Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: DEETLE on April 20, 2016, 06:38:00 PM
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I have now been to 3 doctors now and NO help as of yet... In fact, their difference of opinions has caused me more confusion.
Im almost 50. My symptoms hit severe and fast 4 months ago and are getting worse. Hot flashes, joint pain, migraines daily, etc, etc.
My obgyn told me to just take a few pumps of ESTROGel 0.06% "whenever" im feeling a hot flash..
My GP told me he just wants me to take "progesterone only" everyday, and that estrogen is dangerous
went for a 3rd opinion and they want to do pellets under the skin of testerone and estrogen only but no progesterone
Really don't know which one to follow or believe and I would prefer the creams...
So I finally found this forum and after reading all your stories... I realize NONE of these options are accurate or smart.. So I had my blood drawn and here are my results. PLEASE PLEASE someone take me by the hand and guide me in the right direction. I feel kinda hopeless right now as to how to do this and the symptoms are debilitating me..
my progesterone was 4.90 (took this test 3 days before period started)
Progesterone Reference Ranges
follicular 0.15 to 1.40
luteal 3.34 to 25.56
mid luteal 4.44 to 28.03
postmenopausal 0.00 to 0.73
my estradiol was 117 (FYI i was taking 1/2 pump of estrogel for 2 days before this test, not sure if that was enough to show up in my blood)
reference range 0 to 357
Can anyone explain these to me? thanks so much
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Sorry you are having such a terrible time and not getting any help.
From what you have said, it sounds like you must be in the US. You have had very bad advice and that doctor who told you to take progesterone everyday and that oestrogen is dangerous hasn't got a clue and is frighteningly out of date.
If you were in the UK I would recommend you visit Professor John Studd but have you got a similar specialist of that calibre who you could consult? Take a look of Professor Studd's website to get some ideas and try to find someone similar.
You mention migraines and I do know that in my case, these are only caused by synthetic progesterone in conjunction with low levels of oestrogen so that might be the same for you. You are doing the right thing by taking the Oestrogel everyday but that sounds like a low reading for that amount of gel - is that pg/mL or pmol/L? Even if it is pmol/L it is way too low but even if it is pg/mL, that might not be high enough to keep your symptoms away and I can tell you that I need more than that to keep my migraines away, particularly while taking the Utrogestan (micronised progesterone).
If you get really stuck and don't have any luck finding a specialist near to where you live, you could phone Professor Studd in London and ask his secretary if you can have a telephone consultation. I don't think this is something he normally does but under the circumstances and as you are having such a difficult time, he might agree to it. It would cost you about £300 but it would be worth it.
I hope that helps but do come back with more questions if you need to.
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If you are State-side Prof Studd may know of Consultants in this field who could help you. Might be worth while sending an e-mail to his Secretary and ask the question.
Think of the hormones that we live with from puberty and how they 'work', i.e. when oestrogen is dominant and at which stage progesterone kicks in each month. Then you will know when to take HRT if that is what you want to do.
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thank you both... does anyone have the phone number or email for Prof Studd?? I really need to talk to someone who can guide me..
Mary- This is what my bottle says (ESTROGel 0.06% one pump delivers 1.25 g of gel that contains 0.75 mg estradiol) so do I need to take more of this?? Also, my progesterone cream was compounded so Im pretty sure it is bioidentical (its call PROGEST VSB 10MG/ML in a versabase)
It may take me a few weeks to get answers so is there any basic guidelines that I can at least follow on taking "how much" of both creams for now until I get some further direction.. Please keep the information coming as I really need to understand this as much as I can.. I have spent the day calling doctor offices and haven't found anyone who is educated in these bioidentical hormones, so Im feeling a bit hopeless.
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If you do a 'search' i.e. GOOGLE for Professor Studd, UK you should get to information.
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Professor Studd's phone number is (00 44) 207 486 0497.
The gel sounds like the same stuff as I use so I would suggest you use 3 pumps everyday until you start to feel normal again and then you could reduce the dose to 2 pumps if you like. Re the progesterone, I'm not sure because we don't have that type over here but it sounds like it is 10mg which is a low dose so I would say use it for about 2 weeks and then you should get a bleed shortly afterwards. I am only guessing on the progesterone though and I would recommend you run that past Professor Studd but it is probably bio identical.
Professor Studd usually prescribe 2-3 pumps of gel everyday, 100mg Utrogestan (vaginally) for 7 days every month and a small bead of testosterone.
