Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: KaraShannon on July 19, 2022, 12:04:10 PM
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Hi all
Some may remember that I mentioned being on continuous Estradiol 100 for 3 months, without progesterone because I had a reaction to it.
One reason or another haven't got a doctor's appointment yet to sort out what progesterone to take. I was on Evorel Sequi's norehisterone and did ok on that. I know it's not enough with 100 estradiol but need to start something again while await doctor's appointment. (the reaction was to utrogestan, not norehisterone)
Problem is it was suggested here to take the progesterone 14 days after my period. That was on 5th. So today I should start progesterone. BUT yessterday I got all the bodily feelings of a period starting again, sleepiness, sense of well being, etc. Today it looks like it's beginning, but it could just as equally disappear by tomorrow, I don't know.
So wait 14 days from today, or start the progesterone today because it's 14 days since the last period.
Meanwhile I will contact doctor tomorrow, today I'm way too challenged by stuff :-\ would appreciate your thoughts, I don't want to take progesterone and mess up my hormones if they are in the wrong phase. Thanks
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I'm a bit pedantic.
Basically the question is, do I take progesterone today if my period appears to be starting? (even though I'm 14 days after the last one)
:)
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I would start it today but stop when your bleed arrives even if you haven't completed the course. That should get the hrt cycle in step with your own. When you say 14 days is that from the start of your bleed or the end of it? If it's from the start the timing is not far off right anyway.
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Thanks Sheila
it is from the start of the bleed last time, the 5th.
Today there is spotting so I suppose I would say it's already begun, but who knows these days..............if it has, stay on the estradiol for another 14 days do you think?
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I would start counting again but from the first day of proper bleeding. I could spot (pale pink) for 5 days sometimes before I got a proper bleed.
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Thanks ;D
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Here's what I'm thinking, it's now roughly 14 days since the 'bleed.' It was a little more than spotting but very scant.
But I've been around 4 months without progesterone, I'm getting a blood test soon but I think it's time I started the progesterone. I don't feel like a bleed is due, so I think I'm going to at least put the evorel patch on (should be utrogestan but not ready for the reaction, based on experience)
Some progesterone is better than none I think, I usually feel loads better on the progesterone patches and I'm feeling not so good at the moment, as if retaining water. I think progesterone helps with that so I'll give it a go today.
If anyone has any further thoughts about it I'm all ears I won't be changing the patch until afternoon.
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I’m not an expert and you should discuss this with your GP ASAP, but my understanding is progesterone is very important and that it’s a little risky being 4 months without if taking estrogen. My specialist I see said not to worry too much if my period is not 28 days exactly, when I began I simple took it from the next day of bleeding- light or heavy- and then start on day 15 of that cycle no matter what. Thereafter 2 weeks out of every 4 I take Utrogestan ( you must take it for 12 days minimum for the progesterone ). I would suggest you start it on day 15, today? Regardless.
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I agree with atb that it’s dangerous not to be taking progesterone. And when you do take it, it needs to be taken for the full scheduled time now.
If you are taking unopposed estrogen for months, you have been causing your lining to build up and get too thick - which is why you now have a bleed sooner than expected. It’s not a true period, it’s a breakthrough bleed due to your uterine lining having thickened too much without progesterone.
I don’t usually want to scare or worry people but you really should be concerned about taking unopposed estrogen. It predisposes you to uterine cancer and endometrial hyperplasia. This can happen quite quickly since in research their studies lasted a year usually. You’ve already been 3
Months without progesterone now…
Please don’t stop progesterone early to get it in sync with you own period - because you need the full dose of it and because this isn’t a period. It is going to be your body getting rid of some of the build up which has now happened….
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I agree with atb that it’s dangerous not to be taking progesterone. And when you do take it, it needs to be taken for the full scheduled time now.
Please don’t stop progesterone early to get it in sync with you own period - because you need the full dose of it and because this isn’t a period. It is going to be your body getting rid of some of the build up which has now happened….
Why? I agree with everything you say about the length of time without progesterone but once a proper bleed has started what is the progesterone going to do?
And I disagree with getting your own and the hrt cycle out of step. If it was OK out of step they'd tell you to start hrt at any time not to sync it with your own cycle.
