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Hello
I believe I am going through the menopause. Reason I don’t know is that I came off Depo Provera in December when I turned 50, so I’m waiting to see if my periods will come back. Hopefully not as the reason I was on Depo was because of painful periods. I have a lot of symptoms but one of the worst is heartburn. It wakes me up in the night, it comes after I’ve eaten and after I have a hot or cold drink. (I don’t drink alcohol or smoke)  I’m taking general indigestion tablets which do help, but I don’t want to take too many. I can’t afford prescription medication for it.
When looking at menopause symptoms online I’ve only seen one website (American) that lists it as a symptom.
Does anyone else have chronic heart burn like this?

I can't help re the hrt, but I can relate to not being on the waiting list.

A few years ago I was referred for something and was told it would be X amount of months before I  would ĥear anything and get an appointment.

The time came and I hadn't received my appointment through so rang up and I wasn't on the list. I was fuming, but they said there was nothing they could do, so I had to go on the list Again!!

Now, everytime I get a referral, for anything, I always ring up and get them to check they've received the referral and I'm definitely on the list.

I know this won't help now, but will help for any future referrals.

Pains

“I started to bleed on day 12 of using the progesterone and on day one without progesterone and I already feel an improvement, most notably in terms of mood. I’m still very tired. It’s as though the commencement of bleeding flipped a switch in my brain and I feel much calmer and more like myself. This is exactly how it played out when I was a younger menstruating woman. As soon as I would bleed, the darkness would lift.”

Yes this is exactly how I felt as a menstruating woman. We now know there are several aspects to this – there is the progesterone withdrawal – which can sometimes lead to pms type symptoms, irritability, headache etc that many women got while fertile, and experience when coming off the progesterone phase of the HRT. Then there is the effect of oestrogen. During our natural menstrual cycle oestrogen levels fall just after ovulation, and then rise again falling to a low level for the last few days before the period (coinciding also with progesterone withdrawal). After the bleed starts oestrogen rises rapidly again over the next couple of weeks – but of course with HRT it stays constant.

I used to feel exactly as you did when menstruating – tense and horrible, irritable etc during those last few days and almost a day after the bleed started I could feel all of that melting away – just like the flipping of a switch – I could almost feel the sensation of the oestrogen rising - surging through my blood stream, even though I might have period pain and a bleed, and my mood became light and buoyant again.

Since being post-menopausal it isn’t quite like that because oestrogen does not rise - but I do feel the head fog clearing once the progesterone has gone (which takes a few days) and I feel bright and normal again.

“My question is that my body seems to want to bleed by itself on day 12 of the 200 mg of progesterone. Based on your comment, does that mean that I should not do too long of a cycle? I would like to extend the 16 days to, perhaps 21 days on oestrogen only.”

I can’t remember all the details of your story but if you have been checked out then presumably fibroids, polyps or other abnormalities have been ruled out.

Since the bleed is cyclical then it is likely to do with the hormone regime. You said you used to bleed too much on lower doses of Utrogestan. I presume you had a scan and the thickness was measured? If the endometrium is at all thickened or thicker than it should ideally be, then it still has to shed so sometimes this can be an explanation for an early bleed. In any case even the guidelines if I recall correctly, state that the withdrawal bleed occurs towards the end of the progesterone phase or just after – so you’re within the bounds of normality.

As to the question of lengthening the cycle – well that does depend what thickness your womb lining is, so if it is thickened – it could take several months longer to thin down so in the meantime extending the cycle probably wouldn’t be advisable, if you want to avoid bleeding problems or more thickening maybe.

Another factor to think about is how long and heavy the bleed is – if long and heavy – then there is clearly more lining to shed, but if it is short and light despite starting at the end of the progesterone phase – then that might just be how your body works and extending the cycle may mean the bleeds still start early.  Ideally it would be good to have a scan just as the bleed is finishing when the lining is at its thinnest but if not, see what happens over the next couple of months – depending on the bleed.