What are you currently taking and when did you last have a period? Are you using both the gel and the progesterone everyday at the moment on a continous combined regime? I would suggest you move to a cyclical regime and not use the progesterone everyday - always use the Oestrogel everyday though. It will mean having periods again but you would feel better overall and it will help with the migraines. I also think that the Oestrogel works much better when it is not being permanently supressed by progesterone.
I would stick with gel only for a while to get the feel good factor and then start the progesterone after a few weeks. If you are currently taking both, stop the progesterone immediately but continue with the gel everyday, you will probably have a period and then after a few weeks, start the progesterone and take it for a couple of weeks. I hope that makes sense.
What a nightmare. Do come back with more questions if you need to.
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Who did your consult and testing for the bioidenticals? I would contact the compounding pharmacy and ask about it. The compounding pharmacy that does bio identicals in my town includes consults and support as part of the fee when they test and prescribe, then you only pay for your hormones separately. But here a nurse within the pharmacy handles all of that. They really should give you more guidance.
I do understand your frustration though. A midwife in my gynecologist group was very vague with me, told me to buy progesterone cream and estrogen spray at a health food market, and wasn't clear on how much to apply. I did not follow her advice, because I didn't understand well, stuck it out for another year, then went to my gp and was given estrogen patches and progesterone pills, thank heavens. Of course, in the meantime I had researched on here and basically told my gp what I wanted, but I do feel better doing it under his guidance.
Edit: I just saw your other post. So of your 3 choices from 3 doctors, you've chosen estrogen and separate progesterone cream? Good choice, I think. You said you felt like your gp was giving a standard answer and not tailoring for your needs, let me see if I can reassure you. They have to start somewhere. It really is a guessing game, and looking at your specific hormone levels doesn't necessarily tell what dosage you're going to feel best on. Some women feel fine with a given blood estrogen level, while others need double or triple that level in there blood. Everyone is different. The idea is to take the lowest dose of estrogen that helps you, and the progesterone is used to protect your uterus from overgrowth of the endometrium. They need to start with a low standard dose and see how you react. If it fixes everything, great! If not, you'll be able to say, for example, that nothing has changed, or that you feel good during certain times and terrible others, or that you're having irregular bleeding, headaches, whatever may pop up. From there, things can be tailored to your needs. The separate estrogen and progesterone creams lend themselves to adusting very easily, as your can use more or less as needed. BUT, don't go changing it up daily or you may find yourself in a real mess. Start with a minimal amount (Mary G will have to help you here, I don't know the gels) and if after several weeks you're not well, you could try more. I believe the progesterone would need adjusting based on spotting or bleeding problems, but you really need to talk to your prescriber about that. I don't think there are many(any) on the forum that use compounded progesterone cream.
Sorry for the novel!
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Mary - I cannot thank you enough for being so detailed in your message.. I have been feeling so lost and I feel like I now have direction. Unfortunately I cannot call Prof Studd from the USA.. I have tried several times tonight (i realize they aren't open) but it keeps telling me "call cannot be connected" ??
the doctors that I saw said that my estrogen levels were normal?? is that not true? (of course they also said estrogen is dangerous) what would normal look like?? Im assuming that you suggested 3 pumps because you think I need to get the levels up?? I definitely know I have symptoms, but don't know what symptoms are from low estrogen or low progesterone? how does one tell the difference? I really want to learn.
Lizab - My obgyn and then my normal doctor both "talked" to me about HRT but I wouldn't consider it a consult. I had to force my doctor to run blood work.. Im learning they must not be educated enough on hormones. I wish my compounding pharmacy would do a consult but they just dispense the medicines. I am so glad I found this website so that I can try to educate myself. I cannot believe what misguided information I have been given from my doctors. I like your idea to start low and then see where I am at before I increase dosage. How long should I wait before I consider upping the dose?
Mary- ^^ see above. Is 3 pumps a small starting dose? should I start smaller to begin with? I have always reacted poorly to any pharmaeutical.
Lisab - What do you mean there aren't many that use a compounded progesterone cream? Is there something else I should be using?
THANK YOU SO MUCH LADIES FOR HELPING ME..
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I could be mistaken, but I don't think compounded progesterone creams are popular in UK, where most of the ladies on this site are.
There are other options for your progesterone. There are synthetic progestins, like you would find in birth control pills, patches that have a combination of estrogen and progestin, and most hrt pills. There is also Prometrium, which is bioidentical progesterone in a pill form that can be taken orally or vaginally like a suppository. Here on this site you'll see it under it's UK name, Utrogestan. I don't think compounded progesterone is a bad thing, it's just not common among the ladies on this forum, so it will be difficult for them to advise you in its use.
You can also use different forms of estrogen, either pills, or transdermal through patches or gel. The gel is well-liked among the ladies here.
