Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: discogirl on September 26, 2024, 04:40:42 PM
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Hello everyone,
I wanted some advice regarding progesterone.
I've been on utrogestan orally since March, the longest time I've taken utro orally, however about 10 days ago I started feeling dizzy then I had a really bad bout of tinnitus. I came off utro for a few days to see if it was that and the dizziness and tinnitus stopped so it was obviously connected to the utrogestan.
I'm due to go back on the utro tomorrow and I'm planning on taking it vaginally at night. I had previously been using cyclogest but had a massive bleed on that and I wasn't absorbing the cyclogest properly.
For various reasons I definately don't want to use the mirena coil; I'm thinking I obviously need a different progesterone, however I'm very unsure about synthetic progesterones, and I'm very settled on the 2 pumps of gel (I don't absorb patches well). I wondered if anyone had any experience of different progesterones that have worked for them.
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Hi discogirl,
I think a lot of women don't tolerate oral progesterone. It made me spin out, feel agitated, very angry, and the panic attacks at night were crazy. The side effects for me negated the benefits I was getting from the Sandrena gel. So, I take 100 mg vaginally and have done for 3 years. Sometimes my legs get a little jumpy about 45 minutes after taking it, and days 10 - 12 the insomnia gets worse, but really it's fine. I've just had an endo' scan and all is looking good there, too.
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Hi Aubrey
Thanks for replying.
I presume you're taking the utro sequentially? I'm post meno and take it continuously. Are you post meno and doing a sequential regime? I had a massive bleed last year and my endo lining was about 11mm.
I was thinking about a sequential regime, but the bleed I had last year and but the thought of taking 200mg for 12 days makes me hesitant. I couldn't do just 100mg on a sequential regime due to the bleed I had. I'd be quite concerned about the endo lining thickening and all the problems that would entail x
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I would try the vaginal route before making a decision. The only other one I've tried is noresthisterone. In the evorel conti patch I had no side effects but orally my sleep got progressively worse and I abandoned it after 10 days. It did produce a good bleed though. Apparently only 1mg is required for endometrial protection but the lowest dose they come in is 5mg so perhaps that was the cause of the difference. It's hard to find safety data for individual preparations but I don't think there are any oral synthetic progestogen that don't carry an increased risk of blood clots, a risk that increases anyway as we age. If I'm wrong about this perhaps someone could correct me.
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Hi Sheila99
Yes I'm going to try the vaginal route again on 100mg contiuously first see how I get on.
I am inclined towards sequential as we've discussed, but because of my previous issues I would as you suggested to a 28 day cycle. On your sequential regime Sheila do you use the 200mg vaginally?
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Nobody should be suffering miserable side effects of micronised progesterone because of fear around synthetics.
This has been so misrepresented all over social media that women are now too scared to explore potentially more suitable treatments.
It is incorrect to present micronised progesterone as the only good option and all others as "bad" or "dangerous".
They have different strengths and weaknesses, for example very marginally more breast cancers but significantly less endometrial cancers. There is less bleeding with synthetics and less abandonment of treatment as a consequence.
Synthetics allow higher doses of estrogen to be used, which benefits both quality of life and other outcomes such as bone health.
Micronised progesterone has only ever been proven safe with very low doses of estrogen. It simply hasn't been studied with physiological replacement, and women often end up taking such low doses of estrogen due to bleeding or not wanting to increase the progesterone because of tolerability issues, that they really aren't getting much benefit from HRT at all.
There is absolutely zero evidence that synthetic progestins increase clot risk when used alongside transdermal estrogen.
The only studies showing a statistically minuscule increase in clot risk were with oral combinations.
Many people have happily taken them in the past as contraception, I am thinking particularly of desogestrel (cerazette). The BMS support a double daily dose of this as endometrial protection.
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I know I'm repeating myself but....
Posted on two other threads but didn't get an answer.
bombsh3ll -- Just wondering......Do you have a background in medicine?
Are you a doctor/nurse/medical researcher?
The reason I ask is that you seem to be dishing out lots of "advice" on a wide range of topics.
You state that "studies show ....." without giving any further information regarding said studies or indeed linking to them.
