Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Mary G on November 25, 2022, 11:58:45 AM
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As some of you may remember, I have been trialling Darstin progesterone gel since July because I can no longer obtain my compounded progesterone direct from the UK now that you have Brexited. It was too complicated and costly for the supplier to send it to Spain and I was having to ask friends to receive and post it to me here.
Therefore, in a quest to save money and avoid the complicated scenario mentioned above, I decided to give Darstin transdermal progesterone gel a shot and I can now report some pleasing results.
I visited my gynaecologist yesterday and had a transvaginal scan which showed no abnormalities and a womb lining measurement of just under 5mm. This is slightly above the 3.3mm I had with the compounded progesterone but it is just about within the safety limit of 5mm which is the cut off level for women on a continuous combined HRT regime although my compounding clinic in London would not accept anything over 4mm.
So although not quite as effective as the compounded progesterone, the gynecologist is happy as long as it stays at 5mm and I don't have any breakthrough bleeding in which case, I will have to take a break, have a bleed and then an immediate scan but hopefully not.
I use 1 pump of Oestrogel and 50mg of Darstin gel every day and just like the 50mg compounded progesterone, I don't have any horrible side effects like I did with 100mg Utrogestan.
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Thank you for reporting back.
That is such wonderful news and I’m so pleased for you. It’s such a difficult journey when we don’t have a typical response to the standard dosing. I really wish there was more research on lower doses of progesterone and that Utrogestan came in lower doses.
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Excellent news Mary. :).
Im interested in the fact your body obviously found 50mg compounded prog stronger than 50mg of the gel you are now buying. Although, obviously not significantly enough to cause issue.
I have trialled both 'over the counter' (online) prog cream and compounded prog cream this year and, for me, I find the compounded much stronger. I don't doubt the prog content is the same - but I believe it's in the way we absorb.
So, I'm happily putting my faith in compounded products - like you point out, BHRT clinics have their own standards and limits and are very strict on scans etc.
Totally understand your brexit predicament - I hope it continues to work for you going forwards xx
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Lisa and Crispy, thank you so much for your kind words.
We definitely need more progesterone products with a 50mg dose.
The compounded products really are very good and of a very high standard and I think Darstin is second best but a very good second best!
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It is wonderful you have found a progesterone that you can get hold of and also has no horrid side effects. I am very happy for you. :)
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Very good news Mary G!
Thank you for reporting back on your trial as it will give some women another option, if as you say, they undertake regular scans and I suppose are on lower dosages of estrogen.
Lovely to hear a good news story for once :-*
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Glad you’ve found something that works and importantly has none of the usual negative side effects MaryG. Can I ask is it messy and do you get any bladder irritation with it?x
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Lovely to get your catch up Mary G.
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Thanks Flossieteacake, Matchlove, Perinowpost and CLKD, it is rare to find a progesterone good news story!
Darstin is not messy and does not affect the bladder because it's transdermal and I apply it to my arms at night. It is the same texture as Oestrogel.
It is probably not suitable for those on high doses of oestrogen because you would need to use a very high dose of progesterone ie something like 8 pumps every day.
So it's really a niche product for post menopause women on a low dose, continuous combined regime who can only tolerate progesterone at lower doses.
I should add that my dosage is probably not 100% accurate.
My Oestrogel (Oestraclin here in Spain) and Darstin come in toothpaste type tubes that are squeezed out on to a measuring slide so I have probably been using slightly over one pump of Oestrogel and a shade under 50mg of Darstin but I have stability so I'm not going to worry too much about being precise.
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Good point MaryG in that it it a good option for post menopausal women on a low dose continuous combined regime.
I’m post and on 30mg transdermal progesterone with on day off a week and very low dose transdermal estrogen.
Bit if a Pooh with the dosing but I don’t think overall it matters too much if you’re a bit out. Even with the pumps to me it always looks like a different amount from day to day.
As you say, it’s all about how you feel.
Mx
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Hi everyone
Just reading this post - I hadn't heard of Darstin which was first mentioned on this forum by someone else in Spain about 10 years ago.
I think most of us are agreed - and have said so for many years, that there should be lower doses of utrogestan (specifically a 50 mg dose) for those on low oestrogen doses, as well as more research and licensing into the safety and efficacy of vaginal methods of delivery.
