Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Clovie on May 07, 2013, 07:52:40 AM
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Hello all *waves*
Just wondering if anyone has gone onto the COCP for HRT because they were intolerant of progesterone?
Have been prescribed it, for a short period (as I'm 49) but my specialist is hopeful it will help with my dreadful anxiety/mood swings I get whilst on prog phase of other HRT.
thanks for any replies! :)
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Hi Clovie
I haven't has the COCP for HRT, but I was put on Loestrin when I was 50 and stayed on it till I was 54.
Thinking back, I think I was probably menopausal at the time, but didn't know because of withdrawal bleeds on the pill.
When I first started Loestrin I got very crabby for a month or two but that settled down. I hadn't had any issues with Microgynon which I had taken previously. Don't know what it was in Loestrin, but it did take a while to settle down. Think it may have been the different progesterone.
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Thank you Limpy :)
Off to google loestrin out of interest.
been taking it 5 days now and sadly am beginning to feel a bit 'short' today I've noticed (read grumpy and irritable, its quite a recognisable feeling)
- Or maybe I'm just a miserable bag generally??? ;D ;D ;D ;D
Glad to see my sense of humour remains intact, at least for now ;D ;D
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'Short' is a good way of putting it, I got very ratty with OH, for no good reason.
In fact it was him that pointed out what was happening. I just thought he was being more awkward than usual.
Sadly, he was right, :( I suppose it had to happen sometime. ::)
The good news is that it did wear off, just took a while.
Your sense of humour seems fine! ;D
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that's funny/weird! - it's always my hubby who points it out to me too!!!! ;D ;D ;D
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Hi Clovie
I am puzzled by this because if you are progesterone intolerant - from the HRT you were using - then the pill also contains a synthetic progesterone (well the synthetic type) so you could still react negatively to it although you generally take the same dose for 3 weeks.
I don't know the relative doses of progesterone in HRT compared to the pill.
What HRT were you on - and where are you in meno/periods etc? Also which COCP have you been given.
Some women who get bad pmt after stopping the progesterone ( the withdrawal - like just before a period) are given the mini pill to lessen the dramtic drop in progesterone that happens pre-menstrually. However the COCP won't prevent this because you have 7 pill free days, and your oestrogen will drop during this time too (unlike with HRT when the oestrogen is generally constant all the time for most brands).
Well this has been prescribed by a specialist so presumably a gynae specialising in menopause rather than GP?
Most women (well at least who have posted on here) who are progesterone intolerant are often even more inolerant to the synthetic progestogens, and tend to be prescribed a shorter course of (bio-identical) micronised progesterone (Utrogetsan) than usual and are monitored craefully by specialists to ensure no womb lining build up.
I would be interested to hear a bit more
Hurdity x
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Hi Hurdity! *waves*
Yes, I do not understand it myself either!?
The HRt I have tried in the past have both really badly affected me in the prog phase = worst PMS I've ever had! (1 cycle of Tridestra and before that 1 month of Cyclo-Progynova)
The lady I saw at the clinic was a meno specialist (womens health specialist at a Menopause Clinic) and she really listened to me when I explained about crashing on the prog phase. :'(
She said she had come across this intolerance many times and had got good results with the COCP for some candidates - she did stress that not all people reacted the same. She said it was because the prog was delivered daily at the same time as the oestrog and the amounts didn't fluctuate?
She showed me a list of treatments for intolerant ladies like me, starting from safest to less safe.
First she said I could go onto the COCP because I was under 50 (I'm 49, and my periods went irregular about 18 months ago, started with mood swings, anxiety, insomnia and then sweats etc later on, they started last summer I think)
If that doesn't work she would next like me to try Mirena.
I said I was worried that if I became intolerant to the prog in that I couldn't just stop like I can with tablets as I'd need it removing - (but in response to that she said I could see her or a colleague on any 3 clinic days per week to make a quick appt to have it removed)
Then if that doesn't suit me OR if I choose not to have it I can have utrogestan with a sep oestog.
If I still react badly I can then become a candidate for unopposed oestrogen.
This would be obviously last case scenario before a hysterectomy.