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sheila I think if someone has been regularly taking progesterone every month and has found it out of sync with their bleeding every time, then there's no harm in trying to get it to sync with their own body - they are getting enough, overall.
But if someone hasn't taken any progesterone for 3 entire months, the bleeding isn't anything to do with a period, especially if it is happening 2 weeks after the last bleed (a 'period' is what happens after successful ovulation, it doesn't just mean 'a bleed' and you won't have ovulated if you are bleeding 2 weeks later...). Instead the bleeding is because their lining has built up too much - which is the risk factor for endometrial/uterine cancer and is what progesterone prevents.
Progesterone thins the lining of the uterus, that is its function. Since there is now considerable build up, it's imperative that enough progesterone is taken to get rid of that extra build up and help the body to shed it - or it is a risk for uterine cancer. Taking progesterone for a few days and stopping again because you start to bleed, is not going to work - you need to keep taking it, so it can thin that lining.
But it is also a bit scandalous that someone has been in the position for this to happen and is unable to access medical help to get advice or more progesterone....
By the way, KaraShannon, if norethisterone works for you, the BMS have some info at the bottom of this pdf about using it for the progesterone: https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf
"Norethisterone
5 mg for 12 days a month (cyclical) [given that no smaller (1-2 mg) dose stand-alone norethisterone preparations are available in the UK]
0.5-1 mg a day (continuous combined)
– Off license use of norethisterone in progestogen only contraceptive pills (e.g. Noriday 3 x tablets of 350
micrograms a day, will provide 1.05 mg of norethisterone) may be considered as an equivalent alternative."
Which means that officially you can use the Noriday POP x3 tablets daily (which is norethisterone) if you are really stuck, but you need to speak to a GP ASAP to get onto a progesterone.....
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Thanks for the replies, I will answer properly soon. I've submitted an eConsult to the surgery today, so let's see what the advice is.
I never meant for it to go on as long as it did but I have other health problems and fatigue and then a family bereavement, and then each time wanting to get the timing right and figuring that was important otherwise I'd put in a hormone that is at odds with my body. I have had something of a cycle up until this month where I've had a very light period, so hopefully I've been producing some of my own progesterone, but agree it shouldn't have gone on this long.
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That's good, let us know how it goes.
By the way, when you do start progesterone, you might bleed heavily and/or it might go on for longer than usual. Don't stop taking the progesterone - it is your body getting rid of all the extra build up...
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Taking progesterone for a few days and stopping again because you start to bleed, is not going to work - you need to keep taking it, so it can thin that lining.
But it is also a bit scandalous that someone has been in the position for this to happen and is unable to access medical help to get advice or more progesterone....
I haven't taken progesterone for a few days and then stopped because of starting to bleed....
Yes it's a bit annoying as I've mentioned this a couple of times to the surgery, told well lets have a blood test etc, but then that's weeks away etc, it's just a series of events
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By the way, when you do start progesterone, you might bleed heavily and/or it might go on for longer than usual. Don't stop taking the progesterone - it is your body getting rid of all the extra build up...
No I won't do that, I am waiting for it and expecting it, I even think some of my heart ectopics might be because of build up as before I went on hrt I had a lot of heart ectopics, then a really long period (6 weeks) and in that time not aware of my heart at all
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Ok eConsult auto reply said I will get a reply before tomorrow evening.
I feel in myself that I'm mid cycle. At the start of the cycle I'm usually energetic and at the end I'm usually tired (to put it simply it's more than that but can't type it all out, I know the feelings well, this is why I think there's been a cycle still going).
So now may be as good a time as any, but I will still question the whole thing and get it right, I was doing this correctly and religiously for 2 years before this.
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doctor's appointment at the end of the month, receptionist suggested not doing anything before then.
That will be another month. This is what happens.
I will chat to a pharmacist today too.
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Kara, I wouldn't take medical advice from a receptionist.
What are you afraid will happen if you start progesterone? (Why not start it?)
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I wouldn't take advice from a receptionist, I was just reporting what she said. I'm sure she meant well.
