Menopause Matters Forum
Menopause Discussion => Alternative Therapies => Topic started by: Duffy on November 30, 2017, 05:25:32 PM
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Does anyone tale 300 mg prometrium with estrogen as their HRT regimen? I use vivelle.dot. .05 everyday and prometrium every 90 days dosing 300 mg for 14,days . Hate hate hate the prometrium and,this seems like a lot of it. Also the generic does not seem as effective as,the brand prometrium to me
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Hi and welcome Duffy
I assume you are in the USA? Prometrium is prescribed as Utrogestan here in the UK. The highest dose used here is 200mg per day of Utrogestan, usually for 10-14 days within a monthly cycle (some do stretch to a 6 week cycle) and this produces an effective shedding of the womb lining. I do suspect that 300mg per day for 14 days is perhaps a little excessive, even though you are doing a very long cycle regime. I think Prometrium comes in a variety of dosages in the US, so maybe ask your gynaecologist about reducing the dose to 200mg for a couple of cycles and then having a scan to see if this still results in a proper shedding. Dg x
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I can barely manage 100mg for 12 days, 300mg sounds too awful, can you not use less?
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Cassie. R u taking progesterone every month ....statrting early this year I am only taking four times a year ~ summer, fall, winter and spring (Every ninety days) taking the prometrium for 14 days at the end of each 90 day term. The first 90 day term progesterone was 200mg and everything went fine , except even with 200mg dose I didn't get a bleed at all (guessing I should have) I was all happy that I didn't have to take P again for another 90 days -but started spotting on day 47! Took 200 mg again starting day 47 `for another 14 days ... got a mild period. Have had breakthrough again ..another round of 200mg for 14 days and this time a heavy period. Thought I was going to be good to go and would be able to go the ninety days ...but on day 32 ~spotting again! So I'm on progesterone again but there has been a suggestion to go to 300 mg. This stuff makes me ill, breaks out my skin in the nether regions and causes hallucinations the first 6 or 7 days of use. The whole point of going to 200 mg was to reduce my exposure to the P ..... I am getting frustrated! I know it takes time,for,the body,to adjust to a new method of hormone replacement therapy` But good grief!
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Duffy - I had a lot of problems with Utrogestan( Prometrium) and we are not alone in finding it tough to tolerate. Perhaps try a different progesterone e.g. Medroxyprogesterone (known as Provera in the UK). Doing a 90 cycle is difficult, as break through and erratic bleeding is very common. Why not try doing a 6 week cycle using a different progesterone that doesn't need to be taken in such a high dose. Unfortunately Prometrium is the least powerful type of progesterone available, so is not as good at protecting the womb lining from building up, as many other types.
I would ask to have a scan as well to see what's going on with your womb lining.
Have you considered having a Mirena fitted - this can be the least hassle, non bleed, way to use progesterone with minimal side effects.
Dg x
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DG.. I did so much better with very little breakthro on the compounded P CREAM .... but doc won't allow a 90 day cycle on cream. I have never had kids so probably Not a candidate for Mirena and recent news here in US informs users that memory loss issues are now being reported by users. At 69 I DEFINITELY don't need any helpwith memory loss! Also I suffer from vulvodynia and this limits any internal applications of e or p or live other than coconut oil for years now. I took provera many years ago in my 30s because I never gad a reg period... and doc wanted to be sure I got a bleed to keep lining healthy..PCOS MAYBE? Any way? Been sort of I digress.... didn't the provera eventually become one of the synthetics we have been warned against because of its breast cancer, stroke, and heart disease risk.
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Duffy - at your age things do get tricky. There is no news here in the UK about the Mirena causing memory difficulties, in fact, HRt is known to aid cognitive abilities. However, it may be unwise to consider this option at your age.
I do know a lady in her 80s who is still on HRT and she is amazing!!!! I'm afraid she doesn't share what she is using.
I do think you have a dilemma. My thought would be: go back to a 4-6 weekly sequential regime so you can use the lower progesterone dose. Provera is one of the kinder progesterones so may still be an option but if we wish to continue HRt into our 60s, 70s or even our 80s, we simply have to compromise more on what we can use.
