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[Bo]

Hi Everyone
I have had two visits to the Chelsea & Westminster menopause clinic to try to sort out my problems on HRT. I wasn't getting on with the oestrogen gel (Oestrodose) and I can't take Utrogestan orally: I get 'depressed' & lethargic, or as the last doc I saw said, it 'puts me into a hypnotic state'. So back in March/April, I started to apply it vaginally, but only every other night as, even PV, it would have that 'hypnotic' effect on me, just not as bad. Both docs I have seen at the clinic have told me not to have any breaks.

I also tried testosterone gel, a teeny tiny amount, on two separate occasions, and experienced aggression 

I have recently increased my Evorel patches to 62.5mcg which is almost enough to control my flushes, improve my energy levels, and ensure I can get unbroken sleep (what a relief after 5 years!). I am meant to increase gradually to 75mcg because my blood levels (on 50mg) were too low to protect against osteoporosis, and 50mg wasn't controlling my flushes either. But I want to have the minimum dose to control my other symptoms: one reason for this is awful breast tenderness on the oestrogen - I am on EPO which perhaps helps a bit, Starflower oil is better apparently but it upset my stomach too much.

However, at my appt last month the doc said that Utro every other day is not enough to stop endometrial lining building up. So I increased to every night after that appt BUT I am now, a few weeks later, starting to get those hypnotic symptoms again. Also, my hair is falling out more 
As a result, I want to decrease to every other day again.

I have my next follow up in November when they will arrange an ultrasound scan. The doc said that if I continued on every other night, I would be a 'guinea pig' for this regime...at least in their clinic.

Does anyone/many people follow this 'every-other-night PV' regime? I know we're all different but, if so, are you ok on it?

Thank you 

[Jenna]

Hi Everyone
I have had two visits to the Chelsea & Westminster menopause clinic to try to sort out my problems on HRT. I wasn't getting on with the oestrogen gel (Oestrodose) and I can't take Utrogestan orally: I get 'depressed' & lethargic, or as the last doc I saw said, it 'puts me into a hypnotic state'. So back in March/April, I started to apply it vaginally, but only every other night as, even PV, it would have that 'hypnotic' effect on me, just not as bad. Both docs I have seen at the clinic have told me not to have any breaks.

I also tried testosterone gel, a teeny tiny amount, on two separate occasions, and experienced aggression 

I have recently increased my Evorel patches to 62.5mg which is almost enough to control my flushes, improve my energy levels, and ensure I can get unbroken sleep (what a relief after 5 years!). I am meant to increase gradually to 75mg because my blood levels (on 50mg) were too low to protect against osteoporosis, and 50mg wasn't controlling my flushes either. But I want to have the minimum dose to control my other symptoms: one reason for this is awful breast tenderness on the oestrogen - I am on EPO which perhaps helps a bit, Starflower oil is better apparently but it upset my stomach too much.

However, at my appt last month the doc said that Utro every other day is not enough to stop endometrial lining building up. So I increased to every night after that appt BUT I am now, a few weeks later, starting to get those hypnotic symptoms again. Also, my hair is falling out more 
As a result, I want to decrease to every other day again.

I have my next follow up in November when they will arrange an ultrasound scan. The doc said that if I continued on every other night, I would be a 'guinea pig' for this regime...at least in their clinic.

Does anyone/many people follow this 'every-other-night PV' regime? I know we're all different but, if so, are you ok on it?

Thank you 

You might find this thread of interest, Bo:

https://www.menopausematters.co.uk/forum/index.php/topic,33514.0.html

[Bo]

That's great, thank you. I tried searching before posting but got too many results, many not relevant, but I guess my search string wasn't good enough 

[Jenna]

You're very welcome, Bo - I just had a vague recollection from before!

[Dancinggirl]

With high doses of oestrogen then Utrogestan only every other day may result in the womb lining building up and erratic bleeding could well start. If you have regular scans at the clinic then you may be able to see if this lower dose of Utrogestan will work for you - just keep things monitored by your doctors.
I would have thought that a Mirena might be a good option for you but you may have already have tried this? DG x

[Bo]

Yes I understand the risk of that Dancinggirl but I can't continue with this brain fog and physical lethargy. Apart from it causing day-to-day low mood and impaired function generally, I play match tennis and it really impacts this. I have not had any spotting since being on HRT, even when I was having a 5 day a month break from the Utro (when I started on it last year) and on two pumps of the gel (75mcg) per day, and including when I was 'taking' it PV on alternate days until a few weeks ago. And, btw, on the regime I started on (75mcg of gel and 100mg Utro orally every day for 25 days) i felt awful AND it didn't control my flushes! 

[Cassie]

What dosage of Utrogestan are you on and for how many days?

[Mary G]

Bo, my opinion is that you are taking too little oestrogen and far too much Utrogestan so no wonder you feel that way you do, I would not be able to function at all.  What you are doing is a continuous combined (no bleed) regime but you would probably be better moving to a cyclical regime.  If you are progesterone intolerant as I am, take a look at Professor Studd's website and in particular his 100mg 7 day vaginal Utrogestan regime which is aimed at progesterone intolerant women - this is what I was originally prescribed but I have deviated from it somewhat.

