Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Tribbins on September 02, 2023, 10:02:03 AM
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Is anyone using Cyclogest? Does it get any better? I started last night, on a small amount just to try it out. I felt really anxious after the Utrogestan experience. I used about an eighth of a 200 mcg pessary. Struggled to sleep, woke about 3am with a weird vibrating feeling, unsettled. Went back to sleep and woke again at 9am! Now can't shake the fuzzy, woozy head off. Thankfully I don't have to drive anywhere today, as I wouldn't be able to do so safely.
I hope this is just 'start-up' side-effects - I had to stop Utrogestan after a few days as it absolutely floored me. I think half a Cyclogest will leave me unconscious! Like a lot of others on here, I feel like throwing in the HRT towel. :(
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Hi Tribbins
I use cyclogest, I used to use utrogestan vaginally however at night vaginally it left me wired and unable to sleep and during the day it gave me horrific feelings of dread.
I switched to cyclogest and I use it rectally in the mornings, I use about 170mg as I cut a bit off the end and I actually feel fine on it. However we all react differently to micronised progesterone.
Have you considered other progesterone alternatives?
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Hi discogirl - thanks for sharing your experience, and I'm glad Cyclogest is working for you. Did you find it ok from day 1 or did you have any troublesome side-effects? Interesting that you use it in the morning - do you still get the wired feeling? I sort of felt like that for about half the night before the sedation set in. Used such a tiny amount also. Does using it rectally take away any of the side-effects?
This is only the second type of progesterone I've tried so far, it's hard work being able to speak to a GP. I think the next attempt (if I can't tolerate Cyclogest at all) will be a conti patch, but I'm not feeling great on oestrogen only just yet.
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Hi Tribbins
I'm not an expert in any of this so hopefully some more ladies who are on cyclogest or who have used it will be along to help out but from my own experience, I feel using it rectally is better for me, I certainly don't get feelings of dread from it like the utrogestan. I don't know why as they are both just micronised progesterone. I don't get a wired feeling from it as I'm using it in the mornings, and as I use it rectally I know once it's up, it's up if you get my meaning (sorry tmi!!)
I feel for me, getting the amount correct is vital. I was taking the full 200mg and I felt that was too much so I cut a bit off the end and I'm getting about 170mg.
I hope you get sorted though and I know where you're coming from regarding throwing the towel in I've felt like that on many occasions
I've never used a conti patch but there's a lot of ladies who seem to use it successfully on here x
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Tribbins, that is a very severe reaction to a very low dose (25mg ish?) of progesterone. When did you last take Utrogestan? If it was in the last few days it could be a hangover from that - I used to have side effects for a week after the final Utro dose.
What type/dose of oestrogen are you taking?
I have got a box of Cyclogest but I have yet to try it. I would definitely persevere with it for a little longer because it is better tolerated than Utrogestan and I would imagine that is why the Newson clinic often prescribe it.
Products can have the same ingredients but people will react differently to each product. Take Oestrogel for example. A lot of women on here find their symptoms return even though it is supposed to be identical.
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I’ve never been able to tolerate progesterone, so was relieved when I got on well with cyclogest. Like discogirl, I take it rectally, but I take it early evening. I find around 8pm is better, as any later than that, and I’m wired around 3am. If I take it at 8pm, I’m drowsy at 10pm and then sleep through without feeling groggy in the morning. If I take it at 10pm, I don’t sleep well and am drowsy the next day - which makes me tearful and anxious.
That said, by day 13 of it, I’m done - tearful, out of sorts, feelings of dread. I sometimes can’t do the full 14 days.
I’m kind of dreading being prescribed utrogestan next time as I’m liking cyclogest better than anything else I’ve tried.
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Well, aside from the dizzy woozy head, which eased off during the day, I managed to get a lot done out in the garden - felt really good, energised and so happy :-) so hoping I can get on with Cyclogest in the long-term.
discogirl - I have taken your lead and used the same amount as I did last night but rectally. It was a bit difficult as it was melting onto my finger and didn't want to let go - so I don't think it went as far as maybe it should, sorry totally TMI, maybe some sort of lube would be in order.
