Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Anonymous1 on February 09, 2024, 07:22:02 PM
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Hi,
I recently started HRT Sequential (Evorel 50) and Utrogestan 100mg x 2/day. I noticed a signficant improvement in my mood and motivation on Everel 50. However, I experienced some unpleasant side effects on Utrogestan; including headaches, depression, anxiety, feeling groggy/unwell and tiredness.
I changed to taking Utrogestan vaginally 100mg/day x 1/day. The side effects were a bit less but still bad.
I have chronic fatigue due to long term complex mental health difficulties, chronic stress and peri/menopause. I was not able to tolerate the further reduction in my mood on Utrogestan and stopped the HRT after the first month. I feel better without it than when I was on the Utrogestan.
I booked an appointment at a private menopause clinic. She suggested I take the Everel 50 to get my oestrogen levels up and then re-introduce Utrogestan 200mg orally or Cyclogest 100mg/day vaginally or Everol Conti continuously. I could also consider the Mirena coil. She advised me to trial things for a month. She said the Mirena coil can cause a hormonal surge so can take longer to settle e.g. 2-3 months.
It sounds like a lot of trial and error. For example:- I could end up trialling something a whole month and the side effects still might not improve.
Did anyone have bad side effects on Utrogestan which got a lot better after a month?
Did anyone tolerate other forms of Progesterone better?
I am just wondering whether it is the right time for me to trial HRT if I may have to endure a further reduction in my mood for a month or possibly a few months trialling Utrogestan or alternatives.
I have heard that the Cyclogest can sometimes be better tolerated. However, I tend to be very tired after my evening meal due to chronic fatigue so it will take more effort to use this than a tablet.
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I would be inclined to try Cyclogest.
My experience is probably not relevant to you but I found Utrogestan triggered my silent migraines. Other women have different problems with it like low mood and insomnia but generally speaking, it's not well tolerated and you don't have to be progesterone intolerant to have difficulties with Utrogestan.
50mg Evorel is not a particularly high dose of oestrogen and if you suffer with depression, low mood and fatigue, 200mg Utrogestan is probably too high a dose in one hit. Some private clinics suggest using 100mg Utrogestan vaginally every other day - I tried this but it was a massive fail and it didn't improve over time.
100mg Cyclogest is also a high dose. I would be inclined to try the Cyclogest continuously at a lower dose and have regular scans because chances are, you don't need as much as 100mg every day.
I find I can take 50mg progesterone (but not Utrogestan) every day with zero side effects but 100mg seems to knock out the positive effects of oestrogen and trigger my migraines.
Unfortunately progesterone is the Achilles heel of HRT and difficult to get right. It is not helped by the high doses that are prescribed either.
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Thank you Mary.
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Hi Anonymous
I used Cyclogest for the first 3 years on HRT but the dose I was prescribed was 400 mg for 11 days per 28 day cycle off licence from NHS GP. I used to get regular migraines on withdrawal. Later utrogestan became available so I changed to that and have been taking it for the past 13 years. Usually on long cycle and always 200 mg for approx 12 days vaginally. Needless to say I hate it! I think my tolerance to progesterone has decreased as I've got older. I would be very happy never to have to use progesterone again.
Yes it makes me tired, and especially in the mornings, and various other side effects. The point is that all progesterones have a sedative effect = that is part of what this hormone does - and at the doses needed for endometrial protection, is higher (in one dose) than we naturally experience, other than during pregnancy.
I would suggest that one reason some say that Cyclogest is better tolerated is that the dose given seems to be much lower than I was given. As far as I recall there are not studies researching the effect of Cyclogest on the endometrium as part of hRT, though some earlier studies do not specify brands, when talking about micronised progesterone. I haven't checked recently.
Cyclogest does not come in lower doses than 200 mg since it is designed for fertility and so I am puzzled that your meno specialist has prescribed 100 mg per day, unless she means on average ie 200 mg every other day. It is very important to be monitored when using off-licence regimes like this especially at that dose - to ensure your endometrium is properly protected. I didn't need to worry because the dose I was given was very high!
