.

I also have a family history of osteoporosis.

My question is: does anyone have any experience of Bijuve and does anyone have any experience of it who has had previous symptoms of progesterone intolerance with other progesterones.

I am scared to try Bijuve as the progesterone is the same as in Utrogestan. Is there something better I could try first? I also wondered if there is a chance that a synthetic progestin might work better for me?

Thank you!

[bombsh3ll]

If you are happy with oral you could ask for femoston instead.

This contains dydrogesterone, one of the kindest progestins.

You could also try oral contaceptive pill Zoely, taken continuously. This is what I take, it contains 1.5mg estradiol and another highly tolerable progestin, nomegestrol acetate.

This is available until age 50 on the NHS, 55 privately if low risk.

Also you could consider the mirena IUS.

There is also tibolone, as you are postmenopausal.

If you are intolerant to utrogestan there is little point trying Bijuve, as this is what it contains.

[lizzy76]

That's really helpful, thank you. I think I will ask for Femoston instead.

Just out of interest do you know if the dydrogesterone that is in Femoston is also produced separately so that I could have it with the oestrogen gel or a patch?

Thanks again!

[bombsh3ll]

Yes it is, however it is not available on its own in the UK, only in femoston.

Europe and southern Ireland have it as a standalone tablet.

[lizzy76]

Ok, I've asked to try Femoston, thank you for the advice!

[Dotty]

Hi lizzy76....how many pumps of Oestrogel were you using ?

[lizzy76]

Hi Dotty, Initially I was told one pump of oestrogel (GP) with the utrogestan. Then with Newson clinic two pumps rising to 3 then 4 but by the time I got to the three pumps I just felt so dreadful I stopped taking everything (this was with cyclogest).

[Dotty]

Hi lizzy76..ok .... I was asking because Bijuve is 1mg of oestrogen which is the equivalent of one pump of Oestrogel.

Femoston Conti comes in 2 doses.... 0.5mg and 1mg, so if you needed a higher dose of oestrogen then these may not be suitable.

[bombsh3ll]

It isn't possible to say a particular oral dose is equivalent to a particular transdermal dose with any confidence because this depends on the individual's absorption and metabolism which is highly variable.

Some people don't absorb transdermal very well at all but achieve good levels with oral, and vice versa.

In my personal experience oral doses are more potent than the equivalence charts suggest.

I suspect this is because "standard" oral doses were established pre 2002, based on clinical effectiveness, whereas patches and especially gels have come into use in the wake of the WHI, when it became all about minimising doses.

If femoston conti 1/5mg isn't enough, you can take two daily. If you don't mind bleeding there's also the 2/10mg tablets.

Alternatively, and this should only be done with specialist supervision, the oral combination can be topped up with gel or patch, however this changes the estrogen:progestin ratio so I would only do this with regular endometrial scans.

[lizzy76]

thanks for your replies. Could I take femoston and then add some oestrogel if I feel I need more? also do you think it would be worth using oestrogel for a few weeks to improve my oestrogen levels before starting the femoston? Thinking that might help me deal with the progesterone.
Thanks

[bombsh3ll]

I would just start the femoston.

Estrogen gel has a very short half life and doesn't build up in the body.

If you want to add a small dose of gel on top of the femoston this should be done with medical supervision and ideally endometrial monitoring, as it is more estrogen than that dose of progestin has been studied with, and adequate endometrial protection cannot be guaranteed.

It isn't something you should do by yourself as you could run into difficulty with bleeding and endometrial hyperplasia.

However many people do top up an oral preparation in this manner as long as it is being done safely.

[lizzy76]

Update:
So I asked to be prescribed Femoston but, after much discussion the NHS meno clinic wants me to try Bijuva first and then a Mirena coil before trying the Femoston.
She keeps going on about how the progesterone is bio identical and therefore will be less likely to cause problems.

However, having already tried Utrogeston in every different way possible as well as Cyclogest with both of these causing severe low mood I don't really want to try the Bijuve.

I keep trying to stress that it's the same thing that I've tried before but don't feel I am being listened to.

Does anyone have any thoughts? Should I just try Bijuva? Am I being difficult?

[bombsh3ll]

You aren't being difficult refusing to take a medicine to which you have had a previous adverse response.

Your body, your autonomy. End of.

It is also not acceptable to pressure someone to have an invasive procedure against their wishes when a suitable oral treatment exists.

I know you are in a difficult position when the NHS can't or won't meet your needs, I am in the same position with my combined pill Zoely, which I have to pay for as I live in Scotland despite the NHS in England funding it.

If it were me, I would continue to fight for the treatment you feel would suit you best. A written letter of complaint stating that you have previously had an adverse drug reaction to multiple forms of micronised progesterone and do not wish to have an invasive procedure for your progestin when a suitable oral treatment exists would probably be helpful, stating that you would like a second opinion.

Failing that, maybe if you can afford it pay for a one off private consultation after which hopefully you can get a letter to your GP to continue the prescription.