In short – if the bleed is long and heavy then probably not a good idea to extend the cycle yet. If short and light then why not give it a go and try 21 days of oestrogen followed by 12 days of Utrogestan giving you just under a 5 week cycle?

Any concerns about anything including your bleeds, of course consult your doctor and ideally discuss with or at least inform your GP or specialist about what you’re doing.

Hope this helps and all the best

Hurdity x

Thank you again for such a thoughtful and helpful response. There’s so much in there of value. That’s interesting to read that you had the same experience as a menstruating woman in terms of feeling like a switch was being flipped inside you once you started to bleed.

I had a scan fairly recently and got the all clear for anything irregular. The doctor concluded that my breakthrough bleeding was to do with the HRT and my body trying to adjust. When I took progesterone 100mg continuously, I would have light/moderate breakthrough bleeding every two to three weeks. It just seems that that’s how my body wants to handle this.

As I mentioned to Sheila, my period now (on day two without any progesterone) is like one of my regular pre-menopausal periods. It was typically quite heavy on the first 1 - 2 days so I will see how long it lasts and if it lightens soon. Depending on that, I’ll decide whether to extend to a 21 day oestrogen only cycle next month or hold off with the shorter one for now. I feel like a mad scientist. I have to remind myself to keep emotion out of it and try to stick to facts and data. I’m hoping that I eventually find the right sequence length for me and of course, I understand that that will change as my body does.

Never in a million years though I would be buying tampons and leading once in menopause. There are always new things to learn.

Thank you for your patience and support in explaining everything to me. 🙏🏻

I know you asked Hurdity but after 40 years of a (natural) 6 week cycle my lining was thin so I continued with it in peri as soon as I changed from patches to gel/utro and am continuing with it now. I'm inclined to think that as long as you have a decent bleed it should be OK but the only way to know for sure is to scan after a few months, everything else is guesswork.

Thank you very much. All input is gratefully received. Thank you for sharing your experience.
Sounds odd to say, but I’m happy with my bleed so far. It’s like a proper period as opposed to spotting. I feel like my uterus is getting a good old clean out. Of course, I hear your point about imaging being the only scientific way to measure the endometrial thickness.

Yes, sorry Disco, try it.
It does seem to be helpful having the 3 days off it.
Like now, for me, I’m not depressed or anything, but feel flat, I was like it last month too, then after the break, I felt fine.
Good luck. Let us know how you get on.
Xx

Hi sooper-cooper

Nausea is listed as one of the common side effects and the product info also says "Undesirable effects are more common during the first months after the insertion, and subside during prolonged use.". Hopefully the nausea will settle soon.

Hurdity x

Hi Mary G

Yes it is the 8% Crinone, I don't think the other 4% is available any more. Yes, they come in boxes of 15, which is a months supply for me as I use it every other day.

I am not too worried about it not being licensed for HRT, as it is licensed for fertility treatment and so is obviously (to me) safe and probably safer than some of the synthetic alternatives that g.ps are happy to prescribe as it is bioidentical.

As for the dose,  nobody knows what level of progesterone is required for protection against oestrogen (no studies). The crinone dose (90 milligrams every 2 days, or 45mg a day) is higher than a mirena coil (21 micrograms daily) so again I am not concerned that it is inadequate. It is less than utrogestan but via a different route, and perhaps that is why it is tolerable.

Hi AKatieD

Re Crinone gel - it is not possible to compare the amount of progestogen in a Mirena coil (which is a synthetic progestogen called levonorgestrel) and bio-identical micronised progesterone that is found in Crinone gel. They are completely different compounds.  One cannot even compare the total amounts of progesterone in different formulations such as Utrogestan vs Cyclogest vs Crinone for example - because although they all contain micronised progesterone, the way they are designed to enter the body is slightly different so the biologically active dose will be somewhat different. The totals in the dose give only a very approximate ballpark comparison.

Synthetic progestogens are all given in far lower doses partly because of their stability in the blood stream - so they last longer, and also because of their specific effect on protecting the endometrium which is greater than progesterone itself - an advantage when used as part of hRT, because the reason it is taken is to protect the uterus.