Well, I've started the progesterone patch. I found some dates in a diary, and by miracle, counting through the days since last september, if I start progesterone today I am on the same timing as before. So I imagine my cycle has continued roughly the same through the 3 months continuous (unopposed estradiol).
Things are still not ideal because I was taking a supplemental Evorel 50 with the progesterone, which is unlicensed to be done that way and yes I do get that still may prevent the womb lining from being cleared properly, but that was the regime I was on for a while before and the doctor had told me it was ok (of course it was when I questioned that that I was told to move to utrogestan and then all the problems started).
For now it means I'm starting some progesterone though and I have an appointment in 3 weeks. I'll see how I feel, I feel like I'm retaining water, and I think the progesterone always stopped that feeling and I always felt better on the progesterone phase, so hoping that will take place again, let's see.
Thanks for all the advice and thoughts, I appreciate all of it and feel free to continue because I listen to all of it and just trying to get back on an even keel :)
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Progesterone is a diuretic (according to Lara Briden) - as in - it helps you get rid of water stored. But I'm not sure if that refers to synthetic progestin or just utrogestan/body identical...
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It’s really hard to understand all this stuff sometimes, well often, and so many us get it wrong too so you’re just the same as most of us are or were at some point. You should not have been left to just use estrogen when you still have a womb and that isn’t your fault so you’re doing great by adding the progesterone now and can move forward knowing just a little bit more about how it works. Maybe your GP will want to ultrasound to check your uterus lining?
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Thanks Joziel and ATB, I think I've cracked things, I feel better today now, I think there's slightly less water retention already. Doctor appointment is made and blood test booked, meanwhile progesterone is now in the system. I will discuss with the doctor about trying utrogestan again and / or what can I do if my body prefers the norehisterone (which it seems to even though it's artificial).
A quick google search (I don't rely on that but interesting) suggests progesterone helps with energy, water retention, supports thyroid function, all that explains why I always felt better on the progesterone phase. Because of that I think I will need to give utrogestan another chance sometime as it is body identical and may help me further. I have hashimotos as well.
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Update, the progesterone kicked in, I started getting my energy back, my postural hypotension is so much better I'm hardly thinking about it anymore.
The progesterone might not be body identical, but I seem to do well on it.
Thanks for all the help, I've had my blood test but despite my phone appointment with the GP, the nurse said she was only instructed to take bloods to measure estradiol. So I won't know about testosterone or progesterone. I get the feeling that my testosterone might increase when I'm on the progesterone (noreshisterone) patch (more energy and stronger, less 'weak' muscles)
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Hi
I too was told not to start my Progesterone yet by a private menopause clinic. Why is this being advised?
After posting on here with my concerns (I double checked the letter), I got back in touch with the clinic about this.
I was told not to worry but start it after my August period, which is overdue. If it hadn’t arrived after a further 7 days then take it.
After posting on here and no period showing when it should, I started my tablet last night, my first mistake was not taking it when I got into bed, I was still up watching tv.
Brushing my teeth and getting ready for bed was interesting, as I felt like a zombie. My husband did say I went to sleep straight away though.
Good luck.
Peanut31
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Hi
I too was told not to start my Progesterone yet by a private menopause clinic. Why is this being advised?
After posting on here with my concerns (I double checked the letter), I got back in touch with the clinic about this.
I was told not to worry but start it after my August period, which is overdue. If it hadn’t arrived after a further 7 days then take it.
After posting on here and no period showing when it should, I started my tablet last night, my first mistake was not taking it when I got into bed, I was still up watching tv.
Brushing my teeth and getting ready for bed was interesting, as I felt like a zombie. My husband did say I went to sleep straight away though.
Good luck.
Peanut31
Peanut31
The only thing I'm aware of is that if you still have a cycle, then taking progesterone 14 days after a period is when to start it.
Perhaps others might have more to suggest on this. Good luck
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Update for me.
Thyroid levels are normal (around 1 for TSH which is usually good for me)
Estradiol, receptionist hesitated and then said I need to book a routine appointment.
Anyone thoughts on that? Now I'm worried. She said wait till Thursday for routine appointments to become available. I was a bit nervous about the way she hesitated (past stuff being triggered) so I didn't push and ask is it high or low or what is it saying.
