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[Clovie]

Hi

I know there are some very knowledgeable ladies on here who might be able to offer suggestions and I'd be really gateful for any insight 

I've been on Utrogestan and it hasn't stopped my own cycle.

I'm so sick of bleeding now - and although I was highly intolerant of several progesterones I tried over 10 years ago, (the ones I can remember I tried were in Tridestra, so medroxyprogesterone?, Elleste Duet,  so norethisterone?)  I am willing to at least TRY again with something to see if my tolerance has changed.

I don't want Mirena because obviously I can't get it out/stop it like you can with a tablet. I've had to stop prog tablets dead, and on advice of my doctor to do so, so bad were my reactions to it.

I am afraid of the breast cancer risks of progesterone so was happy with Utrogestan, it had less PMS type symptoms and the lesser of breask cancer risk was a great bonus!

What is the NEXT best thing, as in low risk for breast cancer, that is readily and easily available on the NHS that I can talk to my GP about please?

Thank you.

[flo69]

I can only say what I felt with the progestins you mentioned, I've had them all.

Norethisterone was quite slow to make me feel worse, when it did, it was a mild depression with no physical effects, it took about four months to build up to anything bad, so to me that is the most tolerable.

Medroxyprogesterone was awful from day one I felt ill, by day four I couldn't get out of bed I was really ill like I had influenza, the real one, I've had flu twice and MPA is that bad physically while also working on your mind to make you feel so worthless you might kill yourself (not helped by no sick line, more stress). That was an experience I will never repeat no matter what my GP threatens to take away. She didn't believe me.

Utrogestan wasn't as bad and if I hadn't had to try the other two first (because my GP says progesterone intolerance isn't a side effect of HRT, wait til she gets this age!) then I might have tolerated it better. As it was I was terrified, I had bad indigestion and couldn't sleep from being totally wired, that was enough to put me off before the real bad stuff started.

Mirena coil, I had for maybe three years before I got so fed up with it I removed it myself. It stopped my periods (the above three progestins didn't, I bled any time with them) but again the feelings of worthlessness and depression were creeping back in. I was totally cured after three days without it, had no physical problem from pulling it out myself either.

You can compare to know if you might have a similar physiology to me, I take tibolone, been over two years in total and it makes me feel better with some indigestion.
As for health scares, tibolone is banned in the US because it can be used for doping athletes (if let loose on menopausal women.  ) It is a mild anabolic steroid that our bodies break down into the building blocks of all three hormones that we have lost, so then we make ourselves new hormones out of the tibolone to replace our OE+P+T.

There are the usual warnings about oestrogen+progestin HRT in the leaflet, but tibolone isn't that type of HRT.
Then it says they do not know what tibolone may do long term, they haven't done the studies, which isn't very helpful, but I have high blood pressure, controlled by ramipril, I have enlargement in my heart with two year repeat scans, these are due to a separate syndrome, but these don't make tibolone dangerous. One locum commented it was the safest one for me.
From what I've read it might have no increased risk of cancer whatsoever, but they haven't really done the studies, so the best they can say is maybe it has the least risk.

However if you take tibolone, even though it is a progestin without the side effects, there is no variation in dose, one dose fits all and you will get no separate oestrogen because tibolone is all three in one package.
It's a choice.
I tried oestrogel with tibolone, but concluded it was the same as just tibolone on its own.

[Dotty]

The latest progesterones available are Slynd and Nalvee.

You could also use desogestrel or Norethisterone.

[Clovie]

Jeez. Thanks for your long and very helpful reply Flo - but wowser, what a depressing read!
None it seems look like any fun 

Tibolone sounds interesting, but I've read ladies over 60 can't take it? I'm almost 62.

I've been given 200mg Utrogestan to see if it stops my 'abnormal post menopausal bleeding'  (They can't bring themselves to say periods even though my periods have never stopped, are cyclic, predictable blah blah blah)
I was on 100mg continuosly with Estrogel for about 2 years and despite that level playing field of hormones I still cycled regardless.
I've read 200mg ain't gonna cut it either. Ahhhh.

Interesting how you removed your own Mirena, not sure I could do that, I mean Id be happy to be able to grab the strings and hoik it out but I don't think I could 'reach' and I'm a bit squeamish about 'down belows'  Sound ideal though, that you could do that! 

[Clovie]

The latest progesterones available are Slynd and Nalvee.

You could also use desogestrel or Norethisterone.