Possibly some synthetic progestogens have less of a sedative effect because they can be taken in lower doses due to being more stable in the blood? But they can have other progestogenic side effects which are undesirable too.
Chronic fatigue - have you had thyroid function checked properly? Ditto you may be be low on testosterone....
All the best with your trial and hope you find something that works for you soon!
Hurdity x
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I e just started Utrogestan and Lenzetto and after a few days I felt horrendous. I think it was the Utro and I have no stopped it and symptoms are very slowly getting a teeny bit better but still awful.
I totally sympathise with you
Talli Xx
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Hi,
I recently started HRT Sequential (Evorel 50) and Utrogestan 100mg x 2/day. I noticed a signficant improvement in my mood and motivation on Everel 50. However, I experienced some unpleasant side effects on Utrogestan; including headaches, depression, anxiety, feeling groggy/unwell and tiredness.
I changed to taking Utrogestan vaginally 100mg/day x 1/day. The side effects were a bit less but still bad.
I have chronic fatigue due to long term complex mental health difficulties, chronic stress and peri/menopause. I was not able to tolerate the further reduction in my mood on Utrogestan and stopped the HRT after the first month. I feel better without it than when I was on the Utrogestan.
I booked an appointment at a private menopause clinic. She suggested I take the Everel 50 to get my oestrogen levels up and then re-introduce Utrogestan 200mg orally or Cyclogest 100mg/day vaginally or Everol Conti continuously. I could also consider the Mirena coil. She advised me to trial things for a month. She said the Mirena coil can cause a hormonal surge so can take longer to settle e.g. 2-3 months.
It sounds like a lot of trial and error. For example:- I could end up trialling something a whole month and the side effects still might not improve.
Did anyone have bad side effects on Utrogestan which got a lot better after a month?
Did anyone tolerate other forms of Progesterone better?
I am just wondering whether it is the right time for me to trial HRT if I may have to endure a further reduction in my mood for a month or possibly a few months trialling Utrogestan or alternatives.
I have heard that the Cyclogest can sometimes be better tolerated. However, I tend to be very tired after my evening meal due to chronic fatigue so it will take more effort to use this than a tablet.
Hi there,
I felt horrendous on Utrogestan but have being doing fine on Cyclogest 200mg, taken rectally just before bed every other night.
I don’t find it increases fatigue at all and I have issues in that area due to autoimmune.
E x
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Hello Anonymous,
I have tried Utrogestan orally and vaginally and it makes me so ill and dizzy after just a few days I have to hold on to the wall to stand up... Then I was told to double up my Cerazette progesterone-only pill but it gave me the same symtoms - I have long covid with an ME / CFS profile and progesterone makes me crash. I know you understand what I mean!
I am under the care of a meno specialist in the UK because I live in France and there is no perimeno care here. She is happy for me to stay on just 1 Cerazette pill as long as I have regular bloods done to check my oestradiol levels are not too high and a regular scan. She said that if we need to add in extra progesterone then we will do so with Cyclogest 50mg (by cutting the pessary in half) every evening. She said that not all women need such high doses of progesterone - I just wanted to let you know that some meno specialists get that not all women can cope with 100mg of progesterone every day. Obviously she asked me lots of questions and this is an individual prescription for me, but something you could ask your own meno specialist.
All the best xxx
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Hi Keeponswimming,
Thank you so much for sharing. I'm very interested in progesterone prescribing. Like many women on here I don't get on with Utro. I also know that I personally don't need anywhere near as much progesterone as some women do.
I've got Cyclogest to try on my next cycle and I really hope that works.
Thanks again, and good luck everyone in funding a solution x
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Thank you everyone for your responses. I have stopped the HRT and feel a lot better than when I was on the Utrogestan. I will try it again in a few weeks or so. I have ordered a box of Cyclogest from a independant pharmacy to try. They let me have it as a one off.