Mary G - I only tried utrogestan for 3 days in May - I've only been on evorel 25 since then, it was not a good experience. It has taken me all this time to work up to a 25 patch and a half, so 37mcg. However, this seems to be having some effect on migraines, they're much less frequent and when I do have one it only lasts a day and isn't disabling. I'm annoyingly sensitive to medications and hormones, struggled with severe PMS and can remember looking forward to the menopause so much. If only I'd known..! I'm going to keep going with the Cyclogest, if I can manage a small amount it's better than nothing, and maybe I can have scans.
WishIdknownsooner - your routine sounds like a good one, which I'm going to copy - I woke up at about 3am feeling really odd and unsettled but really struggled to get up at 9am. Really pleased you are able to get on with Cyclogest. I found Utrogestan horrendous. Why do you think you might get prescribed it next? I was prescribed Lutigest first by my GP but it wasn't stocked anywhere so they swapped the prescription to Cyclogest.
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Well, aside from the dizzy woozy head, which eased off during the day, I managed to get a lot done out in the garden - felt really good, energised and so happy :-) so hoping I can get on with Cyclogest in the long-term.
discogirl - I have taken your lead and used the same amount as I did last night but rectally. It was a bit difficult as it was melting onto my finger and didn't want to let go - so I don't think it went as far as maybe it should, sorry totally TMI, maybe some sort of lube would be in order.
Mary G - I only tried utrogestan for 3 days in May - I've only been on evorel 25 since then, it was not a good experience. It has taken me all this time to work up to a 25 patch and a half, so 37mcg. However, this seems to be having some effect on migraines, they're much less frequent and when I do have one it only lasts a day and isn't disabling. I'm annoyingly sensitive to medications and hormones, struggled with severe PMS and can remember looking forward to the menopause so much. If only I'd known..! I'm going to keep going with the Cyclogest, if I can manage a small amount it's better than nothing, and maybe I can have scans.
WishIdknownsooner - your routine sounds like a good one, which I'm going to copy - I woke up at about 3am feeling really odd and unsettled but really struggled to get up at 9am. Really pleased you are able to get on with Cyclogest. I found Utrogestan horrendous. Why do you think you might get prescribed it next? I was prescribed Lutigest first by my GP but it wasn't stocked anywhere so they swapped the prescription to Cyclogest.
Hi Tribbins
Another lady on here put me onto a water based lubricant which I use called 'Yes' you can buy it online from amazon. I sort of use it to lubricate the area if you catch my drift. Some women may not like this method, however if it works I can put up with a minute of discomfort whilst I'm inserting it.
Once the pessary is inserted it dissolves and then obviously enters the blood stream.
Please let me know how you get on with it xxx
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Hi discogirl
Thank you for this info. I don't think using it rectally worked out too well for me last night - I'm not sure what happened as woke about 1.15am feeling panicky, went back to sleep and then woke about 6.30, so feeling very tired, ears ringing and like I have severe PMS today - maybe I just didn't manage to insert enough, maybe it just doesn't suit me. It's disheartening as felt positive yesterday. xx
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Hi Tribbins
I'm sorry the cyclogest didn't seem to work for you.
I think the hard thing is, there are a number of factors at play, whereabouts in menopause you are and also with hormones it's a very individual thing isn't it. What maybe right for me may not be right for another.
I'm not very experienced with menopause or hrt but I know there are other progesterones you could try that might suit you better xxx
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Thank you discogirl, I really appreciate your support. I had a better experience last night - used a quarter of the Cyclogest vaginally at about 8.30pm, went to bed a couple of hours later having spent the evening laying down on the sofa and got an ok night's sleep. Woke up and felt a bit nauseous and woozy but less woozy than the previous two days, although I had to drive to the vets which was a bit daunting as I didn't feel like I was fully present...! However, definitely in a better frame of mind - my husband said that my behaviour yesterday reminded him of how I used to be (used to get pretty extreme PMS). As you said previously, dosage is so important. I'm supposed to take half a 200mcg every other day, so taking 50mcg last night may be ok, if the morning 'hangover' improves. xx
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Hi Tribbins
I agree getting the dosage right is half the battle.