Thank you Dotty   are they readily available and prescribale widely?  My GP I'm expecting to not be happy about it, I might be wrong, but just going by my previous experiences there.
 
I've not heard of them because I've been on Utrogestan for so long.
I'll have a little google to learn a bit about them... 

[Emma]

What the robot says, usual disclaimers:
Looking for alternatives to Utrogestan? 
If Utrogestan hasn’t stopped your bleeding but you want low breast-cancer risk options you can stop if side-effects return, here are some NHS-available choices to discuss with your GP:


1. Dydrogesterone (Femoston, Bijuve)
- Gentler than older types (like norethisterone/MPA). 
- Breast cancer risk: Low (similar to Utrogestan in short term). 
- Available in combined HRT tablets (estradiol + dydrogesterone). 
- Oral – can stop anytime. 
- May regulate or reduce bleeding depending on regimen. 


2. Levonorgestrel IUS (e.g. Mirena, Benilexa, Levosert)
- Coil in the uterus, releases local progestogen. 
- Very low systemic exposure → fewer side-effects. 
- Excellent at reducing bleeding (many women stop completely). 
- Reversible, but requires a minor procedure to remove. 


3. Tibolone (Livial)
- Synthetic hormone (not standard estrogen + progesterone). 
- Helps with flushes, libido, dryness. 
- Can stop periods, though spotting is common at first. 
- Slightly higher breast cancer risk than Utrogestan, but lower than some older progestins. 
- Oral – can stop anytime. 


Summary

Option	Breast Cancer Risk	Stop Quickly?	Effect on Bleeding
Dydrogesterone	Low	Yes	Regulates/reduces
LNG-IUS (Mirena)	Very low systemic	Removable	Often stops bleeding
Tibolone	Slightly ↑	Yes	May stop after spotting

Talking points for your GP
- Your goals: control bleeding, low systemic exposure, low breast cancer risk, ability to stop quickly. 
- Ask about: Femoston (dydrogesterone) or Bijuve (micronised progesterone + estradiol). 
- Consider LNG-IUS (Mirena) if bleeding is the main problem – it is still removable. 
- Tibolone may suit if periods have settled and you want a one-pill alternative. 


 You do have choices beyond Utrogestan. Worth revisiting with your GP – newer regimens are often better tolerated than the older progestins you reacted badly to years ago.

[Clovie]

What the robot says, usual disclaimers:
Looking for alternatives to Utrogestan? 
If Utrogestan hasn’t stopped your bleeding but you want low breast-cancer risk options you can stop if side-effects return, here are some NHS-available choices to discuss with your GP:


1. Dydrogesterone (Femoston, Bijuve)
- Gentler than older types (like norethisterone/MPA). 
- Breast cancer risk: Low (similar to Utrogestan in short term). 
- Available in combined HRT tablets (estradiol + dydrogesterone). 
- Oral – can stop anytime. 
- May regulate or reduce bleeding depending on regimen. 


2. Levonorgestrel IUS (e.g. Mirena, Benilexa, Levosert)
- Coil in the uterus, releases local progestogen. 
- Very low systemic exposure → fewer side-effects. 
- Excellent at reducing bleeding (many women stop completely). 
- Reversible, but requires a minor procedure to remove. 


3. Tibolone (Livial)
- Synthetic hormone (not standard estrogen + progesterone). 
- Helps with flushes, libido, dryness. 
- Can stop periods, though spotting is common at first. 
- Slightly higher breast cancer risk than Utrogestan, but lower than some older progestins. 
- Oral – can stop anytime. 


Summary

Option	Breast Cancer Risk	Stop Quickly?	Effect on Bleeding
Dydrogesterone	Low	Yes	Regulates/reduces
LNG-IUS (Mirena)	Very low systemic	Removable	Often stops bleeding
Tibolone	Slightly ↑	Yes	May stop after spotting

Talking points for your GP
- Your goals: control bleeding, low systemic exposure, low breast cancer risk, ability to stop quickly. 
- Ask about: Femoston (dydrogesterone) or Bijuve (micronised progesterone + estradiol). 
- Consider LNG-IUS (Mirena) if bleeding is the main problem – it is still removable. 
- Tibolone may suit if periods have settled and you want a one-pill alternative. 


 You do have choices beyond Utrogestan. Worth revisiting with your GP – newer regimens are often better tolerated than the older progestins you reacted badly to years ago.

