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[Mojo-swaptop]

Hi all,

I am 47, about a year or so into peri-menopause and currently about 2 weeks into trying evorel sequi after previously being on  2 pumps of oestrogel daily and utrogeston on days 15 to 26 for 3 months.

The gel didn't seem to work for me, I don't know if it was because I wasn't absorbing it enough or if I was applying it wrong (who knew there were so many variables when applying oestrogel?!) and utrogeston didn't really agree with me (heavier more painful periods and prolonged cramping for the rest of the month after my period).

So far I seem to be ok on the patches, still getting a few night sweats and hot flushes but they are less than before and still getting that annoyed/pissed off feeling every so often but not as much. I will be starting the combined part of the cycle this weekend so I'm waiting to see how I cope with the progestin (?) part.

I personally like the idea of the patch (it's less faff than the gel) so would prefer to stay on that and up or lower the dose and take separate progesterone/progestin (sorry if I've got the terms wrong) but not sure what is available, other than utrogeston, so I'd really appreciate you lovely ladies helping me out and letting me know what to ask for when I next see my GP if I need to change from evorel sequi

Mojo-swaptop x

[Mojo-swaptop]

Sorry, I think my question must have either been too difficult or perhaps I was asking something that's not allowed on here.
My apologies.
I will look elsewhere for advice in future.

Thank you
Mojo-swaptop x

[Dotty]

Hi your alternatives would be Provera, Mirena , Slynd, Norethisterone or Nalvee. These are all separate progesterones, but some are off licence.

You could also use Utrogestan vaginally which might help side effects.

Hope that helps.

[Clovie]

Hi Mojo

Sorry, I can't answer your question, but there are lovely kind helpful ladies on here who will, when they see your post try to add knowledge   

Please don't think people are ignoring your question, I for one wouldn't want to advise if I didn't know enough,

I've asked loads of questions on here and had great advice in times of need, please keep asking for advice, we all need somewhere like this when we have questions!

Hope you are having a lovely weekend, I just wanted to give you some support!  I hope you get sorted eventually , it's a hard and emotional time this peri and menopause stuff, and in the meantime that someone pops along to add some pearls of wisdom  xx

[joziel]

Really, there are not great alternatives available. But I don't think you have yet 1) figured out what was happening with utrogestan and 2) trouble-shooted it thoroughly to get to the point of ruling it out and moving to a synthetic progestin with all the health drawbacks that can bring.

The symptoms you describe (heavier periods, prolonged cramping) actually suggest that the amount of progesterone you were taking wasn't sufficient to oppose the estrogen. It allowed the estrogen to build up the uterine lining too much, causing heavier periods - and cramping. The progesterone should be opposing that and preventing the build up. So your dose is too low...

If I were you, I would be increasing my utrogestan. I'm assuming you were on 200mg of utrogestan from days 15 to 26? You might need a higher dose. I take 300mg utrogestan orally plus 200mg vaginally AM and PM. I do this after using blood tests (from Randox Health, at home, the premium test kit) to see how much progesterone I needed to get into the normal luteal range (what we have earlier in life when we ovulate). This is what I needed. (At least - vaginally - the 300mg orally I just take for sleep.)

Many women are not on enough progesterone. It may be that you don't absorb it well orally. You may need to take it vaginally. I didn't like this idea at first, but actually it's really easy and quick and you don't need to think about when you last ate...

And again, you likely need MORE estrogen. You were on 2 pumps of gel. You were then put on a 50mcg patch. This is the same dose. If you have ANY remaining low estrogen symptoms (which you do) you need more. And you need more progesterone to oppose that.

If you really don't want the utrogestan, I would recommend a product which has just come to market - which is dydrogesterone. It is a 'kind' synthetic progestin with fewer of the problematic side effects the others cause. It has just come to market as a separate product and gives an alternative to utrogestan. Here is an article about that: https://pharmaphorum.com/news/gedeon-richter-brings-hrt-option-back-uk-market

[Mojo-swaptop]

Hi Dotty,
Thank you, that's very helpful. I had heard of mirena, which I understand is an IUD, but not the others. Do you know what format they come in?
I'm not quite sure what you mean by off licence, could you explain please ?