I think the ratio of estrogen to progesterone is important as well.
I hope you continue to improve xx
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Hi Tribbins
So sorry to hear about your experiences with progesterone and I sympathise - if that is the cause at such a low dose.
However this amount, especially if you try to insert a small fragment rectally, is really not going to be sufficient to protect your uterus unfortunately - the pessaries have been designed to be inserted as whole though I gather some women are cutting the in half. When inserted rectally I think far less will get to the uterus than when used vaginally though I haven't seen data on this ( maybe there were studies years ago?) but especially as it is not licensed for HRT.
Are you being monitored medically re the approx 50 mg alternate days to ensure your womb lining is OK?
Although I am a big fan of bioidentical HRT and pretty much have only ever used estradiol and progesterone, in your position, if you are ultra sensitive to progesterone, maybe a synthetic progestogen like Provera may be prefereble - because much lower doses need to be taken to protect the womb. As discogirl says the balance is important - this is because of the need to protect the womb. The more oestrogen that is used, the more progestogen is needed.
Wishing you all the best in your journey to find the right solution.
Hurdity x
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Thanks for your response Hurdity - I've used 50mcg Cyclogest vaginally for the past two days. I was advised to use half a 200mcg every other night, but opted to use a quarter every night as I don't want to trigger migraines. I'm currently using 37mcg Evorel patches so not exactly a high oestrogen dose, but it seems to have had an effect on the very frequent headaches/migraines that I was having. Although not as bad as Utrogestan, I'm not feeling great with Cyclogest, just dopey and a bit irritable all day which I hope will ease off.
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Tribbins, I've been using 50mg progesterone every day with one pump of Oestrogel since 2018 and it's worked very well. I was unable to tolerate Utrogestan (100mg in one hit is too high for me) but I don't even notice 50mg progesterone so for me it's the right dose and it keeps the womb lining thin too.
If you suffer with migraines you need to keep your hormone levels as stable as possible, avoid cycles/bleeds and you may need to add testosterone too.
What type of migraines do you have? With or without aura?
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Hi Mary
What progesterone do you use? I have migraines with aura mainly, glittery lights/lots of yawning/neck pain. I think they have been caused by fluctuating/dropping oestrogen. I had to stop work for two years when they were at their worst, during late peri. Up until I started HRT (8 years post-meno) they were a bit more manageable - one 48 hour migraine a week, with several headaches in between, but no more vomiting or vertigo. I feel like I lost 10 years of my life though. I read somewhere that if migraine improves with pregnancy then it usually improves post-meno. If it gets worse in pregnancy then it is worse post-meno. Mine were worse from second trimester, and also the start of ocular migraine which is apparently caused by high oestrogen/spikes.
I read your posts, where you advocate for a low and consistent dose of HRT to manage migraine. Mine definitely improved when I got to 37mcg Evorel, but unfortunately I was on unopposed oestrogen for over 3 months so had to start with some progesterone. I tried Utrogestan but that was just awful, urgh! So Cyclogest is just about bearable but I feel sedated, a bit less today so hopefully I will be able to tolerate it. xx
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Hi Tribbins, I hope you’re continuing to manage.
In answer to your question, I was worried I was going to be put on utrogestan once it came back in stock. Happily, newsons have kept me on cyclogest as I am having few side effects compared to what I’ve had in the past. She said utrogestan often gives more side effects than cyclogest.
She also recommended a trial of testosterone to clear any residual brain fog, which is definitely present for me when I’m on my cyclogest part of my cycle. I know you’re post meno and need to take progesterone daily.