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Hi Anonymous1,
Just to let you know that my meno dr let me get comfortable on oestrogen before asking me to add in progesterone (which was a failure so I'm just on my POP which I already mentioned).
Maybe you could ask if you can just start on the oestrogen part of your HRT to let your body adapt to that for 2 - 4 weeks before adding in the Cyclogest? I felt like a new woman after just 5 days of oestrogen!
All the best xxx
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I have recently switched from utrogestan ( which I took sequi for 5 years and hated it) to norithisterone, which I know I can tolerate better.
It’s not perfect, but it is tolerable.
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I have recently switched from utrogestan ( which I took sequi for 5 years and hated it) to norithisterone, which I know I can tolerate better.
It’s not perfect, but it is tolerable.
That's good to hear. Thank you for your reply.
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Hi Anonymous1,
Just to let you know that my meno dr let me get comfortable on oestrogen before asking me to add in progesterone (which was a failure so I'm just on my POP which I already mentioned).
Maybe you could ask if you can just start on the oestrogen part of your HRT to let your body adapt to that for 2 - 4 weeks before adding in the Cyclogest? I felt like a new woman after just 5 days of oestrogen!
All the best xxx
Thank you for your responses.
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Oh I’ve just posted a new thread. I hate the bloody stuff.
Funny as I spent years going IVF and used to stick 1000mgs up there and loved it then!!
Anyhow, this is one for Hurdity. I want to try long cycle with it but I’m not sure exactly what that looks like. Is it just taking it for 10-15 days every three months? I have a specialist menopause appt today but that is to try and get some testosterone. I was going to raise the progesterone problem but it is an NHS appt so I don’t expect any support for a long cycle.
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I thought I would post an update.
Background; 51, post meno March 2023. Pre-existing health problems: Chronic fatigue, mental health - On medication/supplements.
I started Cyclical HRT a few months ago (Evorel 50 and Utrogestan 200mg/day Days 15-28). 3 month prescription was issued. I experienced a signficant improvement in my mood and motivation within 2 days of starting Evorel 50. I experienced very unpleasant side effects on the Utrogestan orally and vaginally; including severe depression so stopped the HRT after the first month. I ordered Cyclogest from a independent pharmacy and also experienced side effects with this.
I felt very depressed when I stopped the HRT for a month. I think this is because I am now 12 months withouth a period.
I saw a private meno nurse whom suggested taking Evorel 50 for a month i.e. optimising oestrogen; before re-introducing Utrogestan or a different form of progesterone on a continuous regimen.
I re-introduced Evorel 50 and once again noticed a siginficant improvement in my mood and motivation within a few days. I asked my GP to prescribe Evorel Conti. After 2 weeks on Evorel 50 I decided to re-introduce progesterone at half the normal dose to see if I tolerated it. I tried the following: Evorel Conti 1/2 patch, Evorel 50 1/2 patch.
I felt OK on this. I noticed a small improvement in my sleep quality and reduced anxiety.
After a few days on the reduced dose I started using the Evorel Conti patch on it's own (Normal dose of progesterone). After 1-2 days on this I noticed that I felt really tired, a bit sedated and now my mood has gone flat. I assume it is because of the increase in dose of progesterone. I know it is very early days but I am disappointed. I can see that a lot of patience, waiting and trial and error is required to find a regiment that work. I'm pleased that I have had less side effects than on the Utrogestan.
I think I am going to go back to Evorel Conti 1/2 patch and Evorel 50 1/2 patch for the next few days to see if it is definetely the progesterone.
I know that I will need to take the full progesterone dose soon.
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Hey
Bless you, if you don't mind me saying, you are doing changes too quickly. Hormones are great, but they are powerful, it's a hare and tortoise situation. If you are OK on the half and half, then leave it a few weeks, you are not going to make yourself ill in a month (indeed, Prof John Studd put me on E only for the first three months).