Surely you are being given some local oestrogen for you urogenital problems? Many ladies on this site would not dream of going without, at the very least, local oestrogen to treat and prevent ongoing problems with our ‘lady bits' - Vagifem is a favourite but some prefer the creams. I personally use vaginal moisturisers daily - most forum users on MM like SYLK and the YES products. Coconut oil can be great as well. DG x
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''Tks ur response. I use vivelle.dot estrogen patch only .... as my experience with internal e has been very negative... seriously severe yeast infections and then allergic to most of the antifungal cures. The infections cause further degrading oh the Vulvar area....a vicious cycle. I do use coconut oil for external and internal comfort. I seriously considered inserting the prometrium to cervix but the fear of those mega infections stopped me.... I probably should get a hysterectomy to avoid the progesterone requirement but this poses it's own probs as it would be an elective surgery so I wouldn't have to take P So it would be a financial burden, and tho in fairly good health any surgery at my age is scary and last but not least my reading of all things hormonal tells me that with surgery I would have hormonal repercussions even tho I'm past menopause. I CANT go back to the acute v issues that kept me fhousebound, unable to wear even underwear and unable to sit because of the pain in my lady parts. this conundrum almost makes me wish I HAD to have a hysterectomy!
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Urogenital atrophy is utterly miserable. I am 61 and stopped systemic HRT about 18 months ago. I just use Vagifem 2-3 times a week and vaginal
Moisturiser daily. The Vagifem did irritate badly for the first 2-3 weeks when I started to use it but now it is maintaining things quite well and will hopefully becusung this for the rest of my life. The oestrogen creams burned like crazy - I can only use Vagifem.
I wish I could offer more help. DG x
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Do u have to take a P TO protect the uterus? My V skin was so bad the skin was peeling .. internal tearing when sex was attempted . I wonder if I could continue systemic e ~ add in vagifem and when /If a pain free state is achieved ..start weaning from the oatch? The fear of the yeast infection geometry internal applications is pretty strong but while using systemic may be possible to stave off yest while internal tissue adjusts to the insult of direct medication .might be a bit estrogen dominant for a whil but maybe save me from past horrible experience. When gyro made me quit because of women's health initiative results here in us ...she did not wean me even when I questioned that. In about a month mt lady bits were raw and peeling on the outside....dry and inflamed inside. Makes me scared to try anything but this might be a way to start by using combo of internal and system Estrogen
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Duffy
That wretched WHI report that came out in 2001/2 did a lot of damage and it has been largely discredited now.
You do not need progesterone if you only use local vaginal oestrogen - the dose is so small, the womb lining does not build up.
Only systemic oestrigen needs progesterone.
I abandoned full HRT because I got erratic bleeding and this really mucked up my vaginal area as well. The benefits of systemic HRT have be a favour benefits versus side effects.
My strategies for maintaining healthy lady bits:
Keep lady bits aired as much as possible - so no tight trousers.
Wash lady bits with unscented products - there are special feminine washes available but it is trial and error finding the one that suits you. Simply washing with lots of water or saline solution can be the best option.
Avoid scented panty liners or anything that might irritate.
Thrush and bacterial vaginitis are caused by an imbalance in the protective flora in the vaginal fluid - so maintaining this is vital.
Local oestrogen and using the right vaginal moisturisers can really help keep this flora balance right. There was a study done by a highly respected gynaecologist here in the uk on the various vaginal moisturisers available, SYLK and the YES products came high up as the best to use. You should be able to get these online.
I also use something called Multi Gyn Actigel whenever I'm aware thecflora balance isn't right - so itchy or sore or things simply don't smell right.
I too find thrush treatments irritate horribly so just use this Multi Gyn Actigel, which restores a slightly acidic environment to help kill bacteria and fungal infections. It does sting a bit at first and one shouldn't use it all the time as it will make things too acidic but it is certainly better than other options. Using 1-2 times a week can have a preventative effect I find.
I use Vagifem local oestrogen 2-3 times per week and SYLK twice daily but not just before using the vagifem as it may stop absorbtion of the oestrogen.
Diet can also help - I avoid highly acidic foods and drinks - no caffeine or sweet drinks but lots of water.
Don't sit down for too long - lots of walking is best - just keep moving.
To make sure bacteria from the gut doesn't get to the ‘lady bits', make sure you are really clean after opening your bowels - unscented wet wipes specifically for intimate use can help with this.