I looked up Darstin, and I see why I haven't heard of it. It is a very weak gel ( as Mary G says re quantities needed) and designed to be applied to the breasts only to treat breast tenderness. It was first manufactured in 1983 so has been around for a long time.
The data say that when applied to the breasts - 80% of the gel is metabolised by the breasts and 20 % is absrobed systemically.
As far as I can see there is no information nor research on its use in protecting the endometrium.
Your quest to find a suitable alternative progesterone Mary G is highly commendable and your own experience interesting to read, but I would strongly caution against others to try this experiment themselves even if they could get hold of the product - simply because there are no data at all.
The problem with any transdermal progesterone is that it needs to be absorbed systemically and then transported via the bloodstream to the uterus, with all the potential side effects that this involves, if sufficient is to be delivered. Contrast this with vaginal delivery where theoretically a lower dose of progesterone is needed compared with other methods, because it is delivered directly to the womb. Yes there is systemic absoprtion and why we desperately need more research into this - as there are plenty of progesterone products out there used for fertility. We just need the research into lower doses of these formulations.
For example there is Crinone gel - which has been researched for endometrial protection but is 8 x more concentrated ( 90 mg prog/1.125g gel) than Darstin, and is delivered vaginally. The recent BMS paper on progestogens and endometrial protection, from memory quotes research to say that a 45 g dose of Crinone (alternate day dosing?) provided sufficient endometrial protection I think for low/medium oestrogen doses (correct me if I'm wrong here). However again frustratingly - this is off-licence, and probably only prescribed by private specialists ( though there isn't that much written on this forum about experiences of it, so probably not often prescribed) and I can understand why women are trying to find better alternatives.
The difficulty with Crinone gel is that it comes in pre-measured doses delivered by applicator and therefore I imagine very difficult to apply lower doses vaginally in the way it is designed.
The problem is also of course - that private consultation and regular scans are expensive, and beyond the reach of most women so it is doubly frustrating that there doesn't seem to be research going on - no doubt commercial reasons will be cited. Great for those who can afford it and good luck to you...
Re the comments about compounded products - the issue with these is not a blanket ruling that they dont work - it's just that each clinic will produce its own product ( so I understand) in its own way and that these individual products are not produced to the same standard, will vary, and have not been tested for their efficacy in protecting the endometrium - so women using these clinics not only have to pay the very high cost of using them, but also the ongoing monitoring that is essential in ensuring the womb is protected. It is all explained very clearly here: https://thebms.org.uk/publications/consensus-statements/bioidentical-hrt/
We are all on the same journey - to better health and well-being now and on into our older age.
Glad you are feeling well Mary G and will be interesting to read how the situation develops for you personally in terms of the endometrium, as time progresses.
Hurdity x
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I would just add that there are also us in peri menopause who, have adequate estrogen, but progesterone has plummeted - making us symptomatic.
We don't need to be concerned with endometrium protection, as, we're not adding in Estrogen. So experiences on new progesterone products are always welcome.
As I mentioned earlier, I've tried many progesterones, including, most recently, utrogestan (wow. What a massive hit). I don't need the levels in utrogestan (or, I certainly can't take progesterone in such a big hit) but other options are welcome.
Hurdity - I dont think each clinic makes their own compounded products - most clinics tend to use one of the few compounding pharmacies - so there is good consistency. I can only speak from experience of using their products - they are good. But yes, they are expensive.
Is darstin only available in Spain Mary, do you know? X
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Crispy, that's a very interesting point about women in perimenopause with adequate oestrogen and tanking progesterone (that is what kick started my silent migraines) and I think Darstin could be helpful.
The translation is iffy but this explains things in more detail:
https://pharmaonline.tv/en/product_info.php?info=p112_darstin-10mg---g-gel-progesterone.html
As you can see, just like Utrogestan, Darstin in not designed for HRT use as such but if the progesterone did not reach the uterus, my womb lining would be at a very dangerous level ie over 5mm and I would very definitely have had breakthrough bleeding by now. The important thing is I have found it works with zero side effects but obviously I can't guarantee it would be the same for everyone.
I agree that compounded hormones are excellent and I think most UK compounding clinics use the same specialist pharmacy in London. They are always developing new products and if they can formulate a Darstin type gel it would be great because I find it absorbs more easily than cream.