Hurdity - I’m not medical by any means, but by working with nurses constantly, I’ve picked up bits of info (a little knowledge can be a dangerous thing though I admit lol). Medications taken rectally and vaginally enter the bloodstream very quickly. Hence buccal midazolam given rectally for seizures. To my mind, the vaginal wall would be similar to the rectal wall, so that’s why I’m comfortable to risk it. So if it gets absorbed into the blood stream, rather than being metabolised by the liver, more would reach the uterus than utrogestan taken orally. I’d love your take on it. I think I’m trying to say that whatever the route, oral, vaginal or rectal, the progesterone works systemically, not locally, but by bypassing the stomach and liver, it reaches the blood faster. Sorry for the waffle lol. I’d love some proper evidence though.
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Tribbins, it sounds like you suffer with similar migraines as me and unfortunately, unlike menstrual migraines, they do not improve post menopause and can be difficult to treat. Mine are silent migraines which consist of 30 minutes visual disturbance but no headache.
Once post menopause, you need to aim for a steady, continuous combined HRT regime but at the same time, it's very important to (a) maintain a reasonable base level of oestrogen (in my case that is 300 pmol) and (b) not overdose on progesterone. Testosterone increases serotonin levels so it's worth adding that to your regime if you can.
For perimenopause women with migraine aura, continuous HRT is not possible so a higher dose of oestrogen and progesterone is needed on a cyclical basis.
I used to use 50mg progesterone lozenges which were excellent but because of Brexit, the pharmacy can no longer post to Spain so now I use 50mg transdermal progesterone gel which I buy in Spain. I also use just over one pump of Oestrogel and testosterone every day.
More recently, I found that hormone manipulation was not quite enough to keep the migraines at bay so now I have added a low dose of amitriptyline (an AD) which is a migraine preventative at a low dose and it also increases much needed serotonin levels.
Migraine auras are caused by cortical spreading depression which is caused by low serotonin which in turn is caused by low oestrogen. Obviously this means that I'm on HRT for life otherwise I would be plagued with migraine auras forever.
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Hurdity - I’m not medical by any means, but by working with nurses constantly, I’ve picked up bits of info (a little knowledge can be a dangerous thing though I admit lol). Medications taken rectally and vaginally enter the bloodstream very quickly. Hence buccal midazolam given rectally for seizures. To my mind, the vaginal wall would be similar to the rectal wall, so that’s why I’m comfortable to risk it. So if it gets absorbed into the blood stream, rather than being metabolised by the liver, more would reach the uterus than utrogestan taken orally. I’d love your take on it. I think I’m trying to say that whatever the route, oral, vaginal or rectal, the progesterone works systemically, not locally, but by bypassing the stomach and liver, it reaches the blood faster. Sorry for the waffle lol. I’d love some proper evidence though.
Hi yes - both rectally and vaginally anything taken this way avoids what is known as the "liver first pass effect" and goes (and is absorbed) straight into the bloodstream without the body having to deal with large quantities of the metabolic by products, some of which cause even more negative side effects.
However taken vaginally in addition to absorption into the bloodstream , the progesterone is transported through the cervix directly to the uterus - known as the "uterus first pass effect" or something similar - so it does work locally on the uterus (as well as systemically). Some limited research has shown that therefore a lower dose of progesterone when used vaginally can be used by comparison with oral intake. However this research has been translated by some specialists to mean that half the vaginal dose can always be used, irrespective of the oestrogen dose when in reality the mounr of progesterone needed is broadly dependent on the oestrogen dose ie more oestrogen used = more progesterone needed to protect the womb. The BMS has advised that this should not be universally prescribed and that when used vaginally the same dose as oral intake should be prescribed. This does not alter the fact that more gets to the uterus though, so under medical supervision, for women who are sensitive to the effects of systemic absorption can be prescribed a lower dose when used vaginally.
This is a long-winded way of saying for progesterone intolerant women, vaginal use may be preferable because lower doses can potentially be used, but only under medical supervision with regular scans.
Does this help or is it more confusing?
