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[AnnaH208]

Hi all,
Im 42 and perimenopausal - periods started going wacky about 2 years ago, stubborn to lose weight, insomnia, aches, pains, terrible anxiety, mood swings and PMT for half the month.

I started HRT 6 weeks ago with 2 x sprays of lenzetto (brilliant- cleared up aches and pains within a week and felt my mood lift).
Then came the disaster of the 200mg utrogestan for 14 nights orally which made my mood unbearably low and my anxiety levels off the chart. My blood pressure tanked (99/60) which made me feel like a zombie, digestive issues and generally just feeling awful.
When i stopped on the 14th day, I felt even worse (if that's even possible) - i likened it to the hormonal crash a few days after having a baby.  My mood and other side effects slowly resolved as the days wore on but I was then left with hot flushes and night sweats, neither of which i had prior to starting HRT 6 weeks ago.

I have had a review with my provider this morning who has suggested 25 x 100mg utrogestan vaginally with 3 days break which im in agreement with to avoid any dramatic highs and lows but in addition to manage the hot flushes and sweats she has suggested I increase my lenzetto to 3 x sprays daily.
Im a bit reluctant to try this given I wasnt experiencing either prior to starting HRT.

Does anybody have any experience of HRT actually causing sweats/ hot flushes?
Could my lenzetto dose already be too high at 2 x sprays?

It all feels a bit counterintuitive to me.

Would really appreciate some insight/ suggestions

Many thanks in advance
Anna

[bombsh3ll]

At 42 you could be on a combined oral contraceptive pill for another 8 years without all that misery and drama.

I'm 45 and take Zoely continuously (active pills only). no bleeding, no hormonal chaos and it doesn't hurt my blood pressure.

In fact oral estrogens can help provide a little bit of blood pressure support which transdermal doesn't.

I hate my own progesterone but tolerate non-diuretic progestins just fine. On Zoely I don't even feel like I'm taking a progestin.

[AnnaH208]

Hi thanks for coming back to me.
Combined pill was my initial request but as I have a history of migraine the GP vetoed it so HRT is my only option 

[bombsh3ll]

You could still do a build-your-own CHC with 150mcg of desogestrel daily and an estrogen patch that meets your needs with stable levels and no thrombotic risk.

[AnnaH208]

Thanks - are you saying that synthetic progesterone / progestins are better tolerated than utrogestan?
What would be the benefit of this regime over the one ive been prescribed please?
Sorry, im very new to this and it seems like a bit of a minefield.
I actually have a pack of desogestrel in my drawer that the dr suggested i take last year when she said i couldnt have the combined pill (before i was considering HRT ) but I was  concerned it would impact my mood without the estrogen.

[bombsh3ll]

For some people, myself included, certain synthetic progestins can be better tolerated than natural progesterone.

Others feel better on micronised progesterone, it is very individual.

The advantages of a synthetic progestin are that it can shut down your own cycle, allowing a stable, consistent dose of estrogen to be added back. This approach works well for those with PMDD or cyclical migraine for example. Basically you get to ride a monorail instead of a roller coaster.

Likewise a synthetic progestin can keep you bleed free, which no amount of micronised progesterone is likely to do if you are not yet menopausal.

Progestins also offer superior protection against endometrial hyperplasia.

Now some people, particularly on social media think absolutely everyone should be on micronised progesterone because it does have a slightly more favourable metabolic profile and a slightly lower breast risk, however in my opinion neither of these are worth sacrificing your quality of life for because the real world difference in health outcomes is marginal.

So the benefits of using double dose desogestrel instead of the progesterone, plus your estrogen of choice, would (hopefully) be feeling more like you were on a combined pill taken continuously, with no bleeding and no hormonal ups and downs.

The combined pill means not only do I avoid having to take micronised progesterone, it also stops my ovaries from releasing any - no ovulation, no progesterone!

Long term ovarian suppression like this also reduces ovarian cancer risk, which is why I originally went on the pill 16 years ago.

If you have been on the mini pill in the past with desogestrel you will know whether you tolerated it or not.

You are right that it may affect your mood without estrogen but I wouldn't really recommend anyone take it without estrogen, except perhaps someone young with no complex needs who just wanted birth control and no other options were available or suitable.

You can alternatively take single dose desogestrel daily plus 100mg progesterone daily with estrogen, but this is a lose-lose situation in my opinion as it doesn't avoid the progesterone, is less likely to achieve amenorrhoea and has not been shown to reduce ovarian cancer risk.

[AnnaH208]

Hi bombsh3ll,
Thank you so so much for taking the time to provide such an incredibly detailed explanation. I really do appreciate it. Can I ask if you're medically trained? You sound like an expert.

Ironically I'm awake at 1am becaise im feeling rough (all hot and a bit spaced out / dizzy) after my first dose of 100mg utrogestan even though that was vaginally.  I had really high hopes that this would work but looks like whatever way I try and take it in I'm pretty intolerant.
Would you suggest i try to ride this out for say a week and see if the side effects subside or is this pretty much likely to continue / get worse?

What are your thoughts on the mirena coil? This was an option given to me today but I'm concerned about the fact I can't just stop taking it like I would a tablet if I get side effects (I had a friend who was suicidal after a week of having hers put in so im really apprehensive as I'm one of those people who if there's an adverse side effect going, ill get it with bells and whistles

I took the Yazmin pill years ago in my 20s and don't recall any adverse side effects at all so I do hope this is a good alternative option for me. I'll put a request in with the doctor tomorrow to discuss switching over and start taking the pack I already have.

Thanks again so much for your advice - very kind of you
 
Anna

[bombsh3ll]

That's actually suggestive of an allergic reaction - are you allergic to nuts at all? Some of the progesterone capsules contain a peanut oil base.

The Mirena IUS can be a really good option particularly for controlling bleeding but is invasive and not immediately reversible should you have problems with it.

There is another oral progestin option that you may be interested in - I would not have suggested it given your experience with low blood pressure however given that you have previously tolerated Yazmin, the same progestin, drospirenone, that is in Yasmin has just become available as a progestin only contraceptive pill in the UK, brand name Slynd.

This is considered adequate as endometrial protection by an increasing number of menopause specialists, however it remains off label for this indication, although your GP may prescribe it if you say it is for contraception.

Slynd can also be purchased from online pharmacies up to age 55.

Again it can potentially cause problems with low blood pressure as it is a diuretic, so I would take it with caution.

Desogestrel 150mcg (2X cerazette 75mcg pills) has no diuretic effect and should not affect blood pressure.