With utrogestan I've built tolerance over time - Nick Pannay says this, tolerance can be built - but intially I was so sensitive (also autoimmune and I also have histamine intolerance, almost all histamine intolerant ladies are massively P intolerant) that my current gynae told me to aim for 5 doses a cycle (100g vaginally days apart) and I built up from there (and by over time I mean over about 18 months), I can now do about 12, but can eek it up to 17 x 100 per cycle (with say two days of 200). I have regular scans - I use those baby scan places, cheap, friendly and send a digital scan I then send to my doctor.
In my opinion, women are not data, we are all individual and whilst studies say this and that, a good gynae, with years of clinical practice knows best in terms of what is safe and what works, because they've seen it in their practice - provided you are checking in with a competent professional, having scans and monitoring, just take your time to find your level.
x
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Reb - can I ask how much you pay for your scans please, just to get a rough idea what is reasonable? When I last discussed this with my gynae, she didn't feel it was necessary, given that I was having a regular bleed and no breakthrough bleeding. Longer term, she wanted me to take Utro continually though but I don't think I could tolerate that.
I'm not being monitored by anyone currently and as I'm using half the recommended dose and vaginally, I think I probably ought to have a scan for ( hopefully) peace of mind.
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Hiya
I've used a couple but the last I used was Ultasound Direct as they are local to me but they have branches nationwide. Mostly used by women trying to get pregnant, or who are pregnant. They offer an endometrial thickness scan, and I think it was £60. My local one was very nice, lovely friendly people. Last time, for the first time ever the sonographer was a man (regional lead, happened to be there that day) but I had total choice about that, and a female chaperone who never left the room. They'll tell you which day of your cycle it's best to go (as obvs lining builds up naturally just before a bleed).
They then email the images, which I just forward to gynae. I'm due another, as like you, I just like to be on the safe side.
x
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Many thanks for that Reb. I'll check that out
x
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I'm 62 and have been on HRT for about 10 years. Just under 2 years ago, here in NZ, Utro became funded and my GP switched me from Provera to Utro. I loved how great I slept on it, but my energy levels went down the toilet and I started to get some really bad indigestion on occasion. Tried various doses of estrogen, tried vaginal route for the Utro... Took me a year to suspect it was the Utro, and finally in January this year, I switched back to Provera. Feeling sooo much better in all ways. I had about two weeks of breast tenderness and it took a while for my sleep to settle down, but this has happened partly because of regular meditation, I think. Anyway, I guess Provera isn't the gold standard these days, but in the end, Utro felt like whole body poison to me.
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Thank you all for your responses. Some really helpful info Re: Scans.
Yes, I am making changes very quickly. I've hot a difficult decision to make about work life/health balance so I am wanted to get an idea of whether I am going to tolerate a form of Progesterone & how much a difference HRT is going to make.
I have felt better since I went back on 1/2 Evorel 50 & 1/2 Evorel Conti.
Rebecca, I agree with your comments about the value of a specialist clinical experience.
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Hi Anonymous1. I don't get along with utrogestan either. Had a mirena fitted and didn't get any of the same negative effects.
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I'm glad that you found something that suits you.
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I went back to Evorel Conti 1/2 path and Evorel 50 1/2 patch and felt fine.
I re-introduced Evorel Conti full patch yesterday. Within 12 hours I felt very negative, depressed, unmotivated and wiped out. Today I was finding it diffiult to function with these symptoms so added in a Evorel 50 1/2 patch so I am on the equivalent of Evorel 75 and the recommended progesterone dose. I feel a bit better but my mood is still very low. I've headache. The progesterone has cancelled out the positive effect on my mood of the oestrogen. The side effects are not as bad as when I was on Utrogestan but still not good at all.
I am aware that you are meant to try things for 3 months. However, what can you do if you are having difficulty functioning due the the side effects?
I have had a month now where I have just been on oestrogen only or oestrogen and a lower than recommended dose of progesterone. The private meno nurse said I could take oestrogen on it's own for a month before re-introducing the recommended dose of progesterone.