Each person reacts differently to the different forms of hrt, so while one of us may feel awful with patches and brilliant with pills, another may have the opposite experience. That is another way to "tailor" hrt, just changing the route of delivery.
I believe the consensus is that you should be able to feel a difference after a month on. However, it could take 3 to 6 months to get the full benefits. Some ladies report feeling better within just a few days. I was very up and down for the first month, then settled a bit the next two months but determined I needed to try a little higher dose. I'm 3 week in on my higher dose and definitely feel better, though still not 100 percent problem free.
How are you using your progesterone? In cycles to bring on a monthly period? Had you been period free for a year and will take it continously to not bring on periods? Personally, I am taking mine in cycles, and my doctor wanted me to follow up with him after one cycle, at which point he really only asked if the progeterone did bring on a period and if I had any negative side effects such as irregular bleeding, headaches, etc. When all was well then, he asked that I follow up at the end of three months to see if we needed to change anything or continue on the original dose.
Have you looked at the information under the tabs up top? Goodness, I don't see them from my mobile. Maybe it's not on the forum page but on the menopause matters home page. There is a tab there that has info about the different hrt preparations. In fact, poke around and there is a lot of info on menopause in general.
I do hope that helps. It's a lot to take in.
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Lizab - yes Im trying to read as much as I can here.. I am going to try and get the vaginal progesterone then.. sounds like thats the one most everyone here is using and truly I trust you ladies here more than my doctor right now.... I am told that estrogen can cause anxiety? is that accurate? because one of my most horrific symptoms is panic/anxiety (never had this before now) I certainly do NOT want to make more anxiety by taking estrogen. My doctors said to use the progesterone "whenever" so Im thinking to cycle mine like I've read here for 7 or 14 days per month... BUT if the estrogen causes anxiety then maybe I should use it daily??
also, curious how did you decide how much estrogen to use? was it your blood test results or just starting low and increasing?
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That's the tricky part. Too much estrogen can cause jitters, but estrogen can also ease anxiety brought on by hormone imbalance. You really need to know what kind of dose your progesterone is to know how to take it. For example, I take 200mg Prometrium nightly for 10 days each month and that brings on a period. Some take that dose 12 or 14 days. Those that take it continuously are probably taking 100mg. You need to have been without a period for a year or have been on hrt with periods for I think a year, gosh I'm not sure, before you should do continuous progesterone. Actually, you really should contact your doctor and ask for specific instructions in regards to that, as it's important if you still have your uterus that you get the progesterone right. If they are vague about it, it may be because there is some flexibility in how to take it, but don't be afraid to demand specifics. Ask again and rephrase your question to ask again if you still aren't clear on what to do.
I use an estradiol patch. The one I use is available in dose increments of .25, .375, .50, .75, and 1.0 (I think, not positive). I started on .375. When that didn't provide enough relief, I was incresed to .50. I never had my estrogen and progesterone levels checked, only my FSH and that only because I'm very young for menopause. Generally, if you are in the appropriate age range for menopause, they can diagnose and treat based on symptoms and bleeding patterns without the need for hormone tests. In the perimenopause, the time leading up to your final period, your hormone levels can fluctuate, so what your tests say this month may be completely different than what they would show next month or 2 months ago. For the compounded hormones, obviously they have to test to make a custom dose for you, but I don't know how that works.
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Deetle, just wanted to say that it's downright shocking and scary how you've been misinformed by THREE doctors!! :cuss:
You are getting good advice on this thread, and yes, I would trust this forum more than I would trust any of those doctors - and there are some VERY well informed ladies on here! :great:
I think it's generally seen to be best and safest to use bio-identical hormones if you possibly can.
For example, I use Estrogel and Utrogestan which are both bio-identical. They work very well indeed for me :great:
It can all be a bit 'trial and error' to start with but you'll get there.
Good luck! :)
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DEETLE, keep trying Professor Studd's office, you were probably ringing out of hours. I have just called his office but the answerphone is on because they are at lunch. He has patients from all over the world so he can't have blocked overseas calls.
Regarding the amount of oestrogen to take, my advice is this. You are clearly not feeling good now so I would split the dose by 12 hours to keep the levels levels up. This is difficult to do on 3 pumps a day but try to do 2 pumps in the morning and 1 pump at night. Alternatively, you could try 1 pump in the morning and 1 pump in the evening.
We are all different and we all need very different amounts of oestrogen to feel good and I have never had the jitters or felt bad on high doses but I do not feel at all good on low doses. You really need to find your ideal oestrogen dose and you will only do this by trial and error. I would urge you to carry on with the gel because it is very flexible, you can adjust the dose and I think it is the most effective form of oestrogen on the market.