Perhaps simplify and reduce what you use for full HRT and concentrate on getting your lady bits healthier. The local oestrigen may well not cause problems with thrush etc if you follow my strategies.
Hope this all helps. DG x
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Hi Duffy,
DG has given excellent advice as always. I cannot comment on the progesterone component of your HRT, as I had a total hysterectomy years ago so don't need it.
I am just writing to encourage you to start treatment for your vaginal atrophy as soon as possible, as it is an ongoing condition and needs lifelong treatment. I am about the same age as you (68) and developed VA a year ago. I too was affected by the WHI study, and my HRT was stopped in 2003.
I started using Ovestin in June this year, and although it worked to some extent I switched to Vagifem in September. This is much easier to use, the applicator is slimmer, and the product seems to be less inclined to provoke bacterial or yeast infections. Other folk on here seem to get on fine with Ovestin, but we are all different. My regime is similar to DG's, except that I use Vagifem daily at the moment as 2-3 a week did not keep on top of the urinary symptoms. I also use 2 pumps of Oestrogel daily, mainly for my bones but also in the hope that it will help with the VA. I still have Ovestin to use externally, and also some weaker generic estriol cream. The idea is to rub it into the vulva every other night, but I am not sure about this part of the treatment and can get sore when using it. That aside, I use Multi-Gyn Actigel when necessary, Sylk as a moisturiser, and wash the area with just warm water.
Things are not perfect, but there has been considerable improvement. Most days I can sit down comfortably, and can also wear trousers for a while as long as they are loose, but always change into a skirt when I get home.
I hope you can start treatment soon, and find some relief from your symptoms.
JP x
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Yes I use it for 12 days per mth 100mg
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Thanks for your responses Joni and dancing girl. I began my journey into Vulvar disorders in 2002. After many volvar biopsies , steroid creams , attempts at internal estrogen , mega yeast infections , severe allergic reactions to components to any topical meds , nine doctors and so much pain I couldn't believe it , we finally found the solution to stop the peeling skin which was ..075 patch of estrogen with norinthindrone 12 days a month, and No internal anything . Externally no direct applications of any sort, no soap ...nothing. Only then did I begin to heal. I got tested for allergies and found out that I am allergic to many industrial chemicals used in medicines and personal care products. So for me in addition to the atrophy of the Vulvar vaginal area I also have allergies that were part of the overall attack on the already fragile unhealthy skin. Finally I found coconut oil was very soothing And pure, and I used topically . In the 2005 I was brave enough to attempt sexual activity again but it is always iffy and often get tears. I medicate and lubricat with coconut oil only. Tried vagifem again in 2011 and just got all irritated again ...no doubt due to chemicals used in the tab. I relapsed a couple of times but with perseverance and plenty of coconut Oil I was able to resume relative pain-free activity. Around age 65 doc had me begin weaning down from .075 patch to .050 and problems began again but stabilized in about 6 months. But we switched from norinthindrone for bleeds , to Prometrium because she doesn't like for her older patients to use anything but Prometrium. In the beginning I did all right with the Prometrium but it really affects my estrogen balance and eventually I started having problems with breakthrough bleeds and rashes in my nether regions. This is why the doctor switched me to the 90 day protocol so that I wouldn't have to cope with the rashes etc. from the Prometrium every month. I am also hypothyroid and I suspect that that contributes to my need for the patch for the over all estrogen in my body. I am medicated with armor thyroid . I do appreciate a list like this..as women rarely speak of these probs face to face and docs canbe condescending and dismissive.
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Hi Duffy, so sorry to hear that you have been unable to tolerate the usual medications for VA. Just a thought, but do you think that the Mona Lisa Touch (laser treatment) might help? One of the members on here, Maryjane, has had considerable success with this and wrote an article about it for the MM magazine.
JP x
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I will look at her post but I have been wondering that the doc reducing my estrogen over the last few years maybe contributed to my breakthro bleeding and rashes
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Have you had a scan to see what the thickness is of your uterine lining on the 90 day protocol? That would be a good indication as to whether its doing its thing and also as to why you are getting the breakthrough bleeding. I would imagine a shorter cycle on a lower dose may be better.... :-\
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No scan since last yr before following docs suggestion to do the 90 day regimen.
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Then I would suggest perhaps arranging one it will give you an idea as to whether the protocol is suitable for you.