I've noticed the effect of taking both oestrogen and progesterone within days of making starting or changing the dose.
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I do think often the body takes 3 months to regulate but is also firmly believe when things are very bad you just had to stop. I say this from a place of ploughing on with different meds when in hindsight I needed to have stopped. You just know your own body and mind better than anyone and if the progesterone was making you feel so bad you did the right thing in stopping x
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I stopped the Evorel Conti as I could not function on it. I tried Evorel 50 and Provera 5mg/d early evening. I got the Provera from a private pharmacy. I slept very well. However, this morning I have felt extremely tired, like I am under a bit of sedation and bloated and have increased nasal congestion.
I know that I am making changes too quickly. I guess, it possible that the side effects might improve in time. However, so far, I have not tolerated the following and the side effects have excacerbated my underlying health problems and been so bad that I was finding verydifficult to function:
51, 12 months since period.
Long term mental health e.g. Anxiety, chronic fatigue. On SSRI, special diet and supplements.
DUTCH plus test showed testosterone level is ok, oestrogen and progesterone low. DHEA levels is lower end of normal range.
No HRT - Severe depression, no motivation/joy, aches and pains and dry skin etc.
Evorel 25 - Still getting meno symptoms but a bit better e.g. Low mood, aches & pains
Evorel 50 only - Feel great
Evorel 50 & Utrogestan 100mg/d orally & vaginally - Severe depression, no motivation, anger, increased fatigue, flu like, nausea, headache, sleep disturbance.
Evorel 50 & Cyclogest 100mg/d vaginally - Similar to Utrogestan but a bit better
Evorel Conti - Severe depression, no motivation, anger, increased fatigue, headache. I added in Evorel 50 1/2 patch and felt a bit better but still felt very depressed.
Evorel 50 with Provera 5mg/d - Reduced mood, irritability, sedation, bloating, headache, mild period type pains.
Therefore, so far I can not tolerate the full recommended dose of progesterone but have been ok on the following:
Evorel conti 1/2 patch Evorel 50 1/2 patch i.e. Half recommended dose of progesterone - Felt fine
Evorel 50 & Provera 2.5mg/day - Mild side effects.
I know you won't believe it but I have ordered a small box of Femseven Conti to try from an independent pharmacy. I expect it might be the same as the above.
The private meno nurse said I could try oestrogen on it's own for a month to get my levels optimised and then re-introduce progesterone. I took oestrogen on it's own for 2 weeks and then I tried Evorel Conti and now Provera at half then the full dose.
The Meno GP I origionally saw at my GP practice has left. Therefore, I think I am going to have to pay for another private meno consultation to see if I could perhaps continue at a reduced dose of progesterone a bit longer.
I could also try Evorel 50 1/2 patch and Provera 2.5mg/d.
I also wondered whether I could be referred to a NHS Meno clinic. I'm not sure if I meet the criteria for that or whether they can help.
So far I have had one month on HRT (Evorel 50 & Utrogestan 100-200mg/d), one month off HRT and one month back on HRT (2 weeks oestrogen only and 2 weeks experimenting with half/full recommended dose of progesterone). I have not had any bleeding.
I need to make a number of changes; some of which will be difficult which will help my recovery from chronic fatigue. Therefore, my mood and motivation needs to be good to create a positive spiral etc.
I just wondered what other people have done when they have had side effects that have made it very difficult to function which then creates a negative spriral. Have you just put up with them to see if they improved?
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I’ve been on oestrogel and utrogestan cyclic (200mg for 14 days per month) for 2 years. First year was ok. Second year I noticed my anxiety and mood being affected after around 4 days of taking utrogestan.
In January this year the menopause nurse recommended I go on continuous utrogestan at 100mg daily “as it may be better on a lower dose”.