By the way, are you progesterone intolerant? I imagine Prometrium is similar to Utrogestan and you might want to try it but you could buy Utrogestan online if you prefer. I would recommend you use it vaginally and the lower dose of 100mg rather than 200mg.
Hope that helps for now. Keep trying Professor Studd's office!
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CLOVIE - how much of the estrogel and utrogestan do you use daily? I realize we are all different but just trying to get a feel for what others use?
Mary- I tried Prof Studd again and cannot get thru... just says call cannot be connected? How do I know if I am progesterone intolerant? what does that even mean?? where can I buy Utrogestan online?? thank you for this help
Lizab- can you describe "When that didn't provide enough relief, I was incresed to .50." how did you know it didn't provide relief? Im assuming you still had symptoms, what were your symptoms?
EVERYONE- I barely slept but woke to hot flash/heart palps and anxiety??? very scary.. Please tell me what these are from? they are not easy to understand.. I am really scared of this anxiety feeling.. please help me understand it.. is it from too little or too much estrogel?? thank you all
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Deetle, as you say we are all different but since you asked I'm happy to say what works for me :)
I use 3 pumps of Estrogel per day (I WAS on tablets of 2mg oestrogen but found that wasn't enough oestrogen to keep me sane! :D) After upping to 3 pumps and using gel instead of tablets I feel sooooo good! :)
And I use utrogestan 200mg orally 10 days every 2 months. In an ideal world you'd use the progesterone every month. The progesterone opposes the oestrogen you've been taking and causes you to shed your lining. (Apologies if you know all this! :) )
I am progesterone intolerant too. There's quite a few of us on here, I guess its because a lot of ladies who have been prog intolerant all their lives need to come on forums like this as they aren't breezing through meno like some lucky ladies do! Not all ladies on here are prog intolerant though - some ladies who aren't also need support from this lovely board.
What is prog intolerance? If you have suffered from post natal depression or have had pre menstrual tension in the past you are more likely to be prog intolerant. It means you are particularly sensitive to progesterone in your body, and at times such as after a birth and coming up to a period you feel the effects. Effects are in brief mostly (for me anyway!) mood problems, sadness, despair, paranoia, irritability, insomnia, anxiety - all goodies like that! ;D
And the reason prog intolerant ladies tend to end up on here is that the synthetic progesterones they are often given as part of HRT send them into these horrible moods.
Prog intolerant ladies often, through this board in a lot of cases - Me!! - eventually get put onto utrogestan for the prog element, which is much kinder on the system. Not perfect - but better.
I do hope you get sorted!! :)
I have never suffered anxiety or jitteriness from too much oestrogen, on the contrary my anxiety was relieved massively by using MORE oestrogen when I went onto 3 pumps of the gel. I started to feel much better after only about a week. This is all my personal experience of course, and as you say we are all different, and I'm not a doctor. :)
Keep posting for support or to ask questions, there are some lovely more knowledgeable ladies on here than me, who may come on to add to my brief description of prog intolerance. :)
Good luck! :)
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My symptoms were an overall not feeling well, hot flashes, inability to concentrate on anything, not sleeping well, extreme emotions, crying over everything happy and sad, extreme and sudden fatigue, apathy, lack of motivation, anxiety, a jelly leg feeling, dizzy spells but not spinning vertigo, heat intolerance, joint aches, waking startled, a racing heart feeling. I really felt terrible and couldn't put my finger on what was wrong. In the first 3 months on the lower dose, I was like a rollercoaster. I felt like my old self some days and felt awful on other days. I did get relief on the lower dose in less frequent hot flashes, not waking startled, and the joint pains and weak leg feelings subsided, and the heart racing stopped. Also the dizzy head feelings were less frequent. If you see any of my old posts you'll see that I debated going on a higher dose because I did find some relief, but I still felt crazy, so I went for the higher dose. At this point, I'm still battling a hot flash now and then and anxiety, and very rarely I get a little flip flop feeling heart palp. My main improvement since increasing has been in motivation and energy and more stable emotions, although I still have times where I get teary-eyed over silly things. Understand the emotional part is very much out of character for me, so it has been a shock to me. Well, all of it has been a shock. Basically, before I couldn't cope with life and felt stressed about not coping. On too low a dose, I felt fine intermittently, but I couldn't predict when I would suddenly feel awful. And on the higher dose, I cope better in general. For the most part, if I'm having an off time with lower energy, I can rationally recognize what's going on and either push myself through it or accept that I need to rest for a few. It all seems simple and obvious when I type it, but I was really losing it before the estrogen.