The pill she gave me was Microgynon 30.
She said to try this as I reported I seem to recall feeling OK when I used to take this 10+ years ago before my hubby's vasectomy. I had never had PMS before I came off the pill - yet had had PND which she states is also a symptom of being prog intolerant in some women. I am obviously intolerant of my own natural progesterone therefore, as have been on COCP in between my children so was never exposed to it really?
Anyway - have been on it 6 days now and am starting to feel tetchy and short :( :( :(
I was hoping for a bit of a miracle cure, at least for a year or so anyway :(
I WILL persevere with it though for a month or two. I have a follow up appt in 10 weeks but I can make an earlier appt if I need to.
hope this explains things a little bit more Hurdity, clear as mud to me!! ;D ;D ;D
what I cannot get my head around is why she said I was allowed to take packs of Microgynon back to back without a bleed. I thought you HAD to bleed to avoid hyperplasia? Or does constant prog cause lining not to build up at all??
I will report back with how my symptoms feel as I progress.
I hate feeling like this - just want to feel normal again....... :(
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My daughter is on the mini pill. It keeps the lining thin so no need for a bleed much the same as a conti HRT.
It took a few months for her to settle both bleed wise and mood wise. She says it makes her feel a bit flat but for her it's the only one that suits.
I guess you need to give it time to settle.
Honeyb
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I thought taking the pill, back to back, was only advisable for 3 packs, after that you had to stop and have a bleed.
If you just carried on spotting was likely to occur (advice from friendly pharmacist)
Mind you this was about 15 ish years ago, things may well have changed. ::)
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That only applies to the combined pill. You take for 21 days and the have a bleed. It contains oestrogen and progesterone.
The mini pill contains progesterone only. That prevents a build up of the womb lining and therefore is taken constantly with no breaks.
My daughter came off her mini pill recently to see if her terrible cramps would be a bit better now she was older. She had a bleed within a week of stopping the progesterone. Unfortunately she was no better and is now back on her Mycrogynon.
Honeyb
X
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honeybun - Clovie has been put onto the combined pill not the mini pill so is odd that she has to take it continuously.
Clovie - I am still puzzled. I wonder if the person you saw was a doctor/gynae or a nurse? The treatment doesn't sound like that usually recommended by gynaes for prog intolerance.
I presume you have been given the pill because you will be getting extra oestrogen and it will give you contraception at the same time?
However I still don't understand why you have been given it back to back too, ie continuously as you won't get a withdrawal bleed. It is my understanding that with the Pill the womb lining builds up even though it contains progestogen - otherwise there would be no bleed when you stop. This means you may end up having a heavier bleed if you then stop??? I freely admit I know very little about the Pill though.
Progesterone intolerance is quite complex and as I mentioned, true intolerance means that women react negatively to any progesterone including their own - headaches, low mood, depression, severe fatigue etc. Many women who are not intolerant experience symptoms when progesterone suddenly increases and when it falls (like just before a period). That's normal. It happens all our fertile lives. If you've had children and felt fine during your pregnancies - well progesterone is very high all the time and drops after birth.
You might like to read Prof Studd on PND - and the view that it is caused by lack of oestrogen - he is one of the top gynaes in the country and has done lots of research on it:
http://www.studd.co.uk/postnataldepression.php
I don't know why she has suggested a Mirena - except that it will deliver continuous prog and therefore you will not experience any fluctuations ( apart from your own still going on).
In your position I would definitely try separate (low dose) oestrogen and progesterone. If you are not ready to go down the patch route then you can use tablets (eg Elleste) and Utrogestan - the latter would be around 10-11 days per month. You would know how you felt on the Elleste and the Utro and you would definitely know if you were properly prog intolerant and then could be referred to a gynae and perhaps have a shorter course of prog.
If you are feeling rough on the pill too then it sounds as if it is the (synthetic) prog. Years ago I took this (in my 20's) but only for a year as I felt rubbish too.
You could possibly e-mail a question to Dr Currie giving her as full information as possible (lke you have posted) - it only costs £15 and would be an alternative professional opinion - as we are not medical experts!
