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[Helenmelon1974]

Hi all, i am 51 and post meno, I have tried Evorel Sequi and Conti and had a coil fitted (which had to be removed after 12 days) and reacted badly to the progesterone. I had a referral to a meno clinic who gave me the go ahead to use Utrogestan vaginally to stop side effects. She told me that unfortunately using it this way wouldn’t help with my sleep problems. However, I do definitely sleep better BUT I feel so groggy the next day! I’ve tried inserting it earlier in the evening but it made no difference.  Usually I’m up and out in the morning with the dog but it’s taking me a while to get going now! And I feel tired most of the day!


Will this settle? I’m ready to just give up on HRT! The only reason I’m desperate to get on it is due to recurring (possibly embedded) UTIs. I’m due to see her again to discuss long term antibiotics. I also take Hiprex and use Vagifem. The urologist advised that HRT would help with them but I honestly think I felt better without HRT! 😩 Any advice based on experiences would be appreciated x

[bombsh3ll]

You have tons of available options left to try- there are multiple oral synthetic progestins which can be better tolerated than micronised progesterone.

Due to being chemically altered to have a very potent, targeted effect these can be dosed in micrograms or low milligrams Vs the hundreds of milligrams of micronised progesterone needed for endometrial control.

If none of these suit - or even simply if you prefer, it is not a last resort - is tibolone which is often overlooked but can be a real godsend for progesterone intolerant women and a great threefer given it has androgenic activity as well.

[Mary G]

I agree, try something else before giving up on HRT altogether.  There are various forms of progesterone to try that are far better tolerated like Cerazette and dydrogesterone.  I would caution against taking too high a dose of progesterone if you are progesterone intolerant and would suggest regular scans to check your womb lining.  The NHS over prescribe the progesterone component of HRT because they can't afford to offer routine uterine scans.

I think Utrogestan is destabilising hence all the problems with it.

[Helenmelon1974]

Thank you! The meno specialist said my next option is Tibolone so I will look into that 🙂

[Helenmelon1974]

I agree, try something else before giving up on HRT altogether.  There are various forms of progesterone to try that are far better tolerated like Cerazette and dydrogesterone.  I would caution against taking too high a dose of progesterone if you are progesterone intolerant and would suggest regular scans to check your womb lining.  The NHS over prescribe the progesterone component of HRT because they can't afford to offer routine uterine scans.

I think Utrogestan is destabilising hence all the problems with it.

Because I’ve had issues with the coil and Conti (and the pill in the past) I was told Utrogestan was my best option other than Tibolone x

[bombsh3ll]

When you say "the pill" there are many, many different formulations of the combined oral contraceptive pill with very different progestins, different doses of ethinylestradiol and some now with natural estradiol, so I wouldn't assume that you cannot tolerate any progestin.

In my opinion an oral progestin is better than the IUS where there is a history of tolerability issues because it can be stopped immediately if you don't like it. You are not dependent on a third party for removal. Equally with the combi patch, you cannot separate out the estrogen from the progestin.

However tibolone is also a really good option, providing a bit of androgenic activity too, so there's really no need to plough through every single other option first.

A lot of practitioners claim tibolone increases clot risk however this is not true - ref GP notebook. It also has a lower risk of breast cancer. In one study there were 3 additional stokes per thousand ie 0.3% in women over 60 who had other risk factors such as high blood pressure, smoking and diabetes. This wouldn't faze me at all.

[Mary G]

You could try taking 100mg Utrogestan every other day.  I think the recommended NHS progesterone dose is too high which is why so many women struggle with it and end up giving up on HRT.  It's almost like it's set up to fail.

If you are severely progesterone intolerant and you can't tolerate any form of progesterone you could try bespoke progesterone from a private compounding clinic that specialises in bespoke HRT.  I used it for several years with Oestrogel and it was excellent with no side effects at all.  I used a 50mg progesterone dissolvable lozenge with two pumps of Oestrogel every day plus testosterone and it provided excellent womb protection.

The only option left after that is a hysterectomy but I would try all other options first.

Have a look at my compounded hormones thread in the Alternative Therapies section on here.  I'll bump it up for you.

[Helenmelon1974]

When you say "the pill" there are many, many different formulations of the combined oral contraceptive pill with very different progestins, different doses of ethinylestradiol and some now with natural estradiol, so I wouldn't assume that you cannot tolerate any progestin.

In my opinion an oral progestin is better than the IUS where there is a history of tolerability issues because it can be stopped immediately if you don't like it. You are not dependent on a third party for removal. Equally with the combi patch, you cannot separate out the estrogen from the progestin.

However tibolone is also a really good option, providing a bit of androgenic activity too, so there's really no need to plough through every single other option first.

A lot of practitioners claim tibolone increases clot risk however this is not true - ref GP notebook. It also has a lower risk of breast cancer. In one study there were 3 additional stokes per thousand ie 0.3% in women over 60 who had other risk factors such as high blood pressure, smoking and diabetes. This wouldn't faze me at all.

I did read up on Tibolone last night and that risk is in over 60s and as I’m only 51 I’m happy to give it a try! 🙂

[Helenmelon1974]

You could try taking 100mg Utrogestan every other day.  I think the recommended NHS progesterone dose is too high which is why so many women struggle with it and end up giving up on HRT.  It's almost like it's set up to fail.

If you are severely progesterone intolerant and you can't tolerate any form of progesterone you could try bespoke progesterone from a private compounding clinic that specialises in bespoke HRT.  I used it for several years with Oestrogel and it was excellent with no side effects at all.  I used a 50mg progesterone dissolvable lozenge with two pumps of Oestrogel every day plus testosterone and it provided excellent womb protection.

The only option left after that is a hysterectomy but I would try all other options first.

Have a look at my compounded hormones thread in the Alternative Therapies section on here.  I'll bump it up for you.

Thank you, I’ve heard about compounded hormones but have no idea about them at all. I will have a read 🙂