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Sorry, I gave you the dialling code from Europe, from the US it is (011 44) 207 486 0497. I've literally just phoned Professor Studd's office again and both his secretaries are taking calls but they are very busy.
Try to get through to Professor Studd as soon as you can but if all else fails, I would recommend you simply use his tried an tested regime of 3 pumps oestrogel everyday and 100mg Utrogestan (vaginally) each month. I really think this is the best advice I can give you.
Re progesterone intolerance, how do you feel when you take progesterone? Do you feel significantly better when you take oestrogen only? Again, the only way to find out is by trial and error.
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Let me add to Mary G's comment about intolerance. Don't be afraid of it. If you've had problems with hormonal birth control in the past, then you may have reason to be cautious, but even then, bodies change and you won't certainly have problems with it. Lots of women do absolutely fine on progesterone or even synthetic progestins. That said, if you're being hyper-aware, the normal side effects may scare you. Prometrium/Utrogestan can have a sedative like effect. A dizzy drowsy feeling is not intolerance. My first course of Prometrium I did have some other side effects but those went away after 2 or 3 days of it. Women with intolerance I believe get such debilitating effects form the progesterone they can not take it. You'll likely feel something from the progesterone, that doesn't necessarily mean intolerance.
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I would start with 2 pumps of the gel you need it every single day not just when you get a hot flash, that is really silly advice. Rub it into your legs alternating legs @ night when you are in bed it soaks in within 2 mins...
You will need a progesterone taken for a certain number of days per month. I would go with 12 days to start with say from the 15th of each mth through to the 26th. Stop the Progesterone and see if you get a bleed after a few days. If you do not, then the Progesterone is clearly not strong enough and you will need to either get a stronger dose or I would ask your Dr to prescribe Utrogestan which is a tablet the 100mg used vaginally just pop one in 12 days of the mth, you can also use them orally. This regime suits many many women and can be life changing but you most certainly do need oestrogen. All the best.
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Try to get through to Professor Studd as soon as you can but if all else fails, I would recommend you simply use his tried an tested regime of 3 pumps oestrogel everyday and 100mg Utrogestan (vaginally) each month. I really think this is the best advice I can give you.
MARY- ok... Do i start immediately on 3 pumps or work my way up over a few weeks or days?? also are you saying 100mg Utrogestan (vaginally) each month EVERYDAY?? OR 12 DAYS PER MONTH? sorry all the questions, Im just really wanting to get this right.. thank you ALL
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"Women with intolerance I believe get such debilitating effects form the progesterone they can not take it. "
Lizab - ok so if they get debilitating effects from the progesterone and can not take it.. do they just take the estrogen ONLY?? can that be dangerous? thank you ALL for helping me
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Cassie and Mary - Thank you both for helping me with the dose of ESTROGel.. can either of you tell me what I want my blood levels to get to?? or does that even matter?? My doctor said he would test my blood every 3 months (which I asked for) and currently my estradiol was 117 and reference range is 0 to 357.. based on this my doctor said my level was fine??? but obviously I have symptoms? do the blood levels really not matter?
additionally, I remember my doctor saying that there was another kind of estrogen they tested in my blood and that I was very high in this one (he said "you are very high in the BAD estrogen for some reason") what is this other estrogen?
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DEETLE, why not just start with the tried and tested Professor Studd regime which is three pumps of gel everyday (you could split the dose by 12 hours as I suggested on my other post) and then take 100mg Utrogestan vaginally for 7 days only each month. Professor Studd always suggests you take the Utrogestan on the 1st of every month for 7 days to make it easy to remember.
to recap, use the gel everyday from now on and if you have only just had a period, you can leave the Utrogestan for a while in order to get a good dose of oestrogen into your system.
Once you start the Utrogestan phase, you will know how well you cope with progesterone.
You obviously have private health insurance so you can take the lowest dose of Utrogestan (i.e. Professor Studd's 7 day dose) and then have a uterine scan every year to check that your womb lining is clearing adequately. This amount of progesterone is enough for me even though I take a high dose of oestrogen and most women are OK on this amount of progesterone. I am severely intolerant to synthetic progestins and high doses of Utrogestan so there is no question of me ever taking more than Studd's dose.
Re oestrogen blood levels, mine ranges from about 180 to 235 pg/ML which works very well and I feel completely normal on this range so I will stick with it. It might be too high on paper but anything below about 130 is a waste of time for me. Never heard of good v. bad oestrogen, this reading is for 17-BETA estradial.
In a nutshell, you have to find what you feel good on and stick with it! Be prepared for it to take a while to find the right regime.
