Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Lamplighter on May 30, 2021, 10:14:49 PM
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Reading the threads on here it strikes me that progesterone often causes more trouble than it's worth and I wondered why the medical profession is so adamant on making women take progesterone with oestrogen. I undestand it's to do with preventing thickening of the endometrium and thus avoiding potential cancer, but I came across a reference to cancer in this event being very rare. On a par perhaps with developing breast cancer with the use of oestrogen? Low risk in other words.
Does anyone have any details as to why progesterone is considered so necessary? Or indeed, what are the odds on getting cancer or some other negative outcome as a result of not taking it? Am I missing something here?
I'm just curious really, but having worked my way through quite a selection of HRT combinations trying to find one that helps me, I suffered all sorts of side effects which could only have been the progesterone element, so I'd be interested to know why it's required.
Thanks :)
LL
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Hi! I am also in the same boat. I am sick of trying new regimes as the progesterone side effects are awful. I am going to attempt to cut my patches in half this coming week and although I know I can do this short term, if it works I would like to do this indefinitely. I’m sure the response will be something to do with increased risks. I’ll follow this thread with interest x
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There is an increased risk of cancer as you know but you can't have the lining building up forever and not being cleared out. There are occasional threads from people who've done it, the last one I remember was 9 months with no progesterone resulting a very painful, heavy, clotty prolonged bleed. Gp refused to prescribe again unless she had a mirena. Following this path is a really stupid idea.
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Sheila99 - I don't think I said anywhere in my post that I intended discontinuing progesterone, I was simply asking if anyone knew the reasons why progesterone is obligatory with oestrogen.
Being told it's a 'really stupid idea' isn't very helpful :'(
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NicolaJ, likewise. Good luck with halving the patches - hopefully that will still be enough to keep the symptoms at bay :)
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Well I went to collect my prescription today only to be told they are not available (Evorel Sequi) The pharmacy went back to the GP last Thursday to get ‘something else’! Honest to god I could’ve cried. I have to ring them tomorrow to see what they’ve got. So I have no patches to half right now! 😭
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Sheila99
Being told it's a 'really stupid idea' isn't very helpful :'(
Sorry you don't like the language but I would be thoroughly irresponsible to suggest it wasn't. There is a very good reason the medical profession insist on it. You may not be considering it but someone else reading the thread might be.
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NicolaJ that's awful - I sincerely hope they can give you something, but it's a real pain when you can't get what you're used to. Does this mean no Evorel Sequi at all, or is it just the pharmacy couldn't get them temporarily? I'm put in mind of the shortages problem a couple of years ago and hope it's not the start of another round.
Will be thinking of you tomorrow xxx
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Well I went to collect my prescription today only to be told they are not available (Evorel Sequi) The pharmacy went back to the GP last Thursday to get ‘something else’! Honest to god I could’ve cried. I have to ring them tomorrow to see what they’ve got. So I have no patches to half right now! 😭
You need to ring round a few pharmacies to check their stock as there is nothing showing online about shortages that I can see. Anyone else had this problem?
Taz x
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Thanks everyone. My plan today is to do a ring around all the local pharmacies and I also wasn’t aware of any shortages. X
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Reading the threads on here it strikes me that progesterone often causes more trouble than it's worth and I wondered why the medical profession is so adamant on making women take progesterone with oestrogen. I undestand it's to do with preventing thickening of the endometrium and thus avoiding potential cancer, but I came across a reference to cancer in this event being very rare. On a par perhaps with developing breast cancer with the use of oestrogen? Low risk in other words.
Does anyone have any details as to why progesterone is considered so necessary? Or indeed, what are the odds on getting cancer or some other negative outcome as a result of not taking it? Am I missing something here?
I'm just curious really, but having worked my way through quite a selection of HRT combinations trying to find one that helps me, I suffered all sorts of side effects which could only have been the progesterone element, so I'd be interested to know why it's required.
Thanks :)
LL
Hi Lamplighter - in the case of oestrogen and the endometrium, there is a proven causal link between over-thickening and cancer, and while rare it may still occur. There have been studies in the past giving the percentage of women who develop endometrial hyperplasia ( which can lead to cancer if untreated) on different oestrogen and progesterone doses although it is not possible to quantify the individual risk.
The problem is that with such build up the endometrium may start to break up spontaneously and shed, leading to heavy and irregular bleeding.
