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[Hormona]

Hello Ladies

I’ve been on Evorel 50 & Gepretrix (Utrogestan) 100 for 6 months & experienced a life changing & life saving relief & improvement to the crippling anxiety, panic & mood disturbance that I was experiencing previously due to menopause.  Extreme adrenal surges, palpitations, non stop catastrophising, low BP, and rage, joint pain, emotionality & distress all completely eased & the calm of the progesterone felt like such a balm. Insomnia did not abate but my sleep quality def improved.
I’m 53 & post meno.

H’ever I’m noticing crushing & debilitating fatigue/exhaustion, irritability, low mood & depression & what feels like progesterone intolerance creeping in. I get v vivid nightmares if I take Gepretrix at night but incapacitated with fatigue/low mood if I take it in the day (on an empty stomach). I cannot use vaginally as I’ve had pelvic radiation for cancer & cannot tolerate anything vaginally or irritation nor can I have a coil fitted.

I had an appt today with an NHS Menopause Specialist ostensibly to request Testosterone having felt so improved & hoping to see if it cld help with mainly fatigue & libido but voiced my concerns re progesterone intolerance & queried Femoston having read on here that it can be a more tolerable & gentler progesterone despite being synthetic.

The Meno doctor did not seem very clued up about options & suggested I be referred for a hysterectomy. I asked about trialing alternative progesterones first. I have comorbid anxiety, depression & adhd which have all been exacerbated by peri /meno but hugely improved also by HRT (and I’m trying to figure out how much is hormonally driven). I’m on 30mg of Mirtazepine as well.

I asked about dosages & she was v vague suggesting I start on 0.5 Femoston. I said I can’t lose the equivalent of the Evorel 50 due to the potential for relapse & unmanageable anxiety returning (& emotional disruption). She asked if I wanted her to put me on the Femoston 1mg then. I said yes but have subsequently read on here that Femoston 2mg equates to Evorel 50?? I asked the meno Dr & she said I cldnt go on that until after 6/12 of trialling it - even when I explained how anxiety sensitive I am & how much estrogen seems to help (& only a medium dose of Evorel 50 achieves this).

I’m now in a quandary as to whether I trust her as she seemed quite flippant & laughed when I asked if Femoston 1mg is sufficient. I asked who I cld contact if I experience a relapse & she said to contact the private company who are contracted to provide the MHS Meno service & said we’d speak again in 8 weeks.

Can anyone advise re Femoston & the dosages? I’m not sure if this is the best option & am terrified of trading the progesterone intolerant symptoms for the more distressing & harder cope with (for me) anxiety symptoms of not being on enough estrogen.

Kind thanks!

[Dotty]

Hi the highest dosage of Femoston Conti is 1mg.

The rough equivalent to a 50 patch would be a 2mg tablet.

Why did she not suggest using a 75 patch ?

[Hormona]

Hi Dotty

Thanks for your reply. So the Femoston Conti won’t give me the same amount of estrogen as my Evorel 50 patch then. 

Due to progesterone sensitivity I thought an alternative progesterone might help.

Would a higher Evorel patch (eg 75) counter progesterone intolerance?? Apologies if I’m misunderstanding you !

[Dotty]

Hi Femoston Conti is unlikely to give you the same dose of oestrogen but you may absorb it differently.

An alternative progesterone to use with a patch would be a synthetic one. Provera is one option.

Yoir symptoms could be due to low oestrogen….thats why I suggested a 75 patch.

[Hormona]

I hadn’t considered it cld be estrogen related - gives me scope to trial an increase first. Will look into Provera as well - thanks very much 🙏

[bombsh3ll]

Femoston does come in 2/10mg tablets however this is a sequential preparation only, which would likely result in withdrawal bleeding.

If femoston conti is chosen and a higher dose of estrogen required, it is perfectly safe to take two of the 1/5mg tablets per day. This gives you 2mg of estradiol with adequate, bleed free endometrial cover.

Equivalence charts frequently list 2mg of oral estrogen as equal to a 50mcg patch however individual variation in absorption through the skin and metabolism limit the usefulness of such comparisons.

In my experience and looking at studies on plasma levels with both products, I would estimate 1mg oral estradiol as equivalent to a 50mcg patch.

To put it another way, I currently take 1.5mg oral estradiol (COCP Zoely) and when I switch to MHT I expect to take 2mg, however if I absolutely had to use transdermal I wouldn't entertain less than a 100mcg patch.