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I just hung up with the pharmacy and they said they don't know of PROMETRIUM (I'm in US). He thought that maybe it was just progesterone in a peanut oil?? Is there another name for it?
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Yes it is progesterone in a peanut oil known as Utrogestan or Prometrium....
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When I had my last blood test the Oestrogen, if I remember correctly it was marked as E2 on the lab report was around the 600 mark on that level I had no symptoms, it is now down to 300 something as I am just over the 50 yr mark but I am still not having many symptoms so am thinking we are on the right track.
Regarding the so called Bad Estrogen, I do remember at one stage when I consulted a pharmacist who specialised in Bio Identical Hormones that there are 3 types of Estrogen and one is considered not so friendly, however the one that is generally prescribed in the gels and HRT is a so called good one, I would not worry too much about the nitty gritty some of these specialists tend to get in way too deep, keep it simple, use the gel and the cyclical Utrogestan 100mg x 12 days per mth and you should feel 100% better.
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Yes it is progesterone in a peanut oil known as Utrogestan or Prometrium....
1 - What if I am allergic to peanut oil? is there something else I can ask them to use? I would like the suppositories idea but not sure what to tell them to make it with? THANK YOU ALL
2 - Lastly, I've talked with my doctor in detail this morning about everything I've learned here.. thank goodness he is somewhat willing to work with me (actually I may be educating him based on all of you here helping me with knowledge) but he is set on me staying on the progesterone part continually, no breaks, 100 mg daily... is that ok??
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I can't believe your pharmacist doesn't know of Prometrium. It is the brand name for the drug. The generic is something like micronized progesterone. It isn't made in the pharmacy. It is manufactured and it is like pills full of peanut oil, similar to fish oil vitamins. I'm not aware of any alternative formulations without peanut oil, other than synthetic progestin. I would question even if the cream from your compounding pharmacy has peanut oil in it, if I had an allergy.
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Why would you be allergic to peanut oil, surely you would know you were by now.... Order it you will be fine.... :D you can stay on it every day but I prefer just 12 days a mth as it has side effects and I enjoy my sleep, it keeps me awake....
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You might need to ask for Micronised Progesterone..... Utrogestan is also known as that.
It is madness to suggest that you use oestrogel only if you have a hot flush! The idea is to get your level up to a point where you don't have flushes.
Good luck
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DEETLE, the final decision is up to you but I would not advise you to take 100mg of Utrogestan everyday because it takes away a lot of the positive effects of the oestrogen.
You have private health insurance so I would recommend you keep the Utrogestan to a minimum and take 100mg for 7 days each month and have a scan every year to check the lining. If you take more than that, you might find it gives you a low mood and other side effects (I couldn't even consider taking any more) but as I said it is up to you to decide whether to start higher than 7 days and see how you get on.
I wouldn't worry about the peanut oil, if you were allergic to it, you would know about it by now.
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I have something called a g6pd. and peanuts are a known allergy for this. so i am assuming that peanut oil would be from peanuts? although.... my pharmacist just told me she could put the same progesterone with acidophilus in a capsule and I could use that? does that sound right?? sorry it sounds like mine is not straight forward, but I still want to get it correct (bioidentical) and definitely not synthetic.. would that be ok? or any other suggestions?
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Mary G, she may not have private insurance, depending on her age and economic situation she could be on Medicaid/medicare/some other state program, and even with private insurance, it could be difficult to get them to honor a claim for annual ultrasounds. It's simply not the norm, and insurance would likely argue it.
As for how you take the progesterone, I've never heard of doing that, but I think the main thing is that you get the progesterone in some form, any form, to protect your uterus from the effects of the estrogen. You should not go on estrogen alone if you have a uterus.
I understand your confusion from what your doctors have said, but I think that once you get started on it, you'll quickly understand how it all works. As one of the other ladies said, don't get too tied up in the details. It's not something that has to be perfect the first time. If something seems wrong, come back and ask about it. You can always make changes.
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Hi DEETLE
I've come somewhat belatedly to this thread.
What an awful confusing time you've had with the various doctors! It makes me so glad I live in UK with our NHS! OK we do have some GPs that need educating but there are strict guidelines and protocols and basically we can get any of what has been talked about free (or at minimal cost) without having to go privately,. Sometimes we have to make a bit of a fuss but it is possible.
The first thing is to clear up the issues of compounded creams. Lizab is right that they are not popular here. To be correct they are simply not on the radar because they are not approved by NHS nor by most private gynaes. They are simply not used - except by a few compounding pharmacies but most women haven't heard of them. Progesterone creams are not approved because they are not standardised and so the amount of progesterone is inconsistent. The same is the case in US. They are not approved by FDA.