Mojo-swaptop x

[Mojo-swaptop]

Hi Clovie,
Thank you for your kind reply and for your support. I agree, all this peri and Meno stuff can be a very emotional time, as well as confusing when you aren't sure what to do for the best.
I hope you are having a lovely weekend and thank you again for your message

Mojo-swaptop x

[Dotty]

Hi  Off licence is used when a medicine has a UK product licence but is being used in a way that is not stated in the product licence. Some GPs will prescribe off licence and some won’t. An example is using Utrogestan vaginally for HRT. Testosterone is another example as it’s licensed for men.

Mirena is an IUD, yes. The others are all tablet forms of progesterone. The latest one to be issued is Nalvee which has been used before. It is the progesterone which is in Femoston Conti and is thought to be the next best to Utrogestan in being the closest to our natural progesterone.  It should be available on nhs, but maybe not available yet.

[Mojo-swaptop]

Hi Joziel, thank you for your reply.
Yes, I was on 2 pumps of oestrogel and 2 x 100mg of utrogeston on days 15 to 26. I was on this for 3 months before switching to evorel sequi.
 I'm still in my first month of evorel sequi (just started the combined patch) so it's early days for any results and I may not need to change again, so it might be a bit premature to ask about other treatments or stand alone progesterones but I like to know my options well in advance so I can have an idea what to expect

I'm a little confused, you suggest I was not on enough utrogeston to oppose the estrogen but also that I wasn't getting enough estrogen. Maybe it's just me, I'm easily confused at the best of times but they seem to contradict each other.

Thank you for the information about dydrogesterone, I shall read the link you provided.

Mojo-swaptop x

[Mojo-swaptop]

Hi Dotty, ah thank you, I get what you mean by off licence now. It sounds like it can be a bit hit or miss getting some things prescribed by the GP.
Tablet form progesterone sounds good, much more preferable to me than and IUD so hopefully if needed I can have one of those for my prog needs.

Mojo-swaptop x

[joziel]

Mojo, they don't contradict each other. To control your hot flushes, insomnia, night sweats etc, you need more estrogen. Then to balance that estrogen, you need more progesterone. And even on 2 pumps of estrogen, you needed more progesterone to balance it.

[Mojo-swaptop]

Sorry Joziel, as I said I'm easily confused so I misunderstood what you meant. I think I get what you mean now though.

I wish this whole time of peri and meno wasn't so much trial and error and trying to find the sweet spot of treating more symptoms than it causes side effects. It would be so nice if there was just one course of treatment that worked for all. I know, super wishful thinking, but one can dream.

Mojo-swaptop x

[joziel]

It doesn't help when doctors are useless, I've had far more help from forums like this and Facebook than any doctor.

[Mojo-swaptop]

I'm sorry that your doctors haven't been very good, that must be very annoying and frustrating. It's good that there are forums and Facebook groups that are supportive and informative.
So far my experience with the doctors has been ok, they even recommended this forum to me, but I feel like I never know enough to ask the right questions when I see my GP and I feel like I'm learning something new about peri, hrt and all that comes with it every day. I sometimes feel like it's taken over my life and would just love to not think about for a while

Mojo-swaptop x

[Konijntje]

I can certainly relate to that feeling too. I think when it’s a longer journey to get the right treatment, because you don’t respond well to the standard treatment, it can all be very frustrating, especially since you are supposed to try everything for 3 months.

I also research alternative options way before my 3 months are up, just to be prepared on what I want to ask for next. Last option I didn’t trial for 3 months, because I kept feeling worse and I wasn’t sure if it was the hrt or my own cycle, so my doctor agreed to switch me after only 1 month to a birth controll pill with bio identical estrogen. At almost 3 weeks in I already know which one I want to try next if the very annoying side effect doesn’t subside, but at least I feel I’m on the right track this time. I will trial this one for at least 2.5 months (that is when my next appointment is).

Dotty named some other progestagens you could try, I’ve tried half of those (in my current bcp there is drospirenone, which is also in Slynd). One she didn’t mention is dienogest, that will be my next try if my dry mouth side effect from the drospirenone doesn’t let up. I do like drospirenone a lot better for my mood than the others I’ve tried, there is a lot of trial and error in it if you don’t respond well to the normal progesterone/utrogestan.