Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: hoping4best on February 05, 2017, 07:47:22 PM
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Hello again,
I went to my new RE on Friday and he's trying me on a new HRT regimen to see if it will work for me and maybe cause less adenomyosis bleeding/cramps and hair loss (once my hormones re-settle).
Crinone/Prochieve (8%) is a progesterone vaginal gel that I will be trying 2x/week, continuously, instead of oral micronized progesterone or a Mirena. I know not many people seem to use progesterone vaginal gel for HRT, so I will do my best to report back here on how it goes.
For estrogen, I'm switching from a couple years of patch use to Estrogel for the first time. I know not to put Estrogel on or near my breasts. I put it on my thighs this morning. I'm impressed with how quickly it seems to absorb. Am I supposed to vary where I put it? Are hips and my butt fair game for putting gel? I will also search the forum for tips. 🙂
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Hi there hopingforbest - RE??? Haven't come across this one!
I presume you are in US?
It will be interesting to hear how you get on with Crinone - as it doesn't seem to be used here and I presume not licensed for HRT as not listed under HRT preparations. I think it is probably mainly used for fertility? It used to be available at a lower dose too (4%) but no longer.
Looking forward to hearing how you do with this preparation :)
Someone else will be along to advise you on the gel application but I'm sure thighs are fine. I think the usual method is to alternate sides? Doesn't have to be somewhere different every time otherwise you would soon run out of places!
Hurdity x
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Hi Hurdity,
Yes I'm in the US. (Sorry... RE = "reproductive endocrinologist".)
Nobody uses Crinone (has been renamed "Prochieve", apparently? Both names are terrible, lol) here, either. I was hesitant to get a progestin IUD after my scalp pathologist told me she's seen some patients with hair loss lose more hair on the Mirena. Also, I had two paraguard copper IUDs in the past, and my body tried to eject it constantly. So I did a lot of research to see if there were other local "bioidentical" progesterone options, and Prochieve is what I found. My RE is totally open to me trying it. I have no idea how it will go, if it will irritate my urethra, if it will be too messy, or what. But I guess I'll find out soon enough. If it doesn't work, I'll be re-exploring the IUD plan for my progesterone.
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Hi hoping4best
Good luck with your new hormone cocktail, I wish you every success with it!.
I used this combination here in the UK about 10 years ago and didn't experience any vaginal or urethral irritation with the Crinone. I was instructed to apply the Estrogel on both thighs in the morning and to use the Crinone at night. The Crinone was used every other day for the last 12 of a 28 day cycle thus 6 applications per 28 days. x
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Thanks Elizabethrose. Was there a reason you stopped the Crinone?
I'm doing continuous (2x/week) rather than the sequential pattern. But of course the day I got the prescription, I started a very heavy bleed. I have no idea how to take vaginal preparations if I'm heavily bleeding. I assume I don't, I guess.
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Hi hoping4best
Docs were trying to treat pure menstrual migraine that started with peri, HRT was one of many things tried. I'm very reactive to hormone change and very sensitive to any attempt at manipulation and my side effects were instantaneous and impossible to live with. I was sent into a spiral of continuous migraine.
Dosages were adjusted but everything tried failed to suppress my own cycle which continued doing it's thing. At that stage my cycle length varied enormously and as a result some months I had three periods, two from my own cycle and one from the HRT. Totally impossible as the migraines were only present around a bleed. In peri it is sometimes impossible to synchronise HRT with irregular own cycles.
My bleeds were never heavy and I just continued on the planned dosages irrespective of the bleeding. Maybe using at bedtime allowed absorption. If you're unsure about the bleeding can you call your doc to discuss?
My Consultant prescribed this combination regularly and I know other women who used this very successfully. Hopefully it will resolve your issues. x
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http://www.besins-healthcare.com/pdf/OESTROGEL%20Tube_Insert_Ukraine.pdf
Found this whilst looking for application info and it's slightly different from other oestrogel info in that it states correct application will be dry in 2-3 mins. I know it's slightly different for everyone but mine takes WAY longer than that to dry and possibly why I'm not absorbing properly. It also states lumbar region as possible application site.
Might be useful info for some?
It's not the pump dispenser but same product just in a tube so don't get confused with quantities.
Mxx
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http://www.besins-healthcare.com/pdf/OESTROGEL%20Tube_Insert_Ukraine.pdf
Found this whilst looking for application info and it's slightly different from other oestrogel info in that it states correct application will be dry in 2-3 mins. I know it's slightly different for everyone but mine takes WAY longer than that to dry and possibly why I'm not absorbing properly. It also states lumbar region as possible application site.