Hurdity x
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Thanks Hurdity. It does make sense and it’s interesting stuff. God help me if they want to universally up the progesterone dose as I’m on day 8 of cyclogest and am already counting down the days until this month’s cycle is over with! Tears everywhere… (Although I still prefer it to any other synthetic progesterone I’ve had in my life!)
I’m only on one pump of oestrogel, so I’ll continue to risk the back passage for a while, but will bear your comments in mind if I have to increase the dose x
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Is anyone using Cyclogest? Does it get any better? I started last night, on a small amount just to try it out. I felt really anxious after the Utrogestan experience. I used about an eighth of a 200 mcg pessary. Struggled to sleep, woke about 3am with a weird vibrating feeling, unsettled. Went back to sleep and woke again at 9am! Now can't shake the fuzzy, woozy head off. Thankfully I don't have to drive anywhere today, as I wouldn't be able to do so safely.
I hope this is just 'start-up' side-effects - I had to stop Utrogestan after a few days as it absolutely floored me. I think half a Cyclogest will leave me unconscious! Like a lot of others on here, I feel like throwing in the HRT towel. :(
Hi Tribbins - that dose of Cyclogest is extremely low even for a low dose of oestrogen. I hope the initial experience you had started to ease a little since first posting?
I moved from Utrogestan to Cyclogest some weeks ago and I cut the tablets to give me approximately 75 - 80mg daily via rectal route. These pessaries are designed to be taken vaginally OR rectally and both routes are of equal effectiveness. Any spaced out feeling I got from taking them daily eased within a week and from lowering the dose, as I am only taking the equivalent of 2 pumps oestrogen atm. Hope you are settling on them - as with all regimes, it’s worth sticking it out in the interim to give your body time to adjust x
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Hi Furyan
I was taking 50mcg daily, now on 100mcg on alternate days. Last night was the first night where I didn't have any freaky dreams, still a little bit tired during the day but seems to be working out fine so far, fingers crossed. Managed a 5 mile fell walk today and felt good. I felt pretty scared to start off with having had such a crappy experience with Utrogestan, hence the low and anxious start! x
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Hi Furyan
I was taking 50mcg daily, now on 100mcg on alternate days. Last night was the first night where I didn't have any freaky dreams, still a little bit tired during the day but seems to be working out fine so far, fingers crossed. Managed a 5 mile fell walk today and felt good. I felt pretty scared to start off with having had such a crappy experience with Utrogestan, hence the low and anxious start! x
Tribbins, thanks for the update which is sounding VERY hopeful (5 miles? Dammmmmm..!). So glad you waded it out and long may it continue x
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Tribbins, it sounds like you suffer with similar migraines as me and unfortunately, unlike menstrual migraines, they do not improve post menopause and can be difficult to treat. Mine are silent migraines which consist of 30 minutes visual disturbance but no headache.
Once post menopause, you need to aim for a steady, continuous combined HRT regime but at the same time, it's very important to (a) maintain a reasonable base level of oestrogen (in my case that is 300 pmol) and (b) not overdose on progesterone. Testosterone increases serotonin levels so it's worth adding that to your regime if you can.
For perimenopause women with migraine aura, continuous HRT is not possible so a higher dose of oestrogen and progesterone is needed on a cyclical basis.
I used to use 50mg progesterone lozenges which were excellent but because of Brexit, the pharmacy can no longer post to Spain so now I use 50mg transdermal progesterone gel which I buy in Spain. I also use just over one pump of Oestrogel and testosterone every day.
More recently, I found that hormone manipulation was not quite enough to keep the migraines at bay so now I have added a low dose of amitriptyline (an AD) which is a migraine preventative at a low dose and it also increases much needed serotonin levels.
Migraine auras are caused by cortical spreading depression which is caused by low serotonin which in turn is caused by low oestrogen. Obviously this means that I'm on HRT for life otherwise I would be plagued with migraine auras forever.
Hi MaryG ,
do they have transdermal progesterone in spain? I know that some countries have more progersterone options .