The British Menopause Society  produced a paper a couple of years ago in their "Tools for Clinicians" series entitled "Progestogens and endometrial protection"  - the title being self-explanatory.
https://thebms.org.uk/wp-content/uploads/2023/04/14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf

Here is their account of studies using Crinone:

"Stute et al. 2016 reported a systematic review on the impact of micronised progesterone on the
endometrium. The authors suggested that estrogens with sequential micronised progesterone (4%
corresponding to 45 mg/day for 10 days per month) or intermittent (100 mg every other day) for up to
3–5 years may be safe (off-label use). The authors acknowledged that there was lack of sufficient data
regarding optimal vaginal administration within HRT to guide practice.18

However, more recently, a publication from the Early versus Late Intervention Trial with Estradiol
(ELITE) showed that lower dose vaginal intake of progesterone resulted in a substantially higher
rate of endometrial hyperplasia. This randomised double-blinded placebo-controlled trial, reported
on the effect of oral estradiol plus vaginal progesterone against placebo on endometrial thickness,
endometrial biopsy pathology, cervical cytology and total cancer incidence among healthy
postmenopausal women.20

The study only included original ELITE participants with an intact uterus, who were randomised to
either daily oral estradiol 1 mg/day with 4% vaginal micronised gel 45 mg/day for 10 days each month
or placebo. Participants were assessed at baseline and annually during a median follow-up of 4.8 years.
Over up to 80 months of follow-up, participants randomised to oral estradiol plus vaginal
progesterone had progressive and statistically significant increases in endometrial thickness (p<0.001),
underwent more endometrial biopsies (RR 2.11; 95% CI 1.65-2.69) and had a substantially higher rate
of endometrial hyperplasia on endometrial biopsy (RR 15.9; 95% CI 0.97-260.7) compared with the
placebo group. The authors concluded that 10 days of vaginal progesterone 45 mg/day is insufficient
to completely oppose the effect of oral estradiol 1 mg/day on the endometrium.20

More evidence in adequately powered studies is required to assess the optimal dose and duration of
vaginal progesterone intake to provide optimal endometrial protection within HRT regimens.
Based on current evidence if progesterone was considered for vaginal administration (out of license
use) in women who experience side effects with oral intake, this should ordinarily be given in similar
doses and durations as suggested for oral progesterone intake with HRT."

So you're right in that we don't actually know what dose is required. I would always agree that any of the micronised progesterones - most of which are bizarrely only licensed for fertility - would be suitable also for endometrial protection - but we just need the studies.

Anyone using a sub-optimal dose of any of them and especially eg a dose that has been shown to be inadequate for endometrial protection, should only be using these low doses under medical supervision and regular scans. The reason it is well tolerated at low doses is because it is a low dose!! And because it is a low dose, may well not be effective for endometrial protection especially for higher oestrogen doses.

Those on low oestrogen doses such as a 25 mcg patch - then lower progesterone doses or longer cycles at standard doses if post-menopausal, may well be sufficient - but again, because we respond so individually to these hormones and different modes of delivery. medical supervision is needed.

Hurdity x

Yes, bacteria found in all 3 cases 🙄 I've been treated for H Pylori too, with a biopsy taken as part of my gastroscopy to recheck.

Oestrogen gel was mentioned last time, which makes we wonder why this isn't the first course of action over urology referral.

Think I might make an appointment with the extremely helpful GP I spoke to when I had the second uti and talk through what you've suggested as she seems quite clued up.

Thank you x

It would be chicken that had been badly handled and not prepared correctly, if at all this could happen. 

Chicken carries salmonella .......... hence all poultry has to be prepared away from other food stuffs and cooked through completely.  Best not to buy cheap chickens as even if labelled "British" they can have been culled here, taken abroad for processing and packaging, returned to the UK to be labelled ........ 

We buy free range fresh if possible, even then they need careful handling.  A 3lb chook lasts 2 of us 3 meals each plus bones for soup.