Keep us posted...
Hurdity x
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I didnt take HRT went over 36/7
I took mini pill and Ovestin in place worked brilliantly so much so
Thats both my female cousins in UK asked their GP when there tune came and he reluctantly at first gave it to them
Now it seems where I lived more more GPS giving this out in place of HRT to women who wont or cant take HRT pills
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Hi Suzi Q - if the doc prescribes mini pill for early meno at that age then you won't be getting the oestrogen you need and is your right to protect your bones until age 50. Was this the case for you ie mini-pill = progesterone only from age 36 ish? Ovestin just does for the vag area and not systemic. Have you been checked for osteoporosis? Might be an idea if you had premature meno and didn't take the full contraceptive pill?
Hurdity x
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very interesting article by Prof Studd, Hurdity.
Am more confused than ever, as had previously read up a lot and read that prog was to blame!?!
However, the oestrogen makes sense - I felt reasonably Ok on the first phase of each HRT I tried, perhaps I just needed the oestrogen upping to feel better still?
Both times I crashed on the prog >:(
I have taken 6 tablets now of the Microgynon - and I feel awful - prob because of the progesterone in it, even though I am getting more oestrogen - the prog is cancelling it out!?
Arrrggghhh!
Think I will give it another week then go back to the clinic (She was definitely a doctor Hurdity, I saw the nurse before I went in to see her) and cut to the chase.
I want to try a higher amount of oestrogen and then as short a period of time on utrogestan as I can safely can.
Hurdity - you seem to be very knowledgeable on this, can I please ask, do you have any recommendations on a 'higher' dose oestrogen in tablet form I could ask for/research? Is the elleste a higher dose than say the Tridestra I was on?
I am at my wits end I really am.
So confused. :o
I mean, I woke up crying this morning - yes, WOKE UP sobbing. What's that all about????? ;D ;D ;D
thanks for reading
xxxxxx
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Hi Clovie
Look I only know what's on here plus I've read a few research papers etc as I am interested in the subject, so my knowledge is quite limited but I can help to a certain extent - but doesn't replace proper medical advice - although as we have seen this is patchy and in many cases lots of us on here know more about HRT and current thinking than GPs - because of course they are just that - general practitioners.
Re Microgynon - I said I took this years ago and it used to have the same effect - I would cry for no reason and I was young then.
I don't know what Elleste you took?
If you look at the HRT preparations listed on this site,
http://www.menopausematters.co.uk/perimeno.php
you will see that Elleste can be Estradiol 1 mg or 2 mg. Tridestra contains 2 mg Oestrogen in the form of Estradiol valerate which is converted to Estradiol in the body. I seem to remember that the serum levels of estradiol obtained from estradiol valerate in tablet form were less than that obtained from estradiol alone, but don't have time to look this up at the moment. However all the studies on oestradiol levels from given tablets will be based on quite small populations ( of women) and women do vary in how the level of estradiol that gets into their blood after digestion/liver etc.
I know there are women especially those who have had hysterectomoy that have taken more than 1 tablet of Elleste per day to increase the amount of oestrogen - with the advice of their doctor.
You may not want to consider patches or gel - but some women find they can increase the dose easier with gel - but the size of the application area is quite critical I understand (from what I've read) - but I have never used it so can't comment. Also I think you can get a higher dose with patches (100 mcg) without having to resort to horse estrogens - although I haven't checked what levels you would expect.
Of course the higher dose of oestrogen you take the correspondingly higher dose of progestogen you need and this may not suit you. On the Tridestra you would have needed a high dose of prog to counter nearly 3 months of unopposed oestrogen, so I can see how that would make you feel bad!
Many of us find it is a tricky balance between feeling the benefits of oestrogen while minimising the negative effects of the progesterone!
I hope this helps and keep us posted. Maybe think about E-mailing Dr Currie - I have just e-mailed her about another issue.
Hurdity x
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An update...
Been on the microgynon now for about 11 days - been struggling to keep on it. :'( :'(
I am stopping taking it today.
