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[Daisy1]

Hello! I hope it's ok to start a new thread, I have a couple going already and appreciate there is lots on the forum about progesterone and Utrogestan.

Appreciate it's of course not as clear as is it good or is it bad, but I'm feeling so confused about progesterone the more I read about it. Medical and menopause experts I see online, all seem to say body identical progesterone is amazing for especially perimenopause to help calm anxiety, increase feelings of well being and to help balance oestrogen and cortisol. However you see soooo many negative reviews from people actually using it? Why is there such a discrepancy in information and feedback/reviews?

Personally I tried Utrogestan first last summer with a 25mcg oestrogen patch. I started with 200 mg oral for 12 days and felt terrible! Total lack of interest in daily life, felt very sedated, in a sense calm, but weirdly so and very spaced out. I did also have low mood slowly creeping in. Hugely increased appetite, absolutely mad nightmares and disturbed sleep, very hot at night. I also started to bleed by day 8 and had an awful withdrawal feeling really irritated and cross at everyone and everything. I stopped HRT entirely and tried combined pill instead.

Long story, I am now back trying body identical HRT. This time I tried 100 mg utrogestan vaginally and felt pretty good. I felt calm, balanced and felt like I could think more clearly and therefore get more done - rather than the panickly energy I normally have, where I can't actually focus on anything or think clearly. I felt much more friendly, tolerant and kind to my husband and family which they all enjoyed! But then felt awful with the withdrawal again. (Also appreciate 100 mg cyclically isn't enough, but I just had to test out my tolerance for one cycle).

Is it just that the dose and oral method is way to high and therefore caused negative side affects that so many people talk about? Are there some people who find 200 mg orally tolerable and even helpful, like the medical professionals say? I'd be so interested to hear please!

(Personally I think I'm very sensitive to hormonal fluctuations of a cyclical regime and I'm thinking the oral dose is just too much of a hit of progesterone. Maybe 100 mg vaginally or rectally on a continuous basis will be manageable and will help with anxiety, heart palpitations and mood. I'm going to test this out for the next month even though I'm early peri and still having regular, but noticeably and regularly shorter, cycles).

I'm just so interested that progesterone can be so divisive and people have such differing reactions?

[dangermouse]

Perhaps you could try it continuously? Prog withdrawal is tough for most if it can be avoided.

No hormone is good or bad, hormone balance is what works the best, which can be a smaller amount of progesterone for some or a higher dose for others. Utrogestan does seem to have something in the additional ingredients that some cannot tolerate and, as 50mg is a better dose for most, it tends to overdose some using it, which is probably because it is a fertility drug repurposed for HRT so only high doses are available. 

Progestins are a different matter as they just mimic parts of progesterone and tolerance will vary.

For those not using oestrogen, progesterone cream can be more flexibly dosed.

[sheila99]

Everything with hrt is individual, what one person finds fantastic someone else won't. Utro acts as a mild sedative and many women love it because it helps them sleep. But for me it disrupts my sleep but leaves me dopey all day, no difference the dose or delivery method. I have no side effects from the mirena but other women can't tolerate it. I agree you might feel better on conti or the 25/28 regime. Or a synthetic. Anxiety, heart palpitations and mood are all low oestrogen symptoms so it might be worth considering your oestrogen dose. Though anxiety can also be from too much oestrogen and sometimes from utro and other causes too.

[bombsh3ll]

Micronised progesterone is not the wonder molecule it is portrayed as on social media and by the body identical evangelists.

Many women find it unpleasant to take, in fact there generally seem to be far more problems with tolerability as compared to some of the synthetic progestins, whose chemical modification means they can be taken in microgram or low milligram doses rather than the 100, 200+ mg of micronised progesterone needed to protect the endometrium.

I think part of the rationale for trying to convince women it is fantastic is that some form of it is really important to prevent endometrial cancers - Louise Newson is always extolling its virtues when she herself has had a hysterectomy in order not to have to take it.

However there are multiple other options, plus tibolone, so nobody should ever feel like they are stuck with one that doesn't suit.