Might be useful info for some?
It's not the pump dispenser but same product just in a tube so don't get confused with quantities.
Hello Murphydurf
It does dry on me in about three minutes, I slather it onto my arms.
Mxx
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Hi Charlotte - that may be the forensic clue I'm looking for! Takes about 10-15 sometimes longer for me. Will keep trying!
Mxx
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Ah then hoping4best - I presume Crinone is more readily prescribed in US for HRT?
"Bio-identical" progesterone was initially only used for fertility here - and before utrogestan (Prometrium I think in US?) became available (at least for HRT) the two main types were Crinone (gel) and Cyclogest (pessaries/suppositories) and I suspect since the advent of a licensed product, the other two are not prescribed much any more here - apart from to those women who do not do well on Utrogestan. They used to be prescribed by gynaes or enlightened GPs off licence.
My GP used to prescribed Cyclogest and this is the first progesterone I used. I can only recall a couple of members or so in the past (6-7 years) mentioning that they've tried Crinone - one of whom is Night_Owl (I am sure she won't mind my saying), from Nick Panay - who still prescribes it I gather for women who are highly progesterone intolerant - to try. Most gynaes now seem to prescribe Utrogestan because it is licensed for HRT.
Interestingly Stellajane - you mention rubbing it in - I hadn't thought that here is a product which could be applied in the same way as Estrogel so led me to wonder why not? I presume the Crinone gel is not necessarily in a quick dry formulation but presumably could be made so? However I can see the same argument applying to this as to the stronger progesterone creams - application and absorption varies so much by individual that you can't be sure of the amount that would absorb - and while this does not matter for oestrogen (because it is symptom control we are talking about usually), for progesterone it is crucial - it is the protection of the womb which is the ultimate goal.
Re the bleeding hoping4best - fortunately I have never bled before finishing my course of utrogestan (which I take vaginally) so it is not an issue but I can see absorption through the cervix into the uterus could well be lessened if bleed is happening and the flow is the other way - and might carry out the progesterone with the blood.
The other thing is - the progesterone is designed to change the structure of the uterus from proliferative ( growing under the influence of oestrogen) to secretory (changes the structure of the lining to prepare for fertilisation) - so I am not sure whether in fact it can make the secretory changes once the lining has started to shed so the progesterone may well be wasted if you see what I mean. I did try to read about this but can't quite get an answer - ie does the lining start to proliferate underneath, even as the tip layer is shedding and would additional progesterone have an effect.
The good thing about Cyclogest ( the waxy capsules) is that it can be used as a pessary or a suppository so you can still insert it somewhere even if bleeding - but I was never keen on that route ::). That is the closest to non-vaginal transdermal progesterone we have..... (but not licensed for HRT).
Sorry that's a bit of a ramble out loud - but is something I've thought about on and off for a while!
I've probably got a paper on Crinone bookmarked somewhere too....
Hurdity x
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Hi again hoping4best
I just checked through my old notes re the bleeding whilst using the Crinone. I clearly also had this problem and had telephoned my specialist about this. I was instructed to ignore the bleeding and continue using the Estrogel and Crinone on the 28 day cycle. Given I was bleeding frequently it all became terribly confusing and I was forced to keep track of day numbers in a daily diary record!!
Good luck to you x
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Thanks so much everyone for the tips!
My doc doesn't want me to take the Crinone while bleeding, so I'll wait.
I wish I could just take Utrogestan/Prometrium vaginally, but when I tried it, the capsule really, really irritated my tissue and urethra. Bummer.
Stellajane, I'm trying the Crinone to see if I can tolerate it before trying a Mirena, which has the hair-unfriendliest synthetic progestin you mention. I feel like the utrogestan/prometrium also triggers my hair loss, which my hair specialist says is likely. I'm on minoxidil now. It's been 6 months. So far, pictures taken by my doctor show it's starting to help. So I'm hoping it will continue to help.
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Hoping4best - Utrogestan/Crinone contain the same progestogen least likely to trigger hair loss ie are both actual progesterone and not androgenic. However with Utrogestan you are taking by mouth and so the high systemic concentrations may have some effect. This is the same when used vaginally - in fact I did read systemic levels are even higher used this way. I must dig out that paper/reference about Crinone and see if it mentions systemic absorption!
Good luck with it anyway...
Hurdity x
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Hello all,
MurphyDurf, I'm like you, it can take up to 20 minutes for the gel to dry for me. I put it on my shoulders now but I used to put it on my inner thighs and it was the same. I'm having a lot of VA symptoms which I'm using Vagifem for as well - so I wonder if I'm not absorbing the Estrogel properly....