You present "facts", once again without any information to back them up.
This is not meant as an attack, I merely want to ascertain whether you do indeed know what you're talking about or whether Google plays a large part.
Considering that this is meant to be a peer-to-peer help forum where people share their lived experiences, I don't think I'm asking a lot.
EDIT- apologies to discogirl for hijacking the thread
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Hi Sheila99
Yes I'm going to try the vaginal route again on 100mg contiuously first see how I get on.
I am inclined towards sequential as we've discussed, but because of my previous issues I would as you suggested to a 28 day cycle. On your sequential regime Sheila do you use the 200mg vaginally?
You may be interested in this for the blood clot aspect https://www.themenopausecharity.org/2021/10/21/menopause-and-clots/
'Progestogens are the synthetic type (chemically created), examples of these are medroxyprogesterone acetate (MPA), dydrogesterone, levonorgestrel, or drospirenone. Their chemical structure is different to that naturally produced by the ovaries and while they mimic some of the same effects as natural progesterone they don’t act in the exact same way. These synthetic progestogens have been shown to be associated with a small increased risk of clot. In particular, MPA has been shown to have the highest risk of clot.
Micronised progesterone, however, is a body identical hormone with a molecular structure identical to that of progesterone normally produced in the body; it is derived from the yam root vegetable. At present, it’s only available in the UK in one preparation, branded as Utrogestan, and this has not been shown to cause any increase in the risk of getting a clot.'
Of course it may be a risk you decide to take to feel well, just as I take the increased risk in endometrial cancer to have time off utro.
I used 200mg vaginally until it started causing irritation which I think was a va issue. I tried one cycle of 100mg, I didn't bleed but some cycles i didn't bleed anyway.
I felt just as bad on 100mg so didn't repeat it. After the irritation I did 5 cycles using 200mg rectally. It produced a good bleed each time (though less than the noresthisterone one) so for me was more effective than vaginal. This is very much off licence though so if you go down this route it would be safer with the occasional scan.
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I've never been able to take Utrogestan orally. Used as a pessary it's tolerable but I'm still always glad when the prog phase has finished.
I always felt awful during the progesterone phase of my own cycle - moody, spotty, constipated - so I suppose that proves Utrogestan is just doing what it's supposed to do.
For me, having worked through the menu of synthetics, vaginal Utro, though not perfect, does remain the best option.
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I would be really interested to see any data showing an increased risk of clots when any synthetic progestin is taken either alone or with transdermal estrogen.
Every published study that I have ever seen showing an increased clot risk is based on the progestin being taken together with an oral estrogen.
Even then, assuming there is a small increased risk of blood clots (or any other adverse event) this has to be individually balanced against the benefits.
I take a combined pill Zoely, with oral estradiol and a synthetic progestin.
I accept there may be a small increase in my background risk of blood clots, which in my case being a normal weight, healthy lifestyle and no family history of clots is very low anyway, for the benefits this treatment provides me.
There are things I can do to make this even lower like keeping active and well hydrated.
It's the same with anything, but the amount of fear around synthetic progestins is disproportionate to the magnitude of increased risk, where people are really suffering because they don't feel well on their existing treatment.
You can always try something and switch back if it doesn't suit.
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Hi Sheila,
Thanks so very much for this information and it will help me make an informed decision.
The information regarding risk of blood clot is interesting, although I'm not so worried about that so much as I am maybe the psychological effects of them.
I don't know if you can remember Sheila but I did use the cyclogest rectally on continous until I got that huge bleeding, as I wasn't absorbing it. I am going to trial the utro vaginally 100mg see how I get on and then I may have to go to sequential and if I do I will do a 28 day cycle and get regular yearly scans.
Are you still using the utro rectally at 200mg?
Thanks so much for the information that will really help me x
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Hi bombsh3ll
The risk of blood clots doesn't bother me too as I have no family history of them, obviously on a sequential regime there is always the worry of womb cancer.
I think you're right regarding synthetic progestins; I am more concerned regarding how they may affect me psychologically.
