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[Emjay]

Hi,
I am currently on 100mcg everol patch and 200mg Utrogestan for 12 days vaginally.
I am seriously struggling with the progress side of things. Within 24 hours I feel horrendous, have suffered with pmdd in the past and it just automatically sends me into pmdd mode.
I have been to a private clinic and she has suggested I stick with this (although has mentioned that I should be on 300mg Utrogestan for 12 days which there is no way I can tolerate)
Has anyone see a private consultant such as professor studd (I think that's his name)
And been able to use Utrogestan at a lower dose for a shorter amount of time?
I would happily pay for a scan every 6 months or every year to check womb lining.
The g.p has also prescribed me escitaloprám which I think is only adding to how rough I feel to be honest.
She recommended that I take it cyclically but I have been feeling awful most of the month since being on the 100 patch and the 200mg Utrogestan so decided to take 10mg of escitaloprám every day.
I think maybe it smoothed the major downs I was having during the luteal kind of part but since taking the Utrogestan again I feel so horrible. Joint pain, muscle pain, aswell as all the mental symptoms.
I am having a blood test in a couple of weeks, estrogen and testosterone to see what's going on.
Testosterone was below average about 4 months ago then another test showed it was in range but on the lower side so they want to see what estrogen and testosterone is like after being on the full amount of estrogen before they even prescribe me testosterone to try.
I have said all along I think my problem is actually low testosterone and have been gradually feeling worse with the estrogen increases which in the beginning the hrt did help some symptoms, especially vertigo and a lot of pains I was getting, hot flushes etc.
Nothing has got rid of anxiety but a lot of physical symptoms have gone full circle and feeling worse.

[bombsh3ll]

I am sorry you're struggling and I think you should see a specialist - professor Studd's clinic is still there in London being run by those he trained. There is also nick Panay and Louise Newson.

Some if not all see patients remotely.

My only issue with Louise Newson is whilst she is all for individualised care, this extends only as far as treating people with micronised progesterone. She is anti - synthetic progestin and anti- tibolone (both of which which can suit progesterone intolerant women better) so consequently limited in her treatment armoury, and whilst she may support the rare use of a synthetic, probably lacks the broad based knowledge around prescribing these.

As you say, testosterone also anecdotally helps people tolerate progesterone, and the lack of this from your current provider is reason alone to see a specialist.

Professor Studd did used to sanction 7 days per month micronised progesterone with scans.

Historically onger cycle treatment with a 2 week course of synthetic progestins every 2-3 months were used. One brand was Tridestra. Whilst small numbers did develop hyperplasia, the vast majority were fine especially if you had regular scans.

Personally I will be looking to do longer cycle, to give me as close as possible to the quality of life and health benefits of estrogen alone, which may for me mean one of the more metabolically favourable progestins such as dydrogesterone or desogestrel.

As these are much more potent and targeted, a much smaller dose can be taken than micronised progesterone, minimising toxicity.

[Mary G]

I really do wonder why so many medics are wedded to Utrogestan because it really isn't well tolerated.  Utrogestan intolerance is the most debated subject on here and even women like me who were never progesterone intolerant pre menopause have problems with it.

bomb is right, the synthetic forms of progesterone are better tolerated so I would try something like Cerazette or the new dydrogesterone.  Having read up on it, I think part of the problem with Utrogestan is poor suppression of FSH and LH meaning it is not good at stabilising hormones and mood.  In my case it leads to migraine auras but in others it causes problems like anxiety, depression and all sorts of other issues. 

[Emjay]

Thanks both for your replies, they are very helpful.

I haven't tried a synthetic progesterone/progestin yet, well apart from the mirena coil which I did not tolerate at all.
I have been reading about dydrogesterone, I think that may be in femostan or qlaira, will have to read about them all again.
Will look into the ones you have mentioned, thank you.
In all honesty I hope my blood test comes back as low testosterone so I can try it, and hopefully that will help.
I have had zero libido since before and the whole time I have been on hrt, have all symptoms of low testosterone, have been tested as low, i do find it bizarre they won't even let me try it for a while, especially as from my understanding it is easier to detect levels of testosterone through a blood test compared to estrogen which is unreliable.

The dr I saw was at a menopause clinic and she actually follows a lot of Nick Pannays's work (sorry, I mentioned the wrong dr in my 1st message, I'm aware Professor Studd passed away) anyway, she was actually telling me that she was off to a seminar with Nick Panny during my appointment, maybe she will have some new ideas at my next appointment.
She was good/nice, she did say that we will get to the bottom of this and I won't always feel like this so I hope after this blood test with whatever it shows we can come up with a different plan as Utrogestan is not for me.
And sounds like it isn't for lots of women.
I was hoping it would suit me fine as obviously like us all, we would rather go for the type that poses the least risks but there is no point at all if it negatively impacts us in anyway. We are just swapping one horrible thing for a another horrible thing.
I am going to mention shorter progesterone phases to the dr, plus testosterone and also an oral progesterone and see what happens.
If I don't feel I am getting anywhere then I will try to get an appointment at Nick Pannay's clinic I think.

Do either of you use a different progestogen? Any of the ones you mentioned?
And find they have been much better suited to you?

[bombsh3ll]

I am on combined pill Zoely, which I take continuously for menstrual suppression.

It contains body identical estradiol and nomegestrol acetate.

I don't tolerate my own progesterone very well, and being on a combined pill means no ovulation which means no endogenous progesterone release 😃

I have been on various combined pills and also the Nuvaring for the past 16 years which has worked out great for me.

Nomegestrol acetate is in my opinion the kindest progestin but it is not available on its own.

I also tolerate desogestrel, which is available as a standalone and supported by the BMS based on evidence as endometrial protection within HRT.

I have never tried dienogest or dydrogesterone personally but am interested in both these options when the time comes for me to graduate from the COCP to menopause hormone therapy.

[Mary G]

I use two pumps of Oestrogel, testosterone, progesterone gel (Darstin - not available in the UK) and 75mcg Cerazette (desogestral) every day.  I have brainstem auras caused by low oestrogen and general hormone instability so my progesterone options are limited.  I find progesterone gel and Cerazette to be good stabilisers whereas Utrogestan and norethisterone caused endless hormone spikes and migraine auras - in other women they cause other problems like low mood and depression.

Duphaston (dydrogesterone) might be an option for you and I'm thinking of trying it myself because I bought some in Portugal recently but I'm not sure if it adequately blocks FSH and LH and works on the brain in the same way as Cerazette so it's a risk for me but it might work for you.

I also got on extremely well with compounded progesterone from a private clinic in London but I had to stop using it because they no longer post it to EU states after Brexit.  Have a look at my thread on compounded hormones in the Alternative Therapies section on here, I've just bumped it up for someone else. 

If all progesterone options (and tibolone) have been explored but failed, the only thing left is a hysterectomy but I would try everything else first because it's a big operation.