I spread it out the size of a palm, approximately. Does anyone here have any suggestions? Should I be spreading it out more thinly? I use what is described as one dose from the tube; I guess thats two puffs from the pump...
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Hi Hurdity,
I'm trying the Crinone because I prefer to stick with micronized "natural" progesterone. Though my hair specialist says that systemic progesterone of any kind can be a major hair loss trigger for some women. I've been told vaginal progesterone is supposed to have fewer systemic effects than oral, but I guess I'll find out if that's true for me. (Obviously some people absorb progestins systemically from a Mirena, and that's not "supposed to happen", either.)
Here's a link that talks about vaginal progesterone absorption, with references: http://www.aafp.org/afp/2000/1015/p1839.html
Sounds like I'm lucky so far with Estrogel absorption, but I'm on only one pump per day so far. I went from a week on a 0.05mg patch to replacing the patch with one pump of Estrogel. I got a hot flash today, ugh. So perhaps I will need to go up to two pumps.
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Hi Hurdity,
I'm trying the Crinone because I prefer to stick with micronized "natural" progesterone. Though my hair specialist says that systemic progesterone of any kind can be a major hair loss trigger for some women. I've been told vaginal progesterone is supposed to have fewer systemic effects than oral, but I guess I'll find out if that's true for me. (Obviously some people absorb progestins systemically from a Mirena, and that's not "supposed to happen", either.)
Here's a link that talks about vaginal progesterone absorption, with references: http://www.aafp.org/afp/2000/1015/p1839.html
Sounds like I'm lucky so far with Estrogel absorption, but I'm on only one pump per day so far. I went from a week on a 0.05mg patch to replacing the patch with one pump of Estrogel. I got a hot flash today, ugh. So perhaps I will need to go up to two pumps.
Thanks hoping4best!
As I mentioned I read that systemic absorption from vaginal progesterone (the utrogestan capsules) was greater than with oral use ie achieves higher serum levels for the same dose. However taken orally the progesterone is metabolised by the liver and it is the metabolic byproducts (the details of which escape me at the moment) - which can give rise to some unpleasant side effects.
Re non systemic absorption from Mirena - this is a misconception - which I posted about recently. I looked up the systemic levels. Mirena was first developed for contraception and so the systemic absorption compared to oral levonorgestrel in mini pills/CCP is minimal. However when used for HRT - the absorption has to be taken into account so I am not surprised some women react to it!
Do keep us posted about the Crinone!
Hurdity x
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Thank you Stellajane !
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Update: I was hot flashing 5 days into Estrogel so I went from one to two pumps daily and they went away. I may ultimately need more for better systemic help with my urogenital symptoms and because I'm 42, but am holding here for the moment.
I've taken Crinone 3 or 4 times (I'm on 2x/week, continuous). Way more comfortable than vaginal Utrogestan/Prometrim (really bothered my vaginal and urethral tissues), and I feel fewer side effects than oral progesterone. BUT, I am having another crampy bleed (with adenomyosis, cramps are awful). I can't take the Crinone when I'm bleeding per my reproductive endocrinologist. This is my 2nd bleed since the HRT reboot, the first was when I initially restarted a few weeks ago from my month off HRT. And now here's another. Hope it's short.
I wonder how long it takes for Estrogel to reach a steady systemic level, and how long it takes for Crinone to do the same.
My hair is still shedding a ton, but my doctor said to ignore it during major hormone transition times as it's gonna happen then, that's normal for me. I think the minoxidil helps me get regrowth, but doesn't seem to slow down my shedding much.
That's my update!
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Hi hoping4best
How long have you been on continuous HRT? It may well be that your lining has built up a little on whatever you used before and is now shedding - maybe the Crinone is working better? It does take a while to stabilise on any continuous combined HRT and it seems changing the regime also can cause spotting/bleeding.
The Estrogel reaches steady state (in the system) within days and I am sure the Crinone will do so too - progesterone has a very short half life so has to be continuously replenished in order to be effective - even more so than the synthetic progestogens. I can look up the figures if you want?
Hurdity x
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I was on continuous but had bleeding (oral utrogestan and estradiol patch). Then a month of no HRT (a break for bloodwork). Now am restarting. 2 pumps of Estrogel per day, and Crinone on Mondays and Thursdays. Except I'm not supposed to take it when I'm bleeding (though my bleeding was light today and more like spotting, so I took it). The beginning and end of bleeding always makes my urethra and vaginal tissue irritated, so that feels bad right now.
Hormone adjustments are not fun.
Thanks Hurdity!