[dangermouse]

It’s funny Bomb, as I could tolerate Ethynl Estradiol from the pill no probs but the plant based one made me as sick as a dog. I noticed that early on when I was able to take the pill to get through the end of peri and also tried the combined pills that had the plant one in. I had the pack where some pills were just the oestrogen and tried them on their own so I know it was that and not the progestin.

I wonder why they never made an HRT with EE in it.

[Daisy1]

It’s so interesting. Everything I google online and all the podcasts I hear say how great micronised progesterone is, but all the posts on here and other forums there are lots of people struggling with it. The information is so conflicting.

[bombsh3ll]

A part of the problem is that the new generation of menopause specialists, whom I have a lot of respect for and have really advanced women's healthcare and democratised a lot of menopause education, are ideologically wedded to "body identical".

They do not have the skills or the knowledge to prescribe anything else, and as the saying goes if all you have is a hammer, everything starts to look like a nail.

They are unfamiliar with the range, dose and characteristics of various progestins so are a bit of a one trick pony when it comes to prescribing, and many have an inaccurate perception of the difference in various "risks" between preparations, and that as well as tolerability and quality of life, progestins are generally superior at bleed control and endometrial protection.

[Mary G]

I've been on this forum for over 10 years now and I think Utrogestan is the most debated and problematic HRT product.  The medical professional are wedded to it because it's supposedly close to the progesterone you produce yourself but the reality is very different and I would go as far as to say most women have problems with it.

I agree, don't be put off the synthetic forms of progesterone because they have fewer side effects for most women.  I switched to Cerazette in 2024 and bar compounded progesterone, it's the best progesterone product I have used with zero side effects.  I only take 75mcg every day which is half the recommended dose but it works well.  At my recent appointment with my gynaecologist I asked her if she thought Cerazette was dangerous for breasts when used by older, post menopause women and she said definitely not.

Utrogestan is an unstable form of progesterone that is not great at controlling bleeding. It gave me endless migraine auras and importantly for me it doesn't suppress FSH and LH so there's no way I would go anywhere near it again.

Definitely look at an alternative form of progesterone.

PS I would add that a 25 mcg oestrogen patch is probably way too low a dose.

[dangermouse]

So that follows that ethynyl estradiol (synthetic) could be better than plant base estradiol.

Thoughts?

[Arya Underfoot]

I hate all this negativity around micronised progesterone. It literally saved my life. I was really struggling with anxiety, rage, irritability and insomnia until I increased my dose to 200mcg daily. It made such a huge difference to my life, I almost felt normal again. It's only when I introduced an oestrogen implant, which sent my levels too high that I started struggling again. I am super sensitive to oestrogen and a lot of other medications that cause anxiety but progesterone is the bees knees, I love it. I've been using it for over 20 years.  I should also point out that my blood test don't show my progesterone levels as being too high.

I really think we should stop all this negativity as it may put someone off trying a treatment that could help them.  Let people try the hormones and make up their own mind. Let's support people rather than spread negativity.

[Eliphanty]

The body likes balanced, stable hormone levels. Perimenopause is anything but that with big, unpredictable fluctuations. Add HRT to the party and it leaves some women constantly trying to find the correct dose of the correct hormones that suit them. Just because something doesn’t work for one person doesn’t mean it’s bad for another. Some women “get lucky” and the first thing they try works, others spend years trying to find their perfect formula. If it generally improves symptoms then that is a success but I do think we have to accept we might sometimes still feel symptoms. It is difficult to control our hormones to the extent that we feel brilliant every day. Before perimenopause we tended to accept that our cycle brought with it different physical and emotional symptoms depending upon where in our cycle we were - but at least it was predictable and we knew it would pass. Perimenopause is far more difficult to manage because of the wild fluctuations. Obviously if you are taking HRT and it is making your symptoms worse then it needs a review. I can give a glimmer of hope to perimenopausal women that once you reach menopause and especially post menopause your hormone levels stabilise. It seems then to be “easier” to find a suitable balance because your natural levels stay the same and you can top them up at a constant level on a daily basis. The majority of women who are struggling with getting the balance consistently right tend to be the ones in perimenopause. So not good or bad - just more or less suitable or appropriate for some compared to others.