In terms of equivalent to prof studd in us - I'm sure there are many practitioners but the one who is well known is Dr Elizabeth Vliet who has written amongst others a book about menopause called "Screaming to be Heard". She also talks about bio-identical hormones and the con-trick by all the practitioners that make women think they have to shell out a fortune privately to get these when the FDA approved drugs provide esatrdiool gels ( which you have) patches, and micronised progesterone in the form of Prometrium http://www.webmd.com/drugs/2/drug-8042/prometrium-oral/details which should be available from your regular local doctor or whoever you go to for general health/gynae stuff.
Here is her Youtube talk about bioidentical hormones (just ignore the weird hairstyle!)
https://www.youtube.com/watch?v=9XfpAATJkC8
You might like also to see the N American Menopause Society which is the equivalent of our British menopause Society in US http://www.menopause.org/ . There is a find a specialist section http://www.menopause.org/for-women/find-a-menopause-practitioner
They've got a whole page with links about bio-identical hormone therapy and the confusion between compounded ones the body-identical hormones that I have talked about above and are generally available.
http://www.menopause.org/publications/clinical-practice-materials/bioidentical-hormone-therapy
If anyone tries to tell you Prometrium is not available then they are trying to make money out of you. On the NAMS website the approved products are listed here:
http://www.menopause.org/publications/clinical-practice-materials/government-approved-drugs-for-menopause
Actual list: http://www.menopause.org/docs/default-source/professional/nams-ht-tables.pdf
In terms of what you need I can't find anywhere in the thread (but I might have missed it!) where you say where you are in menopause ie what have your periods been doing re cycle etc over the past year - and how this relates to your symptoms that have worsened in the past 4 months? Also if you have only just started trying the gel you mention - and how long you have been trying out HRT? This is quite important to know how best to treat you.
Re the blood tests. The oestrogen will be in pg/ml as you are in US and that reading is normal yes, but also it depends on where in your cycle that test was taken as it varies so much so doesn't really tell you anything. As Stellajane says - she hasn't had a blood tests but her docs go on symptoms. At your age, cycle and symptoms should be enough to decide that you are menopausal and to issue standard (bio-identical - but not compounded) HRT to treat your symptoms, if this is what you want.
Depending on what you say you could start at the standard dose and then work upwards.
As Mary G says it is best to start on cyclical HRT anyway - at least to see how you feel with the extra oestrogen and then add in the progesterone. If you are post-menopausal ( ie no natural period for 12 months) then taking it every day is fine if you feel well on it - but many of us on here don't.
Please clarify about your cycle - and then take it from there.
Absolutely as Lizab says - don't accept the weird stuff your pharmacy is suggesting - you need Prometrium (the same as our Utrogestan) which is bio-identical.
I hope this is helpful - it's a bit long - and hasn't confused you further DEETLE! :)
Hurdity x
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thanks Hurdity and Lizab.... I am currently at the pharmacist lab, hopefully someone can answer this soon.. I am HIGHLY allergic to the peanut oil in Prometrium.. He is reading to me all the other fillers in Prometrium which I am also allergic to the sterate.. so this is not a progesterone I can take. but he is telling me that he can make a capsule with progesterone (plant based only) with acidophilous ONLY... no other fillers or products?? OR he can mix the plant based progesterone with cocoa butter ONLY... no other fillers.. both of which can be used vaginally. wouldn't these be ok?? apparently it is the exact same progesterone in the Prometrium (only without the peanut oil)
Thank you all
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That's kind of a special situation. I'm not a doctor, but if my pharmacist recommended that as a workaround, I'd certainly be open to running it by my doctor. If you can't have Prometrium it seems that is your only alternative unless you're willing to take synthetic progestin. I personally would give the synthetic a go before I went to experimenting, but if your pharmacist and doctor are in agreement that it would work, and you absolutely can't tolerate the synthetic, I don't see why it couldn't work.
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The only way you going to know is by trying it, if you use it cyclically 100mg for 12 days and get a bleed and future ultrasounds show a uterus lining thats say under 5mm then you know its doing its job. I would not think the filler would be too important be it peanut oil or something else, the main thing is the progesterone itself.
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DEETLE - Utrogestan no longer contains peanut oil, but sunflower oil instead and as far as I can make out some formulations of Prometrium do not either but it;s difficult to track down the latest product info. I am sure it will have been phased out due to peanut allergies.
