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[Lucoley]

Morning all.

I have a bit of a dilemma.

I have been on HRT sine July. Im 51 and post menopausal. The reasons for starting were mainly mood related. Morning anxiety, mood swings in the sense of very low/paranoid, really struggled to interact at work etc. I originally started on 2 pumps oestrogel and 100mg micronised progesterone daily. At first it was fabulous but to cut a long story short Im currently 10 days off progesterone due to severe intolerance. It made my anxiety 100 times worse. They want me to try vaginal progesterone. Im loath to do so as Im currently off work and feel Ive spent the last lot of months just so unpredictable.

Im toying with stopping it altogether. I feel I need the oestrogen but of course can't take it without the progesterone. Im now taking beta blockers to help with anxiety which do help the surges. Im on Citalopram longstanding. Thank god as I swear I'd be an inpatient somewhere if not! Obviously my concerns are my moods if I come off but then Im getting sick of the unpredictability of all this.

Bit of a rant really.

[bombsh3ll]

It's such a shame when anyone feels like they have to forego the short and long term health benefits of estrogen due to progestogen intolerance.

This should be a never event because there are so many progestogens options, both oral and non oral, plus tibolone.

Hysterectomy can be considered as a last resort but is seldom needed.

It looks like you have only ever tried micronised progesterone.

I would suggest seeing a specialist to discuss alternatives.

Additionally testosterone can really help with brain related symptoms as well as making the progestogen component easier to tolerate, and in my opinion addressing hormone deficiencies should be first line before psychoactive medication.

[Lucoley]

Youre right. Im going to take it vaginally first to see if it is OK for me. They tried talking me into a mirena which Im simply not willing to try. If it doesn't suit then I'd be waiting for an appt to get it out. Another option mentionEd was a patch with synthetic progesterone. Again Im very cautious. Testosterone was also mentioned but we decided to give the vaginal progesterone a try first on the basis I need to know how it effects me rather than adding in yet another hormone at the same time.

Im staying off the progesterone a little longer as my hormones are going on the rampage after stopping progesterone suddenly.

For me its really scared me. Ive worked long and hard on my mental health prior to this so its a big smack in the face. Don't get me wrong I know its all hormone related bit the thought of having these huge rises in anxiety and panic whilst trying to work in a demanding job and do life just makes me feel sick to my stomach.

[Mary G]

The wretched Utrogestan strikes again and destroys yet another HRT regime.

I would ditch the Utrogestan immediately and find a different form of progesterone.  So many people have problems with that stuff and it's more trouble than it's worth.  Some women tolerate it slightly better when used vaginally but it doesn't make a huge difference for most people and they still dread taking it.  It certainly didn't make any difference for me and I was still plagued with migraines and weird dreams. 

I think Oestrogel is a brilliant product so I would try Cerazette or Slynd instead.  Both are synthetic but they are much better tolerated than Utrogestan and they control bleeding better too.

You could try a low dose coil like the Jaydess but that is more involved so I would concentrate on trying oral progesterone for now.  I would take a few weeks off progesterone to recover and then try Cerazette because you can buy it in a pharmacy without a prescription in the UK.

[bombsh3ll]

It makes no sense to forego testosterone, nor to be so afraid of taking a synthetic progestin that you would consider giving up estrogen, yet accept antidepressants and beta blockers.

Equally I find it hard to understand women struggling on with micronised progesterone when it is making them ill. Is "body identical" really worth being miserable for?

The real world difference in any cardiometabolic health outcomes between micronised progesterone and progestins is absolutely marginal.

They have decades of safety data, offer superior bleed control and a lower risk of endometrial hyperplasia and cancer.

The chemical modification means they can be used in microgram doses rather than the 100-400mg doses required for micronised progesterone, thereby improving tolerability in many cases.

A good specialist who has been practicing since before menopause became fashionable will have all these tools in their armoury and be familiar with their use, however the social media bandwagon jumping, body identical evangelist late comers often only know how to prescribe utrogestan and have nothing else to offer other than increasing the dose or a mirena.