Unfortunately I don't think Darstin is available outside Spain but you might be able to buy it online. I pay €11.86 per tube.
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Would anyone apply hormone treatment to the breasts :-\
How's the weather Mary G?
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Yes CLKD, it does seem strange to apply hormones to the breast but I suppose it's only for one specific breast condition. I always apply it to my arms.
Weather has been very good but a bit windy today!
Everyone - re 50mg progesterone dose, there is always the option of vaginal Cyclogist which is a wax pessary that can easily be cut into 50mg doses.
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Just to add, I received my latest blood test results back today and the Darstin is delivering a progesterone blood level of 4.57 ng/mL (14.53 nmol?). No idea how that compares with other products. Oestrogen was 77 pg/mL which is about 282 pmol.
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That’s interesting MaryG, progesterone is so difficult to reliably measure, especially in serum, so it’s difficult to know.
Have you ever had it tested in saliva, urine or bloodspot by any chance?
M x
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Marchlove, my progesterone levels fluctuated between 5 and 10 ng/mL with the lozenges and the drops so I suppose this level is OK. My base level when not using HRT is about 0.79.
I have only ever had conventional blood tests, never saliva or any other type of test.
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It’s how you feel MaryG which I think you strive to be in tune with.
A base line measurement comparison must be something worth going by, for want of any additional but unfortunately non existent research.
It’s interesting that it’s slightly lower than other forms of delivery, but it’s difficult to read what significance that may have.
Oh a quick aside, at what stage did you get the baseline done, was it before you went on hrt or after you’d stopped it for a certain amount of time? Also, how many years post meno were you?
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Marchlove, it was last year and I literally stopped everything to get a baseline hormone reading. I'm 61 and about 15 years post menopause. Back in 2007 when I was first post menopause, my progesterone level was 0.50.
I feel fine on my current dose of progesterone and the womb lining is just below the 5mm danger line so I suppose that means it's working!
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Sounds good to me MaryG!
My womb lining is about the same, so scans are our companion’s with our particular hrt regime’s.
x
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This is an update almost one year later.
I had a transvaginal scan a couple of days ago and my womb lining measurement was 3.8mm.
I was almost surprised when the gynaecologist inserted the dreaded probe and said that's very good, no problems at all. I was expecting to be nudging 5mm. Darstin is not supposed to work on the endometrium!
I have now been using 1 pump of Oestrogel, testosterone and 50mg Darstin progesterone gel every day since July 2022 and although it's not as strong as the excellent compounded progesterone I was using before, it is still very good with zero side effects and obviously good womb lining protection with a measurement like that.
Several months ago I got a bit slap happy with the Oestrogel and had a slight bleed but other than that, nothing to report.
Last week I decided to start interspersing Cyclogest @ 50mg twice weekly but that is far too recent to make any difference to the womb lining. I have to say I don't like Cyclogest as much as Darstin but I have found it far more tolerable than Utrogestan.
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Hi and congrats Mary G and glad you have found something that works and I think it’s really important to let us know all different options with menopause and peri. What has led the majority of us to this forum is that because we are having issues and the standard regime doesn’t work for us.
I am seeing a consultant and am in peri and she has mentioned both cyclogest cut into half or crinone gel as our next options so yes private meno consultants can prescribe and seem happy to so worth a discussion.
As hurdity says I’m unsure with the crinone whether smaller doses can be taken or not.
I’ll report back if I find any success!
And yes Crispy compounded products tend to be made at maybe One of 3 different compounding pharmacies in the uk so there isn’t much variation.
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Thanks Scampi. For women who struggle with the progesterone component of HRT, I think the key takeaway is flexibility and openness to different types/doses of progesterone.
In theory, my regime should not have worked and my womb lining should be dangerously thick but it very obviously has worked. It also proves that not all women need the same high dose of progesterone to get good womb lining clearance. I wonder what the result would have been if I had dosed myself up to the eyeballs with 100mg progesterone every day for the past year?
Dogmatically sticking to the NHS guidelines means many women give up using HRT altogether and then struggle on with debilitating symptoms for years on end. A more flexible approach would avoid this.