The extent to which the lining builds up is dependent on the oestrogen dose as well as the individual woman so for example there is (or was) an ultra-low patch (maybe still available) in US called Menostar (12.5 mcg) which was prescribed without progesterone although even in this case an annual progestogen course was recommended just to clear out any build up of lining.
Another option to minimise progesterone is to take it on a long cycle - which of course must be done under medical supervision. I am on such a cycle although mine is not very long - I now only extend the standard cycle by 2 weeks ie 6 week cycle but some women take progesterone every alternate month. Of course this only works if post-menopausal because otherwise your natural cycle could get in the way although some specialists argue that if you ovulate naturally then you are producing plenty of your own progesterone.
I hope this doesn't sound confusing?
Hurdity x
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I developed polyps and endometrial hyperplasia very quickly on HRT, even with Utrogestan as the progesterone element. They were concerned that they couldn't actually rule out atypical hyperplasia: the precancerous form. It was quite frightening that this seemed to happen within 11 months of me starting on 3 pumps of oestrogel and either daily 100mg utrogestan or every other day vaginally.
I now have a Mirena and things seem to be settling in. I have had no problems at all with the Mirena and it doesn't make me drowsy like the Utrogestan did. For my endometrium I obviously needed a very direct form of progesterone and Utrogestan for whatever reason didn't do the trick. Perhaps some women need it more than others or stronger/more direct doses of it?
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If you have a womb, there’s no getting away from some form of progesterone, otherwise you are heading for a very thick womb lining which could ( I'm guessing) end up as a nasty flood?? The way forward is either a hysterectomy or mirena I think.
I’ve been on patches a few months now and have experienced several episodes of bleeding. My 100mg of utrogestan isn’t sufficient I don’t think so going to discuss other options at my menopause appointment this week. Striking the hormonal balance is hard work!
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Thank you everyone for the info and for sharing your experiences, I appreciate it :)
Hurdity, what you wrote sounds positively terrifying :o and thank you for such a comprehensive answer. Together with what the others have written, I now am much more informed than when I asked my question.
I do have another question though, about this Mirena coil - I've assumed it's a form of birth control and therefore used by peri-menopausal women, and not suitable for post menopause. How does it work, in that I gather it's not like taking progesterone?
NicolaJ how did the search for your HRT go yesterday?
LL
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I had my Mirena inserted for the first time at 56 for exactly this reason: providing the progesterone element of HRT.
I managed to persuade the nurse I didn't need a pregnancy test!
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Hi! After six failed attempts at various chemists I got my six boxes this morning! Many are putting the local shortage down to the ‘Davina’ effect (in their words) This is great for new ladies finding HRT but not so good if they can’t keep up with demand. I hope it settles soon! I live in Newcastle, not sure how this is impacting on other areas of the country.
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Thanks Grheliz1, that's useful to know. Lol about the pregnancy test. You never know, they do say that 50 is the new 30 these days ;D
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Hi! After six failed attempts at various chemists I got my six boxes this morning!
6 boxes? I'm only allowed to have one month at a time! :o
Taz x
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I’ve never had more than three to be honest, I was a bit shocked! But hey Ho!
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NicolaJ I must have missed your post, sorry. Well, six boxes sounds like a good haul - maybe making up for not having it eh? And it will end up as 12 if you start cutting the patches in half!
Taz2, likewise, for some reason my surgery is now doling out the HRT one month at a time (really stupid as you end up having to reorder two weeks into the month in order to make sure you keep the continuity up). Long gone are the days when I would get a six month prescription, so much easier and more practical.
LL
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I still have slight reservations about cutting in half over a longer period ‘if’ it works, which I’m hoping it does. There’s so much on here about it, I think it’s ok? 🥴
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NicolaJ, I know nothing about sequential HRT having always used a continuous sort (I started HRT five years after menopause), and having a look at the patient leaflet online I don't think I can even guess at what to advise. I suppose it depends on whether you are thinking of halving all the patches, or just the ones with the progesterone?
Hopefully someone familiar with sequential HRT can reassure you about this. xxx
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I plan to half all of them, started today with the oestrogen patches. X
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In that case I can't see a problem because you aren't lowering the ratio of progesterone to oestrogen just halving the total input amount. The only drawback might be that you'll only be getting half the benefits of the oestrogen and that might not be enough.
But fingers crossed it all works for you. xxxx
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Thanks Grheliz1, that's useful to know. Lol about the pregnancy test. You never know, they do say that 50 is the new 30 these days ;D
Snort!
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That’s my thinking too and thanks. Fingers crossed! 🤞x