THANK YOU Emma, this is EXCELLENT!   

[Konijntje]

I’m intolerant to progesterone and lots of progestins. I’m now trialing drospirenone, which I can tolerate better mood wise, but the diuretic effect is bothering me. I’m hoping the dry mouth and skin will get better (only 4 weeks in), otherwise I’ll ask to be switched to dienogest.
I’m trialing the drospirenone as Drovelis, which is a birth control pill with natural estrogen (estetrol, which is interesting and will be available as hrt next year too), but it is also available as stand alone as Slynd.
If I’m going to trial dienogest, it will also be in a combined pill (qlaira), but that one is also available as a standalone (it’s often prescribed for endometriosis).
I’m 50 and my cycles are becoming horendous, so that is why I’m doing the birth control while trialing new progestins.

Both of these have an excellent safety profile and are newer generation progestins that are often tolerated better. However, these things are very individual, so it’s still trial and error to find one that agrees with you. I can tell I respond very differently to drospirenone than to levonorgestrel, which is good.

If you haven’t tried dydrogesterone yet, that could be an option to try too, it also has a good safety profile and is first choice here (the Netherlands). I didn’t tolerate that one myself, but have only trialed it for a short period, so maybe should have tried longer.

[Clovie]

I’m intolerant to progesterone and lots of progestins. I’m now trialing drospirenone, which I can tolerate better mood wise, but the diuretic effect is bothering me. I’m hoping the dry mouth and skin will get better (only 4 weeks in), otherwise I’ll ask to be switched to dienogest.
I’m trialing the drospirenone as Drovelis, which is a birth control pill with natural estrogen (estetrol, which is interesting and will be available as hrt next year too), but it is also available as stand alone as Slynd.
If I’m going to trial dienogest, it will also be in a combined pill (qlaira), but that one is also available as a standalone (it’s often prescribed for endometriosis).
I’m 50 and my cycles are becoming horendous, so that is why I’m doing the birth control while trialing new progestins.

Both of these have an excellent safety profile and are newer generation progestins that are often tolerated better. However, these things are very individual, so it’s still trial and error to find one that agrees with you. I can tell I respond very differently to drospirenone than to levonorgestrel, which is good.

If you haven’t tried dydrogesterone yet, that could be an option to try too, it also has a good safety profile and is first choice here (the Netherlands). I didn’t tolerate that one myself, but have only trialed it for a short period, so maybe should have tried longer.

Wow! I really am going to have to get up to speed on this new stuff!
Thank you for your reply! 

Are the medcations  you refer to suitable for me I wonder? I'm almost 62 but still having cycles of my own (though the docs cannot agree blah blah blah)
I just want to do the work for them so to speak, give them some suggestions that hopefully one they can agree for me to trial

Hope your trial goes well! 

[bombsh3ll]

If you are looking for an oral option that will reliably stop bleeding and is available on the NHS you could ask for provera.

Desogestrel 150mcg is slightly safer and better tolerated but only available at half that dose on the NHS as birth control, and only up to age 55.
Therefore access to this may be trickier.

Dydrogesterone is not yet available as a standalone and additionally is less reliable for bleed control in those who are still menstruating naturally as it doesn't typically suppress ovulation (it is a retroisomer of natural progesterone).

[Konijntje]

Are the medcations  you refer to suitable for me I wonder? I'm almost 62 but still having cycles of my own (though the docs cannot agree blah blah blah)
I just want to do the work for them so to speak, give them some suggestions that hopefully one they can agree for me to trial

Hope your trial goes well! 

Drovelis could be suitable in my opinion, but you probably won’t get it prescribed at your age, because it’s birth control. Also not qlaira.
But Slynd is an option as progestin part of hrt and since it is a progestin only pill will suppress your cycle too. So, if you don’t have any contra indications for the diuretic part, it could be the easiest to get prescribed and make you bleed free.
I don’t think dienogest will suppress ovulation on its own completely (it’s only available in combined pill), but because it has a pretty strong effect on the endometrium, it might make you bleed free too. It is also available (not sure about UK) as a combined oral tablet hrt as Climodien (2mg estradiol/2mg dienogest). The standalone is also 2 mg and could be combined with transdermal estrogen (not sure what brand in UK, in the Netherlands there are generics available). However, this standalone isn’t commonly prescribed for hrt I think, but maybe if you point to the combined Climodien preparation, a doctor might prescribe anyway.