It should also be more widely publicised that the Chelsea and Westminster menopause clinic sanction the low dose Jaydess and Kyleena coils for women who are progesterone intolerant or sensitive to high doses of progesterone - with regular scans of course. I think they also ship in the much sought after Duphaston although I might be thinking of one of the private clinics.
In your case, I think you will find Cyclogest more tolerable as long as you use a low dose. I have never tried Crinone but if it's a vaginal gel, you should be able to use a low dose.
Good luck with the appointment and please report back.
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I will do thanks Mary G,
Just a note on Duphaston, another consultant offered me this. It’s only available via one pharmacy in London apparently but was also hideously expensive. So I declined. And I think it would only be available privately as you say.
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Hi Mary,
Thank you for your posts. I’ve struggled with utrogestan and have gone to my GP asking if I might try Cyclogest as an alternative. He checked with the practise pharmacist who said they would contact the menopause clinic, after trying to persuade me to use patches which I had explained I don’t want and anyway fall off.
It has all gone very quiet and I can see I am going to need to be persistent if there is any chance of it happening. In the meantime I’m without HRT and being over 60 don’t want to leave it too long but NHS does not appear to be well equipped for such requests.
I’m curious whether Darstin available without prescription in Spain? Also if you are still using Cyclogest at times and, if so, how you doing with it.
Thanks,
Lesley
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Hi Mary,
I’m curious how things are going with the Cyclogest? I think a regime similar to yours might work well for me.
I’ve never needed to use much oestrogel max 1 pump, and utrogestan knocks me off my feet and seems to do weird things with my emotions.
I stop everything early last year and since have developed tinnitus and feel rubbish much of the time.
I’ve asked my GP if I can try Cyclogest but this seems to have sent them into a bit of a flurry! I think I might end up with a menopause clinic referral.
Last time I was there my uterine lining was ‘thin’ but still came away with the dreaded utrogestan and a stern talking to about it. After having told them I found it difficult to tolerate.
It’s frustrating seeing possibilities that might work and then encountering what seems like endless obstacles to trying them out. Especially as I already feel exhausted and brain fogged much of the time since stopping oestrogen.
I’m also interested how Scampiedoodle got on with crinone. I asked my local pharmacist about it a while ago but was told it’s not available here (uk).
I’m not sure about posting etiquette, so many apologies if I’m stepping all over the rules and doing things i shouldn’t be doing! I don’t really participate in forums and am unsure of what’s ok and what’s not.
Thanks,
Lesley
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Lesley M, I'm sorry to hear about your problems with Utrogestan but it's very common (the most debated subject on here) and a lot of women don't get on well with it. You certainly don't have to be progesterone intolerant to have problems with Utrogestan but fortunately, it's nothing like compounded progesterone, Cyclogest or progesterone gel in my experience.
I'm afraid my Darstin progesterone gel is not available in the UK and Cyclogest also seems to be difficult to get hold of but I don't know why because it's not expensive - it's under €20 per box of 600mg pessaries in Spain. When you consider the pessaries are cut into 50mg doses, it makes them quite economical. It's years since I had a UK prescription so I'm a bit hazy on that but is it £10ish per item?
I find I have excellent womb lining protection with the gel but I added in a 50mg vaginal Cyclogest dose a couple of times a week just for good measure but since my scan, I haven't bothered to do it very often because I don't really need it. I found I could tolerate 50mg Cyclogest well and without any side effects which is encouraging but overall, I prefer Darstin and it's more user friendly.
I buy Cyclogest, Darstin and Oestraclin (the Spanish equivalent of Oestrogel) at the pharmacy without a prescription but some pharmacies can be a bit sniffy about selling it without a prescription although it's not a controlled medication like antibiotics. On the rare occasions I have used a prescription here for non HRT medication, they always hand the prescription back to me anyway so I can reuse it.
One further thought... bespoke progesterone from the compounding pharmacies in the UK are excellent with zero side effects and again, I always had good womb lining clearance/womb lining protection with these products despite all the dire warnings. That said, it's expensive which is a major drawback for many people.
So there are quite a few options available.
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Hi Mary,
I only just found your reply and really appreciate it.
I finally got hold of Cyclogest and am tolerating it better but still get tired with it.
I had a consultation with a menopause consultant who suggested an estring which I’m trying but am not sure about. Time will tell.
Thank again for your reply.
Lesley