I had to get up at 4am this morning as I felt so so down :(
been waking up feeling utterly utterly miserable and waking hubby up with my sobbing a few times.
I was laid in bed thinking all depressive thoughts - is this it? my future looks sooo bleak, a dark lonely black road into old age then death.
While I've been on this hormonal rollercoaster (started HRT back in November) I can't be bothered to do my hair anymore and avoid going out of the house unless I'm with my hubby. Can't be bothered much with make-up but if I DO go out without it, it just feeds my self loathing and gives people a reason to look at me like I'm a sad old miserable nutcase. I used to look forward to going to see bands and such life with my hubby - now I feel I have no place at such places :'(
I'm so sensitive, I find I can easily take offence at mostly everyone as I think everyone is against me, that people don't like me - and who can blame them, I'm so boring.....
Sense of humour which is usually very good is gone - and most importantly - I've given up trying to make friends now.
( We moved to countryside after hubbys redundancy so he could start new job, can't find a job, (too cheesed off to work now anyway) My kids are older now and youngest still at primary but gets taken to school by taxi due to distance so don't see anyone all day, can't sell house in order to move...big sigh....... :'( )
Please forgive me waffling.
so lonely.
thank god for the internet. I don't know any other ladies who are at this stage perimenopausal, or will admit to it anyway.
Wish there was a facebook group for affected ladies to chat about other things than our hormones to have a giggle, make us feel we are still human and not be defined by our failing hormones :(
sorry for waffling - am going to pluck up courage to make apt to go back to clinic.
wish me luck. :'(
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Hi clovie
So sorry to hear you are obviously feeling very miserable at the moment.
It does sound as thought the microgynon does not agree with you.
I would definitely make that appointment! Have a look at what I've suggested earlier in the thread. in your position I would stop the microgynon - and have the bleed that will occur I imagine. Then I would ask for a separate oestrogen (could be tablet or patch or gel as I suggested) and progesterone and I would go on the oestrogen for at least 3 weeks before starting the prog and see how you feel on this. Then take Utrogestan 200 mg for 10 days as per the license. If you are progesterone intolerant you may experience side effects - either while taking it, or just after you stop or both.
If the effects are still really bad then you may be able to negotiate taking the prog for a shorter time eg 7 days per month - along with regular scans. Gynaes can vary this at their discretion. This is what Studd recommends for prog intolerance - I think I probably said before.
Re feeling lonely - whereabouts in UK are you? Is there a village nearby? Do you drive? Can you get involved in something at the local school where your child goes eg the PTA or help at events? That would get you out to meet people. I live in the country too but in a village and when my children were small my social life revolved around them, the playgroup and then friends from the school and I was on the PTA for a long time.
Try little steps - set yourself a little goal each day eg something nice for your hair, and treat yourself to something new to wear, somewhere to go out at least once a week....
How does your husband feel about it and is he supportive?
You must talk to someone about how you feel. I am sure it is down to hormones and once you are able to take something to make you feel better you will want to do your hair and go out again. The peri-menopause is a drag isn't it - with hormones all over the place?
Another really drastic step which I know someone who used to be on here had, in your position, was a hysterectomy - because she had severe PMS and a related syndrome I can't remember the name of. I know it's very drastic but then she was able to take oestrogen without any of the awful depressed feelings which it sounds as though you are having.
Do keep us posted and good luck with that appointment. If necessary get referred to someone else!
I hope you feel better soon.
Hurdity x
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Thank you Hurdity
feel quite not as utterly bleak today. took sleeping tablet last night, you see so wasn't up at 4am.
I did stop the tablets
I tried to make apt at the clinic (where the doctor had said there were 3 clinics a week and would be able to drop in and see her had I chosen to have Mirena coil inserted and needed it removing urgently if I'd had symptoms)
I told the miserable receptionist I needed to see someone urgently as I'd stopped my medication and I was feeling extremely low.
3 weeks she said was the next free appointment - 3 WEEKS!!!! good job I didn't decide to try the mirena coil, as the doctor was kind of pushing for.