Regarding the desogestrel would I be ok to use them on a continous basis; would they strong enough to give me endometrium protection?
I wouldn't discount trying anything to be honest as I've heard some women are no good on utro but they fair much better on the synthetic progestins.
Thanks for your help bombsh3ll xx
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Hi Sheila,
Are you still using the utro rectally at 200mg?
The last one was noresthisterone but I think I'll go back to utro in future, or perhaps try splitting the noresthisterone so I get a smaller dose. Given that I use a 6 week cycle I may use a noresthisterone cycle once or possibly twice a year instead of utro, the blood was a bit clotty and heavier so I think it's done a better job than utro.
Bombsh3ll I think you're relatively young which might put a different slant on it? I already have one risk factor I can do nothing about because I'm over 60 and it's a risk that increases with increasing age. It's one reason I was quite so p**d off when I found out I had to take 5x the dose of noresthisterone I actually needed. They list oral contraception as a risk factor too so I assume the same is true for the same preparation used for hrt. But everything in life is a tradeoff and feeling well is perhaps more important than a small increased risk.
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The recommendation of the BMS regarding desogestrel 150mcg is that it is taken every day. This doesn't mention cyclical use at all - I think this is probably due to desogestrel 150mcg being a suppressive dose so should render most individuals amenorrheic with continuous use anyway regardless of menopausal status.
Conventionally the current belief is that cyclical progestogen is only required in those still having periods (although in reality cyclical is preferred by some postmenopausal women for various reasons including tolerability)
However there were a small number of studies done in the 1990s, eg Saure et al, who used cyclical desogestrel 150mcg with oral estradiol of 1mg and 1.5mg, showing endometrial safety.
I therefore think this is a feasible option although as with any regime using less progestogen than guidelines recommend, endometrial monitoring should be considered if used long term.
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Sheila - yes I am 44 and plan to continue Zoely into my early 50s until I can be reasonably sure old aunt Flo is dead, then I'll switch to something else oral.
I can think of few things worse than 5mg of norethisterone!
Is Noriday not still available in the UK? That's 350 micrograms. If you want to take 1mg the closest thing is to take 3 of them.
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Hi the BMS guidance says you can take 3 Noriday tablets ( Norethisterone) or 2 desogestrel.
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Hi Dotty
Thanks, I'm trialling the utro vaginally again, see how that goes and to be honest I have been looking at desogestrel.
Hope you're keeping ok xxx
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This is an interesting thread and sorry to come to it late.
Discogirl, if the vaginal Utrogestan doesn't work out, you could try Cyclogest at a tolerable dose, it has fewer side effects.
I agree with bombsh3ll re synthetic progesterone and I would not dismiss it out of hand just because it is synthetic. My migraine specialist floated the idea of Cerazet 75 because apparently it's well tolerated by women with migraine aura and can actually help to prevent them - it's important for women with hormonal migraines to achieve amenorrhoea via a stable level of hormones. Because of my complicated history of migraines and constant monitoring, she said I could use 75mcg.
I can understand why you would be reluctant to try the Mirena coil but what about one of the lower dose coils like the Kyleena or the Jaydess?
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I had previously been using cyclogest but had a massive bleed on that and I wasn't absorbing the cyclogest properly.
Was it ever suggested that you increase your cyclogest? Wondering because when I had to increase my patch to 75 a couple months back (still can’t believe I had to do that!) I found that 100mg cyclo wouldn’t cut it. I had to rapidly increase it to 200mg, which seems to work ok so far - I even suspect I might need more but I’m giving this dose time to settle. Point is, I’ve known some women to increase their progesterone by quite a bit to balance how their particular bodies process oestrogen.
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MaryG - I was on cyclogest rectally I was cutting it so maybe using about 150mg and ended bleeding badly on it. If utro vaginally doesnt work I would consider cyclogest again but I would have to use the full 200mg and I would use it vaginally.
Furyan - Thats a thought about the kyleena or jaydess coil. I think i just dont like the idea of something like a coil being inside me. i mean if pills dont work you can stop them then and there obviously with a coil you cant. But its still an idea.. Kyleen and Jaydess must have less side effects xx