PMxx
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pepperminty, yes, branded progesterone gel (Darstin) is available in Spain but it's only really suitable for women on a lowish dose of oestrogen. I use it (about 50mg every day) with just over one pump of Oestrogel and it works very well. To give you an idea on the ratio, my blood levels of oestrogen are about 300 pmol.
If you use a higher dose of oestrogen and you want to use a transdermal form of progesterone, you would need to get it from a compounding pharmacy like the Specialist Pharmacy in London. They are able to produce bespoke progesterone creams that are stronger than the gel that I buy off the shelf.
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pepperminty, yes, branded progesterone gel (Darstin) is available in Spain but it's only really suitable for women on a lowish dose of oestrogen. I use it (about 50mg every day) with just over one pump of Oestrogel and it works very well. To give you an idea on the ratio, my blood levels of oestrogen are about 300 pmol.
If you use a higher dose of oestrogen and you want to use a transdermal form of progesterone, you would need to get it from a compounding pharmacy like the Specialist Pharmacy in London. They are able to produce bespoke progesterone creams that are stronger than the gel that I buy off the shelf.
Thanks for letting me know. I do wish instead of coming up with more types of estrogen they would provide a better selection of progesterones for us all in the uk. If there are ones out there already why dont they make them available here.
PMXX
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pepperminty, yes, branded progesterone gel (Darstin) is available in Spain but it's only really suitable for women on a lowish dose of oestrogen. I use it (about 50mg every day) with just over one pump of Oestrogel and it works very well. To give you an idea on the ratio, my blood levels of oestrogen are about 300 pmol.
If you use a higher dose of oestrogen and you want to use a transdermal form of progesterone, you would need to get it from a compounding pharmacy like the Specialist Pharmacy in London. They are able to produce bespoke progesterone creams that are stronger than the gel that I buy off the shelf.
Thanks for letting me know. I do wish instead of coming up with more types of estrogen they would provide a better selection of progesterones for us all in the uk. If there are ones out there already why dont they make them available here.
PMXX
I agree pepperminty. It seems the will is not there and the NHS really want women to stick to their strict progesterone guidelines because they don't want to (or can't afford to) give women routine uterine scans. This means that many women are overloaded with progesterone they don't need because the NHS have to cover themselves by working on worst case scenario plus some. Even if you are not progesterone intolerant per se, the type of quantities you are expected to take are difficult to tolerate and have a drag effect on the uplifting benefits of oestrogen which is counterproductive.
Manufacturers should start by producing a 50mg dose of Utrogestan but there are other types of progesterone out there that are better tolerated like bespoke lozenges and creams that could be mass produced - I know they work well because I have used them, backed up with scans of course. A stronger version of my progesterone gel would be good too.
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Re Darstin progesterone gel:
I looked up and posted about this last year on this thread: https://www.menopausematters.co.uk/forum/index.php/topic,64085.msg887322.html#msg887322
Just to recap on and requote some of the points I made then:
It is a very weak gel 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 absorbed systemically.
As far as I can see there is no information nor research on its use in protecting the endometrium.
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 to protect the endometrium. 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 absorption 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.
There is already a gel – Crinone gel which is delivered vaginally but is 8 x more concentrated ( 90 mg prog/1.125g gel) than Darstin,, but not licensed for endometrial protection though has been researched but 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.
Hurdity x
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Re Darstin progesterone gel:
I looked up and posted about this last year on this thread: https://www.menopausematters.co.uk/forum/index.php/topic,64085.msg887322.html#msg887322
Just to recap on and requote some of the points I made then:
It is a very weak gel 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 absorbed systemically.
As far as I can see there is no information nor research on its use in protecting the endometrium.
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 to protect the endometrium. 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 absorption 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.
There is already a gel – Crinone gel which is delivered vaginally but is 8 x more concentrated ( 90 mg prog/1.125g gel) than Darstin,, but not licensed for endometrial protection though has been researched but 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.
Hurdity x
Yes more research and there are quite a few progesterones out there , including dygesterone , so why oh why don't they get thier act together and license them in the UK for HRT.