I sdaid OK but I might have to see another someone else there if I didn't feel any better :(
She took great delight in telling me only 2 docots and both booked up solid :( :(
Got off phone burst into tears, phoned hubby - he got on the phone to her and told her she needed to get one of the medical team to ting me regarding me stopping my tablets if I couldn't be seen!!!!
I have taken one of the oestrogen only tablets from my old Tridestra pack and intend taking them until I see someone.
So I must wait now until tomorrow afternoon for someone to ring me hopefully .
Thanks for reading :( :( :(
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Hope things get better
:hug:
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Clovie,
sorry you are feeling so low but I can completely understand.
I started peri meno feb 2009 and didn't have symptoms til October 2009 and then awful ones. anyway like you went on hrt but when it came to the progesterone part it literally made me crazy like you feel in that faze, it is not you it is the progesterone. For some women it just doesn't agree with them. I tried synthetic and natural and they both made me crazy, I lasted a bit longer on the natural but not much. In the end I had to have a hysterectomy and still trying to find hormonal balance but at least it is easier without the progesterone side of things.
It is hard when you feel that bad but it dos get better and at least you know what is making you feel so bad. take care xx
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Thank you for the hug Limpy, I needed it xxxx
And thank you for your reply Paisley!
Not happy that you have been through same thing as I'm going through :( but sure is good to hear from someone who knows how I feel right now (a bit unhinged!! ;D)
I am just waiting it out until the prog gets out of my system ....again :(
I'm soooo soooo very sorry you are still feeling poopy even though you've had a hysterectomy!!!!!! :o
That was always my worst case scenario- thinking if it gets that bad I can have one and I'd be fine after that!!!
How awful to go through all that and still feel not quite right! :hug:
I don't want to go see my GP and tell her how I'm feeling as she will prob suggest anti-depressants, I had post natal depression twice and each time I went through a fair few anti-depressants and not one of them made me feel any better - they made me feel WORSE in fact, all the weird scary side effects (night terrors!! :o) and on top of that my already almost non existent sex drive gets wiped out completely on them :-\
I have spoken to my meno doctor now and I can carry on with the oestrogen phase Tridestra until I see her in 2 weeks - she's already trying to get me on Mirena again yet I have TOLD her I want utrogestan!!!
My hubby coming with me so I stand my ground.
it must be a cost issue why she keeps pushing mirena???
Sick of feeling poopy, and anyway, as I say, so sorry you're still not right Paisley. If you want to chat please message me I'd be happy to swap notes...
Take care all
xxxxx
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So glad you have talked to your meno doctor clovie and she is happy for you to be on the oestrogen only tabs for the moment, and I do hope this makes you feel better. If it does you will absolutely know it is the progestogen causing this.
I don't know about the cost issue because lots of women are given monthly HRT, but it does sound to me as though your doc thinks your problems are to do with fluctuating progestogen levels so that's why she wants to put you on continuous prog - which the Mirena does, as does the pill when given continuously. It doesn;t sound as though she has considered that you may be progesterone intolerant.
Great that you will have support from your husband when you go for your appt. At least the Utrogestan is worth a try and maybe as I said you will be a candidate for taking a shorter course of prog per month and be monitored with regular scans to check on your womb lining.
Back when you first posted, you said that Utrogestan was low on her list and not sure why - seemed to want you to go on pill and Mirena first - but if you don't want it - don't have it!! Unopposed oestrogen would not be recommended - I certainly wouldn't want to risk this because it can cause hyperplasia quite quickly, from what I've read, which can lead to cancer
Hoping you feel better really soon and if there is anything else you need to ask before you go to the docs we can try to help
Hurdity x
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thank you, again, Hurdity, you're a star :hug:
I will have a think about which oestrogen to take with the Utrogestan (that I am now going to push to have and will refuse Mirena) and ask if I can't work it out.
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Another thing I thought of - if/when you ask for Utrogestan I suggest you ask for it in 100 mg doses so that you can experiment about when to take it - on account of your history of problems with progesterone.
The manufacturers instructions suggest taking it in two x 100 mg doses if there are undesirable side effects eg drowsiness, nausea or dizziness - although it is supposed to be taken at night on an empty stomach so hopefully you would be asleep for the peak concentration in your blood. Nevertheless it still can cause some side effects in severely prog intolerant women - so just something to bear in mind.