A 50mcg oestrogen patch is not a high dose and I found that it didn't provide me with anything like enough oestrogen - confirmed in blood tests.  Even a 100mcg patch was barely scratching the surface and it was only when I switched to Oestrogel that I managed to attain the oestrogen dose I needed to completely eradicate menopause symptoms.  You probably would have got on well with Oestrogel if you had obtained the right product - apparently Oestrodose is not as good. 

You are on the right track but on the wrong dose of both products in my opinion.  My advice to anyone who has problems with progesterone is to reduce the dose and have regular scans, it is not worth ruining what should be a good HRT regime by dosing yourself up to the eyeballs with progesterone that you probably don't need anyway.  Most women do very well on the Professor Studd low dose progesterone regime but obviously there are some who will need more progesterone but don't guess how much you need, find out by having a uterine scan and set your progesterone dose from there.  You will probably have to pay for it but so what?  If you are intending to take HRT for the foreseeable future you want to make sure you get the dose right and get the best out of it.

I'm not suggesting anyone takes any unnecessary risks but the medical profession must give progesterone intolerant women more flexibility on progesterone doses and cut the dogma because it is making HRT unviable for so many women.

[Bo]

I am currently on 62.5 mcg Evorel patch, and considering increasing to 75mcg, (although my flushes are controlled almost 100% on this dose), and 100mg Utro PV every night. I am going to reduce Utro back down to alternative nights now - having read the other posts and research abstracts in the suggested link - because I felt fine when I was doing this before. I felt even better when I initially increased from 50mcg to 62.5mcg of the oestro patches, I finally started to feel like my 'old self' again, but that was before the increased prog levels (coming from using Utro daily) 'kicked in' again. Also, after reading those other posts, I wonder if having the Utro daily is contributing to my very sore boobs; perhaps it's not just the oestro 

TBH, I would rather change back to Utro on alternate days than change to a week per month (or every other month) of stronger prog dose. The Menopause clinic doctors (Dr Panay's clinic) know I struggle with the prog but have not suggested a cyclical regime. They suggested that I could try another variety of prog, but that's it.

I agree with so many posters - why don't they offer a 50mg Utro capsule! The prog causes so many problems   

[Mary G]

If you tolerate Utrogestan every other day then stick with that and the 75mcg patch.  The upside of this regime is that you will not have to put up with periods.

Re breast pain, I have never had any breast discomfort with oestrogen only HRT but I always have it with continuous combined HRT.  When I had my first Mirena coil fitted in 1998 for contraception, I asked the gynaecologist at the FPC if it would cause breast pain and she said "no" but it did, almost immediately.   

I hope you feel some improvement soon.

[CLKD]

I don't think that HRT per-vagina would cause you to feel 'hypnotic', even nightly. 

[Bo]

I don't think that HRT per-vagina would cause you to feel 'hypnotic', even nightly.

Well, it seems like it does for me. I will try to remember to update after a few weeks of reducing to alternate nights. 

[Bo]

If you tolerate Utrogestan every other day then stick with that and the 75mcg patch.  The upside of this regime is that you will not have to put up with periods.

Re breast pain, I have never had any breast discomfort with oestrogen only HRT but I always have it with continuous combined HRT.  When I had my first Mirena coil fitted in 1998 for contraception, I asked the gynaecologist at the FPC if it would cause breast pain and she said "no" but it did, almost immediately.   

I hope you feel some improvement soon.

Thank you. I will see how I get on re breast pain after a few weeks of reducing Utro to alternate nights. I won't change the EPO dosage so I can compare properly 

[CLKD]

Good idea about the update ;-)

[matildamouse]

Wow Jenna I am so impress with your memory!

Bo, I am on Estradot 50mcg patch and alternative days vaginal progesterone. My scans have been good for the past few years.

I also want to increase my estrogen as I am getting this 04h00 wake up's for the last month with breakthrough flushes so I am sure going up to 62,5 or 75mcg will sort that. My doctor actually suggested last year already that I increase to 75mcg. My plan is to see her next week, first go for a scan and if my lining is still thin, I will increase the progesterone.

This is a link I wanted to post where research was also done with much less progesterone etc.

http://www.whria.com.au/wp-content/uploads/2016/08/HRT-Micronised-Progesterone-2016.pdf

The bit what was important to me was the conclusion of the research:(mP4 = micronized progesterone)

Recommended dosage of mP4 for women using E2 orally or transdermally:

Oral route
Cyclical: 200mg mP4 for twelve to fourteen days per month
Continuous: 100mg mP4 daily

Vaginal route
Alternate day: 100mg mP4
Sequential: 45-100mg for at least 10 days a month
Minimal dose: 100mg twice a week (more research needed; endometrial monitoring may be required)

Transdermal route
Not recommended

Please keep us updated with your decision and result as we all learn from each other while we are trying to cope on the menopausal journey!