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[GalwayGirl]

Hi all

I cannot get on with progesterone and my endometrium is too thick. Can anyone advise on how long it will take the thickness to reduce if I stop estradoit? I was planning to wean off by cutting a bit of the patch off each week - I’ve had hardly any progesterone in last year and am worried about the thickness and hope it will return to normal ? Thanks as always

[Cassie]

Perhaps you should have a good "clean out" so a day 10 course of 100mg utrogestan and then a withdrawal bleed and then taper back on the Estrogen?

[GalwayGirl]

Thanks  Cassie but can’t do progesterone - had very bad affect on my MH.

[Mary G]

It's really difficult to know what to suggest it you really can't take any form of progesterone.  Have you had your womb lining measured via a scan?

With so little progesterone and all that build up, I'm surprised you haven't had breakthrough bleeding.  If you completely stop taking oestrogen there a chance you will bleed out but there is no guarantee of that without progesterone and in any case it might not fully clear out.  If you can grit your teeth for one last time, a dose of norethisterone will strip your womb lining out.

Looking ahead, have you though about a low dose Jaydess coil?  Alternatively, what about trying bespoke progesterone from a compounding clinic?  I take it you are in Ireland and they have them there I'm sure.

[GalwayGirl]

Thanks so much Mary - I’m very conflicted as I have had debilitating depression for the last year and am just getting stable. I have been prescribed Slynd but too worried to take it so thought I might be better off coming off the estradoit- but now I am questioning it based on your message ! I don’t know what will be worse - I dread both options x

[bombsh3ll]

I would definitely make sure all options have been explored before abandoning all the benefits of hormone therapy.

Often women will give up treatment due to progestogen intolerance having only ever tried one type.

Slynd is an excellent option for some people. It's not even a progestogen strictly speaking, it is a derivative of spironolactone.

There's also tibolone which is often overlooked and can be great for truly progestogen intolerant women.

It also has some androgenic activity which usually benefits mental health.

[GalwayGirl]

Thanks so much bombsh maybe I will have to take the plunge with Slynd - have just seen too many reviews of it still affecting people’s depression and it says so in the leaflet but my GP is a very good meno specialist and recommended it so maybe I need to try it. Just wish I didn’t have to do either !

[CLKD]

Have U seen any reports on people who have had benefit from the Drug?
It's difficult when 1 suffers with MH issues.  Damned if we do, damned if we don't 

[Mary G]

GalwayGirl, if you already have some Slynd, I would bite the bullet and take it for a week or so then stop to provoke a bleed.  It will probably be a heavy bleed.

You definitely need to look at other progesterone options but you might find the Slynd (drospirenone) is tolerable.  Angeliq oral HRT (which I found tolerable but progesterone heavy) contains Slynd  but interestingly, the progesterone dose is 2mg in Europe but only 0.5mg in the US (both versions contain 1mg oestrogen) so I would probably aim to take something like 1mg every day on a continuous combined basis.  No way do you need 4mg every day unless you are on a mega dose of oestrogen or have an ongoing problem with womb lining build up.  Obviously you will have to cut the tablet into four.

So to recap, I would take the full 4mg dose of Slynd for at least a week and more if you can, stop taking it, have a bleed and then start taking it again every day at all reduced dose.  I would be aiming at around 1mg per day if you are severely progesterone intolerant and I would also have a transvaginal scan in a few months to check it's a high enough dose of progesterone.

I hope that helps.

[GalwayGirl]

Thanks Mary G that’s very helpful- I was quite wary about the 4mg as it seemed a lot- I am down to 50mcg (I cut a third off 75 patch due to shortages) my womb does feel heavy and thick though - last scan in May it was 6.8mm have had 2 bleeds since then bought on my half a pessarie of cycolgest - it’s all I can tolerate and felt deeply depressed and suicidal on last one in June. It just makes me so nervous I just don’t know what’s worse stopping estrogen or coping with awful worsening of depression.

[Mary G]

GalwayGirl, it sounds like you have nothing to worry about!  If your womb lining was 6.8mm in May and you have had two bleeds since, your womb lining will not be dangerously thick in that short space if time.

Cyclogest is usually well tolerated and if you have regular scans, you can probably bumble along taking small amounts of progesterone to provoke a bleed every now and then.  I've done this in the past and it worked well and I too was able too bring on a decent bleed with a small amount if Cyclogest.

If you are regularly monitored via transvaginal scans, you can mix and match get away with a multitude of sins and I found I didn't need anything like the NHS recommended levels of progesterone.  If you are severely progesterone intolerant, it's either that or a hysterectomy.

[GalwayGirl]

Thanks so much Mary G you have reassured me ! My GP has been frightening me a bit about my lack of progesterone and said she won’t keep prescribing estradoit if I don’t take something soon.
Thanks again xx

[Kathleen]

Hello GalwayGirl


When I was with the private clinic, Newson Health I was given Cyclogest as my progesterone.  I had some bleeding and was referred to an NHS consultant who suggested Lutigest as an alternative.

I left the clinic and returned to my GP but they were only prepared to prescribe Utrogestan.

Your GP seems to be more HRT aware than most so perhaps you could mention Lutigest and ask her if it is an option for you?

I hope you find a solution soon and please let us know how you get on.

Wishing you well and sending hugs.

K.

 

[Cassie]

Apologies to GG dont mean to hijack your post but it may be relevant... Mary G, you seem super knowledgeable on these things,  in your opinion, what would be a safe dosage of BHRT Prog to take each mth with the standard prescribed dose of 1.5mg Oestrogen, bearing in mind these are transdermal, not sure how much gets absorbed. Should it be more than 20% Prog?

[bombsh3ll]

When you say BHRT - I take it you mean body identical hormone therapy - progesterone as endometrial protection then yes of course this is suitable.

Micronised progesterone which is body identical is available as utrogestan, cyclogest and a couple of other trade names.

However if you are talking about a progesterone cream then no, this absolutely should not be relied on for endometrial protection as the progesterone molecules are too large to cross the skin barrier.

This is why the only licensed forms of progestogen available for transdermal are synthetic progestins, in combination patches.