Here are the ingredients that I can find:
http://www.medbroadcast.com/drug/getdrug/Prometrium
Each capsule contains micronized progesterone 100 mg. Nonmedicinal ingredients: sunflower oil, gelatin, glycerin, soya lecithin, and titanium dioxide.
Can't see anything about sterate ('stearate)
The point about custom making stuff is you can't guarantee the absorption but as Lizab says if your doctor thinks it's OK then that's fine. The compounding pharmacies are not regulated as you will see from the links I gave you.
Hurdity x
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I cannot thank you all enough for helping me. I have a new question not sure if I'm suppose to start a new topic but I have done two pumps of estrogel yesterday and one so far today and feel completely wired. Like on overdrive. It's extremely uncomfortable. Should I start lower to avoid this?
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I'm thinking absolutely not. If you can deal with it, that will likely subside within a day or two. If you're extremely uncomfortable, for peace of mind you could back off for a day or two and then try again, but unless you're getting a severe side effect, like an allergic reaction, you should probably just go with it. That said, I confess that when I first tried estrogen, I developed a headache (pure coincidence) and chickened out. I removed my first patch after 24 hours and didn't try again for a few months. Similarly when I increased my dosage, I felt strange and switched back to the lower dose within 24 hours, and tried again in a few days. Both times I'm sure we're my own over thinking and paranoia, as the second tries were uneventful. The reason I want to say absolutely not to you is because, as I mentioned somewhere earlier on the thread, you need to take a dose and stick with it long enough to see what happens. If you start mixing things up from day 1, you'll probably suffer as much from the fluctuations as you suffer without any hrt.
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maybe I need to back off then for a day or two, cuz this I feel really revved up..
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Why dont you start with less, I have always used less than the prescribed dose, I started on one pump and found it was more than enough to control any symptoms, I pushed it up to one and tiny blob more but def not 2 pumps....try this and use it at night as you get into bed but give it time to settle I would not skip days once you start the gel stay on it or you are likely to get breakthrough bleeding, esp with the oestrogen.
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If you use it at night DEETLE and share a bed with someone, then do make sure they do not come into contact with the skin area you have applied the gel for at least an hour to prevent transference.
Hurdity x
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A few comments I'd like to make, after reading this whole thread –
Seeing as you are already dealing with a healing period from benzo use, I would NOT recommend taking progesterone continuously on a daily basis. This could compound the GABA receptor issues you already have. It really doesn't matter what your doctor wants you to do. As I always said on BB, sometimes you just need to nod your head and politely agree with what your doctor is saying, and then go home and do exactly what you want to do. Let your doctor write whatever prescriptions they want to. You just choose the ones you actually want to fill. You're in charge.
Don't worry too much in the short term about taking any more progesterone. Find out what dose of estrogen works for you and get stable on that. If you've recently had a period, your lining won't build up to a point of being a concern in just a couple of months. When you do take a course of prog, start out with say 7 days and see how you feel. If you feel you've had enough, wait and see what kind of bleed you get. However, if after the 7 days you feel you can cope with a few more days then see if you can get to say 10-12 days. It's all trial and error. You won't get it right straight away. It could take months to get a routine you feel happy with.
I also wouldn't be messing around with a compounding pharmacist. Frankly, it's the compounding industry (particularly in countries like USA, Canada and Australia) that is responsible for this whole “progesterone cream is a cure-all†nonsense. Consequently we have a whole lot of doctors and websites allowing women to overdose on progesterone, or advocating the use of a progesterone cream to oppose estrogen, when it is not proven to be strong enough to oppose estrogen.
If you are allergic to the ingredients of Prometrium, there is nothing wrong with trying a progestin instead. I would personally rather stick with something that is regulated before I would resort to a compounding pharmacist TBH. Sometimes we get a bit hung-up on using “bio-identical†stuff, but basically you will end up using what actually works for you. For some women progestins work just as well as progesterone. A lot of women find medroxyprogesterone (Provera) quite tolerable. Norethisterone seems to be less tolerable by a lot of women, but there are obviously a lot of women who do use it because it's widely available, and is also the only progestin available in patch form.
Everything is going to be trial and error for you. Probably nothing is ever going to be "perfect", like whether you do or don't have periods, or do or don't use a progestin, but you will work out a routine that works for you, including how much estrogen to use, how much, how often and what kind of progesterone/progestin to use. It takes time and patience. Blood tests rarely help very much, so I wouldn't be too concerned with the figures. Most women (and doctors) prefer to go by symptoms. I wouldn't have a clue what my levels are. I've only had one blood test done and that was about 6 years ago. Whenever I've mentioned more tests to my GP she just says, “What's it going to tell us that we don't already know?â€.