After 6 weeks I was suffering terribly with extreme anxiety, sweating, shaking, heart pounding, night sweats and panics. I was and still am suffering with awful bladder issues and external burning. So not sure if that was the root of my anxiety as I feel nothing is helping me. But, describing this to nurse she said sounds like progesterone intolerance. She said stop the utrogestan and go on a long 11 week cycle then a two week provera at 10mg daily. I’m still on my oestrogen only phase which is worrying but she said it’s ok as a one off, not continuously.
My anxiety has reduced considerably but my bladder issues continue. So I can’t blame utrogestan for that.
To make matters worse, they found 2 fibroids (5cm & 1cm), so not sure if that’s the cause of my bladder problem.
It’s all so worrrying.
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Thank you for your reply Sara. I'm sorry to hear about your bladder issues. Yes, it is all very worrying; particularly when symptoms are having such a big effect on level of functioning. Is your menopause nurse private or at NHS menopause clinic or GP?
The menopause has been a very big shock for me. Things seem to have got worse since I got closer to 12 months without a period.
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Anonymous1
I too hated taking Utrogestan.... I was (am) on 100mg patch of Evorel, when the Utrogestan was introduced to my cycle i felt a distinct dip in mood, anxiety and generally feeling boggy in the mornings. Headaches, just bleugh. I asked my GP for Provera and they wouldn't prescribe it, I tried continuous too to see if half the dose meant the symptoms were less but I just felt the same with messed up bleeding patterns.
I decided to have the Mirena fitted last September, it's been a game-changer for me as every other progestogen (apart from Femeston) has been horrible. I had a period straight after for a few days, then some spotting for a couple of weeks but after it settled it's hand on heart been great. The freedom of not having to take daily tablets that make you feel awful is just one huge benefit!
If you don't think the Mirena is for you (and I understand it's a very personal choice) then what about long-cycling? Under supervision you can take your progesterone for one week in every 3 months... it might be easier to tolerate if you know it doesn't come every day/month.
I hope you can find something to suit you and feel well with it.
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Hi MerryGoRound,
Thank you very much for your reply. I am sorry to hear that your GP wasn't more helfpul. I am pleased that you managed to find something in the end. I am just taking half a patch of Evorel Conti now whilst I decide what to do next and FemSeven Conti arrives which I will try next. There is a lady whom runs a Menopause group in my town so I think I will see to I can arrange to have a 1:1 chat with her.
Flower
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UPDATE
I ordered some FemSeven Conti from a independent pharmacy. I introduced it gradually starting with 1/2 patch and 1/2 patch of Everol 50. I have been on a full patch of FemSeven Conti on it's own over 2 weeks now and am tolerating it.
I feel better on this compared to no HRT. My body aches and pains are alleviated by it. However, my mood is still quite flat and I still don't feel like my normal self. The progesterone seems to cancel out a lot of the benefits of oestrogen on my mood. However, the progesterone has improved the depth of my sleep. There are likely to be other factors affecting my mood. However, as I have never had this 'flat' feeling befoe I think it is atleast partly hormonal. I have also put some weight on. I don't know whether to just stay on FemSeven Conti a bit longer before increasing the oestrogen e.g. Evorel 25. I have some Evorel 50 patches left.
I tried re-introducing Cyclogest as I would prefer to be on a body identical progesterone; starting with 1/2 the usual dose but still experienced side effects.
When I saw a private meno nurse a few months ago due to difficulties tolerating progesterone she suggested having a month on just Evorel 50 to get my oestrogen levels up before re-introducing a form of progesterone. In the end I had 2 weeks on just Evorel 50 and then I have had about 4 weeks where I have tried a few forms of progesterone but started at a lower dose alongside the standard dose of oestrogen. I hope that as it is a short period of time it will have not affected the womb lining. By trying a few different progesterones and introducing them at a lower dose to begin with I have managed to find something I can tolerate.
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When I was struggling with Utro intolerance, my specialist said it was OK to just have oestrogen for up to 3 months before introducing Utro again but at a lower dose (vaginally), so you should be fine with what you've done