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[cocopop100]

Hi meno friends, I’m increasingly convinced utrogestan is the culprit for my fatigue. My question is - could I stop utrogestan for a week, but continue with my estrogel, to check my theory?! Would this cause any dramatic health issues within that time? I know the uterus needs the protected from progesterone but is this more of a longer term thing? I’m post-menopausal btw so taking HRT continuously every day. Thanks so much! Ps. I’m trying to spk to my GP but they’re being pretty unhelpful and saying they’ve never known utrogestan to cause fatigue and need to refer me to meno clinic !

[bombsh3ll]

Utrogestan is known to cause grogginess especially if taken orally.

It is absolutely fine to omit this for a few weeks (up to 3 months is reasonable although no guidelines exist on this, it is just judgement and pragmatism, and you may well run into bleeding) to assess.

You are correct that endometrial cancer develops over years not weeks (and most women taking long term estrogen only in the 60s and 70s never developed cancer, it is a risk, not an eventuality).

Be prepared that you more than likely will have some withdrawal bleeding if you stop the progesterone even briefly. This is normal and doesn't require investigation.

You could also consider taking the utrogestan vaginally. This bypasses the production of sedating metabolites.

Ultimately there are multiple alternatives to micronised progesterone so nobody needs to put up with unpleasant side effects having only ever tried one option.

[cocopop100]

Thank you so much - great advice

[CLKD]

Have U decided which symptom U would like to ease first with HRT? 

[cocopop100]

Hi, yes I think the main thing was the vasomotor symptoms for me. They went within a couple of days on 1 pump estrogel tho.

[cocopop100]

Hi, I’ve been advised to also pop this question on this thread as the two are connected…

I’m struggling with fatigue and low mood and generally feeling awful and think it’s the utrogestan. I’m on 100mg per day continually (vaginally) which I’m taking alongside 2 pumps estrogel.

My question is, what progesterone alternatives can I look at? My GP is clueless so I think I need to go to them with a request. I’m trying to research through all the brilliant threads on this site but the info is quite overwhelming! (While also being hugely useful!!) So far I have -

- cyclogest suppositories
- lutigest
- provera
- cerazette
- dydrogesterone
- prometrium
- zentiva
- tibolone

I’m sure there are more!!

Could anyone suggest the best place to start?

Thanks so much

[cocopop100]

Utrogestan is known to cause grogginess especially if taken orally.

It is absolutely fine to omit this for a few weeks (up to 3 months is reasonable although no guidelines exist on this, it is just judgement and pragmatism, and you may well run into bleeding) to assess.

You are correct that endometrial cancer develops over years not weeks (and most women taking long term estrogen only in the 60s and 70s never developed cancer, it is a risk, not an eventuality).

Be prepared that you more than likely will have some withdrawal bleeding if you stop the progesterone even briefly. This is normal and doesn't require investigation.

You could also consider taking the utrogestan vaginally. This bypasses the production of sedating metabolites.

Ultimately there are multiple alternatives to micronised progesterone so nobody needs to put up with unpleasant side effects having only ever tried one option.

Ps. Thanks again for your helpful advice. Also I just want to mention that I do already take the utrogestan vaginally. But am still convinced it’s causing fatigue. From what you’ve shared do you think this isn’t possible?

[sheila99]

It's absolutely possible, I took it vaginally and was still wiped out. Vaginal use avoids digestive problems but I don't think it makes any difference to fatigue. Although no utro is fine for a period personally I wouldn't go without it for more than a month. Another option is to use it sequentially (2x100mg for 12 days, I used a 6 week cycle though your GP may not approve of this). I don't get fatigue with norethisterone (I used half a tablet as they only come in 5mg but you only need 1 mg. If you're on 50mcg oestrogen it's the same as in evorel conti patches. I now have a mirena which doesn't have any side effects for me.

[bombsh3ll]

Absolutely it can still cause fatigue vaginally, just not as much as oral, so some find this an adequate solution.

Assuming you can't take the combined pill due to age (which is my own first choice - I take Zoely), my personal preference for alternative progestins in order of desirability (ignoring issues of cost, access or licencing) would be:

1. Dydrogesterone
2. Dienogest
3. Cerazette (2*75mcg tabs daily)
4. Drospirenone/Slynd (I have a personal contraindication to this as it is a diuretic but most people are fine with it)
5. Tibolone - provides estrogenic, androgenic and progestogenic activity as a threefer.
6. Norethisterone
7. Provera

Cyclogest, lutigest, prometrium and zentiva are all just different brands of micronised progesterone.

There is also the mirena IUS which provides good endometrial protection and bleed control. Personally this is not for me, primarily because I have a medical contraindication but more generally it is invasive and dependent upon a third party for removal, you can't just stop it yourself if it doesn't suit you.

Whilst things may be improving I am aware of multiple instances where women have really struggled to access removal after suffering from side effects - appointments can be hard to come by and there is some reluctance on the part of NHS clinicians to remove them due to device cost and lack of trusting women to be "compliant" with self administered progestogens.

[Minnie Mouse]

Lots of really useful advice.
I'll share what happened to me, just in case it helps anyone....
Been HRT for 5.5 yrs, and was long convinced that Utrogestan was my enemy, tried different regimes and orally, vaginally etc.
Was about to give up & go Mirena, until a high cholesterol blood test scared me enough to start a major major detox: healthy eating, no saturated fats, no alcohol, especially no alcohol 
My biggest surprise was that suddenly I seemed to tolerate the Utrogestan, and I feel normal again on it after years of hating it.
I've also got better at taking it properly (empty stomach).
Good luck with finding out what's best for you.

[bluebird68]

I've been on micronised progesterone for a few weeks vaginal. I found that I am sleepy and my thermostat is on boil a lot of the time. I am a low absorber of gel and patch and the GP is writing to the gyno for advice. If the boiler mode and groggy feeling is related then iay have to go on oral or quit. Horrible existence but always hope

[Vicky81]

Absolutely it can still cause fatigue vaginally, just not as much as oral, so some find this an adequate solution.

Assuming you can't take the combined pill due to age (which is my own first choice - I take Zoely), my personal preference for alternative progestins in order of desirability (ignoring issues of cost, access or licencing) would be:

1. Dydrogesterone
2. Dienogest
3. Cerazette (2*75mcg tabs daily)
4. Drospirenone/Slynd (I have a personal contraindication to this as it is a diuretic but most people are fine with it)
5. Tibolone - provides estrogenic, androgenic and progestogenic activity as a threefer.
6. Norethisterone
7. Provera

Cyclogest, lutigest, prometrium and zentiva are all just different brands of micronised progesterone.

There is also the mirena IUS which provides good endometrial protection and bleed control. Personally this is not for me, primarily because I have a medical contraindication but more generally it is invasive and dependent upon a third party for removal, you can't just stop it yourself if it doesn't suit you.

Whilst things may be improving I am aware of multiple instances where women have really struggled to access removal after suffering from side effects - appointments can be hard to come by and there is some reluctance on the part of NHS clinicians to remove them due to device cost and lack of trusting women to be "compliant" with self administered progestogens.

Hi bombsh3ll I hope you don't mind me jumping in....just saw this post and wondered if you could give us your thoughts on why you picked the first 2 progesterones then have cerazette as 3rd choice please?
Many thanks xxx