[bombsh3ll]

Unfortunately neither climodien nor Drovelis is available in the UK, and slynd is also only licensed as birth control.

As slynd is new to the UK market even younger women wanting it for birth control are struggling to access it through the NHS, so it is really only available for HRT through specialist private clinics.

I would give the provera a try because most people are fine on it and you should be able get it from your NHS GP without any delays or quibbling.

The other options all rely on the provider having a level of up to date knowledge and interest that most GPs simply don't have, because they are expected to treat everything, with 8 minutes allocated per patient.

[Konijntje]

Unfortunately neither climodien nor Drovelis is available in the UK, and slynd is also only licensed as birth control.

As slynd is new to the UK market even younger women wanting it for birth control are struggling to access it through the NHS, so it is really only available for HRT through specialist private clinics.

I would give the provera a try because most people are fine on it and you should be able get it from your NHS GP without any delays or quibbling.

The other options all rely on the provider having a level of up to date knowledge and interest that most GPs simply don't have, because they are expected to treat everything, with 8 minutes allocated per patient.

I’ve seen Drovelis in the UK, on thelowdown (I read reviews there, because it is also quite unknown here, even though it’s available) ? Not sure how that works though, you can order birth control without a prescription?

Sorry if I gave unhelpful information, healthcare system is different here I guess.

[flo69]

What the robot says, usual disclaimers:
Looking for alternatives to Utrogestan? 
If Utrogestan hasn’t stopped your bleeding but you want low breast-cancer risk options you can stop if side-effects return, here are some NHS-available choices to discuss with your GP:


1. Dydrogesterone (Femoston, Bijuve)
- Gentler than older types (like norethisterone/MPA). 
- Breast cancer risk: Low (similar to Utrogestan in short term). 
- Available in combined HRT tablets (estradiol + dydrogesterone). 
- Oral – can stop anytime. 
- May regulate or reduce bleeding depending on regimen. 


2. Levonorgestrel IUS (e.g. Mirena, Benilexa, Levosert)
- Coil in the uterus, releases local progestogen. 
- Very low systemic exposure → fewer side-effects. 
- Excellent at reducing bleeding (many women stop completely). 
- Reversible, but requires a minor procedure to remove. 


3. Tibolone (Livial)
- Synthetic hormone (not standard estrogen + progesterone). 
- Helps with flushes, libido, dryness. 
- Can stop periods, though spotting is common at first. 
- Slightly higher breast cancer risk than Utrogestan, but lower than some older progestins. 
- Oral – can stop anytime. 


Summary

Option	Breast Cancer Risk	Stop Quickly?	Effect on Bleeding
Dydrogesterone	Low	Yes	Regulates/reduces
LNG-IUS (Mirena)	Very low systemic	Removable	Often stops bleeding
Tibolone	Slightly ↑	Yes	May stop after spotting

Talking points for your GP
- Your goals: control bleeding, low systemic exposure, low breast cancer risk, ability to stop quickly. 
- Ask about: Femoston (dydrogesterone) or Bijuve (micronised progesterone + estradiol). 
- Consider LNG-IUS (Mirena) if bleeding is the main problem – it is still removable. 
- Tibolone may suit if periods have settled and you want a one-pill alternative. 


 You do have choices beyond Utrogestan. Worth revisiting with your GP – newer regimens are often better tolerated than the older progestins you reacted badly to years ago.

Hi, can you link where you get this information that utrogestan is lower risk for breast cancer risk than tibolone?

The last studies I saw hadn't found tibolone causes any increase in breast cancer risk from baseline, so lower than that is a negative risk.

Are you saying utrogestan improves breast cancer risk from baseline?

[bombsh3ll]

I don't think tibolone has ever gone head to head in any study, randomised or observational, against utrogestan for breast cancer risk. 

However my understanding is also that tibolone does not increase breast cancer risk above that of untreated women who have never had breast cancer. There was some debate around it possibly increasing recurrence in survivors, which was low numbers/poor quality.

Progesterone with estradiol did not seem to increase breast cancer in the first 5 years in the E3N French study, however there was a small increase in use beyond about 7 years. Most of these individuals were taking the progesterone continuously (which I personally wouldn't do), and it is also unclear what proportion were taking it orally vs vaginally, the latter being common in France.

I am a prophylactically mastectomised non-carrier within a BRCA family and having watched it take 7 of my relatives, if I still had my cancerbags I would be going for the tibolone.