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[Hurdity]

Darlingbabs - you mentioned feeling fine on Depoprovera? This contains MPA which is the same as Provera - the other progestogen licensed for use with hRT so another thought would be to try this as your progestogen. Not sure how different you would feel from taking it orally than as an injection and whether the side effects would be greater?

The other thing is you are talking about pumps of oestrogen - but it all depends on how much you absorb. Without blood tests you don't know whether this is working well for you. Women do vary in how much they absorb from the different methods so have you had blood tests ( I know these are unreliable and vary greatly - but might be a guide?)? If it turns out you don't absorb gel well then a patch might help? I can imagine it must be quite difficult spreading 4 pumps of gel - and less is absorbed if it's spread too thinly over a very large area as well (ie if it dries too quickly before being absorbed).

Mirena sounds like a good idea to try too....

Hurdity x

[Darlingbabs]

Thanks hurdity,all really helpful. I have replied on my jaydess/mirena post as I didn't get given either in the end but have come home with loestrim and instructions to come off estrogel. I have everything crossed that this does not tip me over the edge!

[dangermouse]

Perimenopause is not the same as an early menopause though, and the treatment for both can be the opposite.

Peri can start from about 35 and it can be very gradual for some where you just feel a bit off until it gets worse and worse but you will still have your periods. An early menopause is when you stop your periods at an early age (late 30s, early 40s). The latter may signal a true oestrogen deficiency but the former is likely to be a progesterone deficiency or just crazy volatility!

Utrogestan is a funny one, it's meant to be natural progesterone and nothing else but I tried it the other day and I felt drugged, like when you take Diazepam (I am very sensitive though!) and I don't think I've heard one woman here say they feel good on it. Progesterone cream (for use on its own only), on the other hand, makes you more energised, rebalanced, calmer, clearer and more motivated.

Something just doesn't seem right there with this Utrogestan product.

Just for anyone reading - to reiterate about Utrogestan....

There is nothing "not right" about it at all - in the sense that it is progesterone aka progesterone and structurally identical to that made in our bodies and exactly the same as in progesterone creams!

As I have said many times on the forum, progesterone is a very unstable molecule in the body and when we take it exogenously (from outside the body) this is completely different from when our own ovaries pumped it out all the time from the corpus luteum after ovulation. Because it is unstable, it is metabolised quickly and we only take it once a day. It therefore needs to be taken in suffuciently large quantities so that after digestion ( when taken orally) and then metabolism by the liver, there is sufficient in the blood stream to be carried to the uterus to protect it from overthickening from the oestrogen we take as HRT. It is the large dose (leading to large doses of the metabolites) that is somehow "not right" for some women.

Taken orally there are many more metabolites (metabolic breakdown products) than when used vaginally and it is these metabolites especially which can give rise to the unpleasant sdie effects - linked to its sedative effect. At the quantities taken orally this part of it does act like a drug - but has to be like this because of the womb protective effect.  So yes - the metabolites from progesterone I think act on the same receptors as some of those drugs you mention (?GABA receptors I think - from memory - bit hazy here...). This is why it should be licensed to be used vaginally as part of HRT in UK as it is elsewhere in Europe, and the doses necessary to keep the womb lining thin, reduced accordingly.

The fact that prog cream doesn't make you feel like this is due to: 1. It is absorbed transdermally therefore fewer metabolites (same as with vaginal utrogestan) 2. The dose absorbed is much lower and insufficient to protect the uterus - otherwise some side effects would probably be felt.

Hurdity x

Interesting. So does the vaginal route not cause any grogginess or is that more to do with it being a very high dose?

I wonder if you could also use it sublingually by breaking the capsule.

[Hurdity]

Hi dangermouse

There should be much less grogginess even with the same dose of progesterone used vaginally. The paper I go to about this says there are 30 different metabolites from oral dosing, one of which is pregnanolone that causes the sedative effects:

"After oral administration, progesterone can be
metabolized to more than 30 metabolites, among
which some exert specific physiological activities
The most important pathway is the formation
of 5a- and 5b-pregnanolone which exert
considerable sedative effects after binding to the
GABAA receptor."

This is from Kuhl 2005: Pharmacology of estrogens and progestogens: influence of different routes of administration

Interestingly a buccal method is mentioned in this same paper - which I presume is sub-lingual - but this must have been experimental only as I've never heard of it given this way. However it was a specially made suspension so i doubt the utrogestan - micronised progesterone - would work in the same way - well not to protect the uterus anyway. Might be worth a try and see what happens?

Sorry Darlingbabs - bit off topic here!

Hurdity x

[Darlingbabs]

No worries. All very interesting x