PMxx
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pepperminty, yes, branded progesterone gel (Darstin) is available in Spain but it's only really suitable for women on a lowish dose of oestrogen. I use it (about 50mg every day) with just over one pump of Oestrogel and it works very well. To give you an idea on the ratio, my blood levels of oestrogen are about 300 pmol.
If you use a higher dose of oestrogen and you want to use a transdermal form of progesterone, you would need to get it from a compounding pharmacy like the Specialist Pharmacy in London. They are able to produce bespoke progesterone creams that are stronger than the gel that I buy off the shelf.
Thanks for letting me know. I do wish instead of coming up with more types of estrogen they would provide a better selection of progesterones for us all in the uk. If there are ones out there already why dont they make them available here.
PMXX
I agree pepperminty. It seems the will is not there and the NHS really want women to stick to their strict progesterone guidelines because they don't want to (or can't afford to) give women routine uterine scans. This means that many women are overloaded with progesterone they don't need because the NHS have to cover themselves by working on worst case scenario plus some. Even if you are not progesterone intolerant per se, the type of quantities you are expected to take are difficult to tolerate and have a drag effect on the uplifting benefits of oestrogen which is counterproductive.
Manufacturers should start by producing a 50mg dose of Utrogestan but there are other types of progesterone out there that are better tolerated like bespoke lozenges and creams that could be mass produced - I know they work well because I have used them, backed up with scans of course. A stronger version of my progesterone gel would be good too.
What a great summary of the issue that I have with the prescribed progesterone! I’m not progesterone intolerant at all yet I find the daily doses recommended for HRT intolerable: I simply cannot take 100mg daily let alone 200mg for the recommended periods.
Which begs the question (for me) whether this dose truly mimics what happened in nature as a menstruating woman. Clearly, whatever amount I made naturally back then was enough as I never had uterine or mood issues. Interestingly, a number of sources I’ve read suggest that (healthy) menstruating women naturally produce around 20 - 30mg of progesterone during the luteal phase, which seems a lot less than prescribed HRT (that’s off the top of my memory though, google it to clarify). If true, it might add weight to your view that the NHS pushes doses that are way over what many women can tolerate. There seems to be a pattern as to the side effects reported among women who feel they are taking these excessive amounts.
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Furyan, I just had a look and yes, 20-30 nmol is the level of progesterone produced by women in the luteal phase which is much less than 200mg Utrogestan.
For post menopause women on a continuous combined HRT regime, 50mg of progesterone every day should be enough for the majority of women (it definitely is for me) and at that dose, it's unlikely to cause side effects unless someone is progesterone intolerant.
That is why the Newson clinic prescribe 100mg Utrogestan every other day. It is the closest they can get to the magical 50 mg every day and from years of experience, they know it's ample for most women.
Less dogma and more flexibility is needed.
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Furyan, I just had a look and yes, 20-30 nmol is the level of progesterone produced by women in the luteal phase which is much less than 200mg Utrogestan.
For post menopause women on a continuous combined HRT regime, 50mg of progesterone every day should be enough for the majority of women (it definitely is for me) and at that dose, it's unlikely to cause side effects unless someone is progesterone intolerant.
That is why the Newson clinic prescribe 100mg Utrogestan every other day. It is the closest they can get to the magical 50 mg every day and from years of experience, they know it's ample for most women.
Less dogma and more flexibility is needed.
“Less dogma and more flexibility is needed” - absolutely agree with this Mary. For HRT and a great deal more health needs. Going through another turning point with my thyroid and it’s incredibly frustrating trying to have an informed conversation with medical professionals who stick rigidly to dogmatic procedures rather than seeing the broader picture. Not good that some professionals are heralded as gatekeepers to our health and well-being. For chronic health needs, this can end up doing more harm to the patient than good - going against the very oath they swear to :(
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Not just flexibility, but also the acknowledgement that the patient is the expert when it comes to their own body - how we feel, what side-effects we get, it's all subjective. Yet we are obliged to hand all our trust and power over to healthcare professionals, and hope we get one that respects that.