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Well, I wouldn't worry too much because it's not a blood test which is going to tell you that you have some awful scary disease or anything(!!) :)
You're on quite a high amount of estrogen at the moment, is that right? So it might be quite a high result. The thing to say about that is - IF YOU ARE FEELING BETTER(!), then you should fight to stay on that dose. Even if it is like 800-1000pmol. Because some women really do need those kind of levels to feel good.
Many non-HRT knowledgeable doctors might be freaked out by levels like that and might try to bring them down and get you to reduce. Try to resist that, if you are feeling better on a higher dose. And if your doctor insists on reducing you might need to see a private menopause specialist to get them to approve you being on a higher dose - they can write to your doctor and tell them this is okay and your doctor should then accept that and you won't need to stay going private....
But really don't worry, whether the estrogen result is 20 or 1200, it doesn't mean you're going to die(!)!
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Thanks, major trigger there. You are right of course.
I've not spoken to them yet and tonight I have to change the patch back to estradiol 100. I felt so much better on the Norehisterone and now that period is over for another 2 weeks and I'm dreading it as clearly the postural hypotension, dizziness, heart not 'keeping up,' etc, is something to do with estradiol as it all went away with putting norehisterone back and I was just getting back into a normal life...
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Kara, are you saying that when you are on the estrogen only patches you are getting the side effects? But things are better when using the combined patches with norethisterone?
So - the estrogen dose is the same, the only difference is whether you are taking progestin or not?
I don't know your history but you could see if you could trial a continuous regime. Sometimes there are times to do this even if you are peri-menopausal. (I have a history of mild endo and continuous is recommended even in peri, to suppress the endo.)
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Thanks Joziel
I wasn't getting side effects, not for 2 years, but I increased the estradiol because the doctor said it was ok, nothing about it not being licensed to use that way with evorel sequi.
So then I was on 100 Estradiol, started getting dizzy...........thinking it was during the noreshisterone phase, spoke to the doctor, they said time to go on Utrogestan, tried it, bad reaction, problems seeing a doctor, family bereavement, very dizzy, 3 months later I find that I was on unopposed estradiol for that length of time.
I felt so much better starting the noreshisterone recently, almost back to my old self. I've now started the estradiol phase again, my period came during the norehisterone phase. Unfortunately last night I was 'nesting' terribly, stressing over everything not being 'done.' Didn't think anything of it I just thought I needed to get things done, but today period started again and the most awful period pains that put me to bed for 2 hours this afternoon (and I tolerate a lot of pain and never need painkillers). I wouldn't say it was worrisome in the sense of needing a doctor or anything, but not feeling great, plus temperature a bit higher than normal (again not a fever or worrisome, just higher than usual for me). Haven't eaten all day and that's very unlike me, lol.
I wonder if my uterus is just clearing the lining away as this isn't normal for me. Of course I'll keep an eye on it, but it's only been today. I am due to see the doctor anyway.
I'll talk to her about maybe being on combined continuously. I seem very 'well' on norehisterone, though mood just drop a little.
(edited to add I've never had any problems before or symptoms of endo, but worth bearing in mind thanks)
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Well update. Since the last post I've been a lot better. Almost no postural hypotension and it was bad to the point of disabling.
I haven't had a period since the last post, just stopped my norehisterone patch again tonight, so hoping I will soon have a period otherwise I'm kind of out of sync.
Still haven't seen the doctor. I've tried 3 times to make an appointment but told to come back another time and try to make an appointment again. I forgot to try again today because all the rules I have to remember about surgery times are hard to keep in my head as I don't work there, I work somewhere else and have loads of other schedules to remember. I thought my job was contact the surgery and make an appointment but no, that's not working.
It's possible with the sarcasm that my period is on it's way, but I'll stand by what I've said regardless of what patch I'm wearing ;D
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Well it was. Mood improving gradually.
Another thing, I've become a bit phobic of using pessaries ;D sounds daft but I do seem to have ringing in the ears and postural hypotension with them. Whether that would still be the case if my estradiol patch was lowered I don't know. Hopefully see the doctor this week.