Re the oestrogen - it is a matter of preference ie tabs or patches/gel and just make sure you take one that is estradiol. The most common one is Elleste Solo. The others are either horse urine derived (Premarin) or oestradiol valerate. Although that is converted to estradiol in the body - might as well not have to do this and just take it straight if you are having pills!
They are all listed in the menu ( green writing) on the left:
http://www.menopausematters.co.uk/treatafter.php
Hope you are beginning to feel better?
Hurdity x
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Hello all
Been back to see my meno specialist - and I feel like I'm banging my head against a brick wall!!! :'(
Good job I took my hubby to help me stand my ground regarding the Mirena coil which she tried to push on me again despite me telling her I wanted to try utrogestan.
She eventually relented and said OK I could try them, but was very pessimistic about them working for me :'( asking what I was going to do next if/when the utrogestan didn't work :(
Also - she told me I would need to take the utrogestan continuously!!!!!!!!
I said no because I am clearly prog intolerant (she agreed with me there) but she said I needed to take it continuously to protect my womb!!!!!!
I was on the verge of tears at this point :(
She went on to give me a good telling saying how risky it was to take prog for only part of my cycle blah blah blah, making me feel foolish like I was dicing with death >:(
In the end she agreed to me taking utrogestan for HALF my cycle - but said I need to have a bleed every month.
I am at a very low place right now. I cannot bear the prospect of me going through this prog hell every single month :'(
Even my own GP gave me long cycle HRT to reduce the amount of time I am exposed to the prog. She was totally against this. I feel like I have taken a step backwards. She wouldn't hear of it. And talked only of me trying the Mirena coil if this utrogestan makes me feel bad.
I ideally wanted to have a two monthly cycle because I am sooo badly affected by prog, you see.
She also told me I could not possibly supplement my oestrogen tablet with a gel. I told her I felt that I wasn't getting quite enough oestrogen (I've read upping oestrogen might help with my awful insomnia and wanted to try that before I ask for anti-depressants - but then again I am afraid to ask for any help in this area after having read a post on here the other day :o :o )
I feel like I've not been listened to, feel I have been fobbed off. Feel like I am being pushed onto Mirena :(
If anyone has read this, thanks for reading xx :(
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What a terrible time you are having. It's dreadful when you feel they are not on your side.
I can't remember, sorry, but have you considered just trying with no HRT at all. You could use Vagifem to protect against VA but is this all really worth it. Would you feel any worse than you feel now.
I hope you are not offended by this suggestion but if it was me I think I would say enough is enough and try without anything.
Honeyb
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Clovie it must be so stressful, after you / we thought the meno clinic would be helpful.
Might be worth speaking to the GP who gave you long cycle HRT, explain to her how you feel and get her suggestions.
You say you took your OH with you, what does he think? They can surprise you with very sensible comments sometimes!
Also, Honeybs suggestion of just using Vagifem, or other vaginal oestrogen may be worth a go.
I can't remember how old you are, but is contraception an issue? if it is a COCP will serve multiple purposes, may be worth having another go.
The thing is you are in control, pick what you want to do. Get opinions off GP, OH and others.
Don't panic!
:hug:
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Honeybun - thank you for your reply, no I'm not offended at all, I love your suggestion - but :( - I had horrendous hot flushes without the oestrogen, got so bad I was putting off going anywhere as was embarrassed by it, a red and sweaty face is not a 'good look' ;D plus my mood swings irritability and insomnia were still there at the same time (granted not as bad as when on progesterone)
Limpy - thanks for reply - Might go back and see my GP who was happy to prescribe long cycle in form of Tridestra - bottom line - what I want is long cycle (2 months) oestrogen with the least offensive prog for the least possible but safe duration. I also think my oestrogen needs topping up a bit, at least willing to try it for a short time to see if I'm right, and it may also help with my nonexistant libido.
Not too much to ask eh? ;D
Think I'm going to have to end up seeing someone privately.
thanks for reading xxxx