To answer my own question, no it hasn't got easier - I've struggled with Cyclogest, even 50mcg daily is too much after 5 days due to headaches, blurred vision, mood changes and fatigue. 100 mcg every other day results in feeling flat, detached, pointless on the 'second' day. Either way it undoes most of the positives that the oestrogen achieves. I've not even spoken to a GP for 3 months, they sent me a review date for next March. I was told by the receptionist when I asked for the Cyclogest prescription (I had to ask - they were quite ok to leave me on oestrogen only until I pointed out after 4 months that this wasn't ok) that if I didn't get on with Cyclogest then I had to stop the lot. Messages relayed by a GP via a receptionist.
I just feel drained by the whole experience, probably mostly drained by the progesterone actually. Having spent 40-odd years dreading periods and their onset, and saying 'roll on menopause' I've tried my best to get through it without HRT, but that resulted in me having to stop work for two years due to chronic migraine, and subsequently only being able to work limited hours due to absolute lack of energy as well. Oestrogen alone was good, migraines have lessened to such a degree and I started to get some energy back but at a cost of losing hair at quite a rate and then having to take progesterone which has just negated any positives. It even stops me being able to exercise, I just feel fatigued and breathless. I can't risk feeling so low, as I start thinking 'what's the point?' so I'm cutting down the Evorel and going to see if I can at least tolerate 50mcg Cyclogest every other day until I can speak to a GP.
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Tribbins, were you severely progesterone intolerant pre menopausal? This really matters because if you were, I'm afraid the only real solution is a hysterectomy. If not, you need to review your progesterone type and very importantly, dose.
From what you have said, your migraines are caused by low seratonin levels which are caused by low oestrogen levels. I didn't really find 50mcg patches very effective and if you reduce your dose, I think it will make your migraines worse. You need get a good dose of oestrogen into your system and you need to aim for a blood level of about 300 pmol to have any real effect on seratonin levels and to counter the ill effects of progesterone. If you just bump along on a low dose of oestrogen, it's not going to do anything for you. The fact that your migraines improved when you started taking oestrogen only is a strong indicator and your doctor should have picked up on that.
Obviously I'm not a medic but I'm convinced you need more oestrogen and probably a low dose antidepressant to get your seratonin levels up. This should make the 50mg progesterone dose more tolerable.
Have you tried Oestrogel?
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Mary G, I just don't know. I used to feel poorly before a period, much the same as I've felt on Cyclogest (headache, fatigue etc) then terrible heavy and painful periods I felt pretty good when I was pregnant aside from fatigue and a few nasty migraines in the later months. In the couple of years leading up to menopause I was going bonkers before a period, and was prescribed Fluoxetine, which only made me feel worse. Like a lot of women on here, I'm really sensitive to medications. I took a combined contraceptive in my twenties, and coincidentally also had a lot of issues then with mental health, and headaches. Migraines only really got out of control around 9 years ago, coming up to meno and then afterwards. I found that they have decreased drastically with one and a half 25mcg Evorel patches, I had two in the past three months, as opposed to every week. I was increasing oestrogen but stopped as that would mean increasing Cyclogest as well and I just can't face it.
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Tribbins, I know how you feel, this stuff can really wear you down and in my case, it's been 19 years since the very start of the menopause.
It sounds like you could be progesterone intolerant but at the same time, you need decent levels of oestrogen to feel good and keep the migraines away. Unfortunately, if you suffer with the same type of migraine as me, they do not improve post menopause and often get worse. I'm not progesterone intolerant but I can't tolerate high or unstable doses and I also need a steady flow of oestrogen. It's not easy though.
Why don't you provoke a bleed and then have a good long run of oestrogen only and see how it goes for a while?
You could try buying some 5-HTP supplements to try and raise your seratonin levels naturally and see if that helps.
Ultimately, I think I would be inclined to book a consultation with a menopause specialist who also has a good understanding of hormonal migraines.