Risks of Provera

[Bluebell66]

I take Provera for 10 days every three months as part of my HRT. I take Elleste solo every day. The Provera I was told is supposed to induce a bleed, which it doesn't. I have spoken to my GP who doesn't seem concerned, apparently it's not unusual. I am having very, very sparse periods, not really proper periods, just finished one but prior to this, the last one was May. I am worried about the lining of my womb not being shed, could this cause cancer of the womb lining, I am also worried about the breast cancer risk of Provera. Would I be better on a natural progesterone, and if so, what would that be?

I lost my husband to cancer three years ago, so this is a very real worry to me. I am 50 years old by the way.

Thank you in advance for any advice xx

[PollyPerky]

It's not dangerous not to have a bleed- apparently 15-20% of women on sequi HRT don't. If you are on a low dose of oestrogen- 1mg?- then the lining isn't building up enough to be shed. If you are really worried, you could sort out a private ultrasound pelvic scan to have it checked (there are places nationwide who do this and costs vary from about £100 -£300.)

(I'm on long cycle HRT with 2-3 monthly cycles, but I do have proper bleeds - sometimes quite heavy so I'm reducing the cycles to 6-8 weeks.)

The type of progestogen in Provera is one which is linked to - albeit only slightly- a higher risk of breast cancer (I've only found this out for my own information by drilling down into the NICE guidelines and other research papers online - I don't take it myself.)

The alternative is Utrogestan which is micronised (natural) progesterone. You'd use this they same way- 12 days every 3 months or daily if you are on a continuous regime. I'm using it- it's either loved or hated! It can have a sedative effect so it's always taken at bedtime.

[Bluebell66]

Hi Polly, thank you so much for your response, I really appreciate your advice and knowledge. My Elleste is only 1mg. The GP did mention a pelvic ultra sound to check my womb, so maybe I'll pursue this. I think I tried Utrogestan but couldn't tolerate it, maybe I should try it again. Can I just clarify, taking Elleste solo 1mg daily, I would still take the Utrogestan for 10 days every three months? Many thanks.

[PollyPerky]

If your GP is happy to arrange a scan, go for it!
If you are only using 1mg then you may not be absorbing much. A lot of the active part of pills is lost in digestion. (I use gel and the dose is roughly 1.5mgs but I assume a lot is absorbed.) Is the amount you use controlling your symptoms ok? if you stay on HRT long term you might want to think about changing to transdermal- patch or gel- because they are safer re. blood clots.

Yes you could use 200mgs Utrogestan for 10 days every 3 months though it's slightly safer to use 11 or 12 days. You know you can also use it vaginally? I don't for various reasons, but its licensed in Europe this way but not the UK. Some women find it reduces the side effects. (Just pop the capsules in at bedtime.) They don't prescribe 200mgs capsules anymore so you have to use /take 2 x 100mgs.

[Bluebell66]

Thanks Polly. I think 1mg of Elleste is enough, it's difficult because I'm still struggling with the loss of my husband. The grief inevitably causes severe anxiety and depression, which in turn causes headaches, poor sleep and fatigue, so I'm not really sure how much is due to that and how much is due to menopause symptoms. Thank you for the long term usage advice, I've been on it nearly two years now.

I didn't know you could get Utrogestan for vaginal use, so will ask the GP about this too and discuss a scan.

Thank you so much for your time Polly, I really appreciate it.

[PollyPerky]

I'm sorry to hear about your husband etc.

I'd be careful of saying too much to your GP about using it vaginally, because it's not licensed to use this way in the UK even though it is in France and Europe. He's unlikely to know about it and according to posts on another meno forum many GPs haven't heard of it at all (for oral use.)

The capsules are the same wherever you use them- there aren't different ones for oral /vaginal use.

[Bluebell66]

Thank you Polly.

Oh I see, so they would prescribe Utrogestan and I could either take it orally or use it vaginally?

[PollyPerky]

Yes, exactly.

[Bluebell66]

Thanks so much Polly.

[Deux]

Bluebell, so sorry to hear of your bereavement. You've got a lot going on.( If it helps at all, I find a magnesium supplement about 30 minutes before bedtime can help with sleep.)

I found on Utrogestan I slept like a log as Polly says it can be quite sedating.

Can I ask a question? did you experience any side effects with Provera?

I'm fairly new to HRT and I'm on transdermal gel and a bleed 4x a year. I had my first bleed using Utrogestan and whilst I tolerated it fine when I was taking it, I had the worst period I've ever had.

So doctor has prescribed me Provera for next bleed as she says it's less androgenic and she thinks I was reacting to the androgens.

[Bluebell66]

Thank you for your kind words Deux.

When I'm on Provera, which is 10 days every three months, I have general PMS type symptoms, increased stress, anxiety, headaches etc, but they don't result in a bleed.

Thank you for the advice about magnesium, I have actually just started this over the last couple of nights, along with Melatonin and L Theanine, which are all meant to promote sleep. I'm desperate for something to work, as I'm barely getting three hours a night, and that's broken.

I think I may try the Utrogestan again, it was two years since I last tried it.

Good luck with the Provera, I hope it suits you, I'd be interested to hear how you get on with it. That's interesting what you said about the androgens.

[awonderfulsenseofvariety]

Hello, I am interested to see this thread as I have just started long-cycle HRT also. I use Oestrodiel gel and had my first three monthly go on Provera in October. I was also wondering whether I should ask to swap to Utrogestan, just because I'd read it might be slightly safer.

I did have a bleed in October but it wasn't terrible. I had been having some bleeding whilst just on the Oestrogel anyway, so I think my own hormones might still be activating a cycle.

I have found my sleeping is terrible - I was really hoping the HRT would help with this. I found it especially bad for the two weeks I was taking the Provera. I could fall asleep OK but woke up after about an hour and that was pretty much it for the night!

I am planning to try the Provera for the next go in January and see how it goes. Would be interested to hear how you all get on too - I haven't seen much info about long-cycle experiences. Maybe we could keep each other updated.

Sorry to hear about your bereavement, Bluebell.

[PollyPerky]

deux Utrogestan ought not to have any androgenic factors- it's natural micronised progesterone the same as we have ourselves.

Long cycle HRT is usually done under the guidance of a specialist OR if a GP is happy to refer you for pelvic scans every year or so. There is a higher risk of endometrial hyperplasia with it, so the uterine lining has to be monitored , ideally.

Personally, I'd not use any synthetic progestogens because they probably do have a higher cancer risk, which is worth thinking about if you are on HRT for some time.

[Bluebell66]

Awonderful - thank you so much for your comments, they are really appreciated. I totally understand the sleep problem, I am exactly the same, I get about three (broken) hours a night and am then up at 4.00 am for the day, it's exhausting.

I think my next move is to ask my GP for a pelvic scan, I had one several years ago which showed slight thickening of my womb lining. Because I am on oestrogen and am not having proper bleeds, even with the Provera, I want to have it checked again.

It would be really good to keep in touch to compare notes, I would like to know how you get on.

I tried Utrogestan and had severe, unpleasant side effects to it, so I feel my only option is Provera.

Polly - are you able to tell me what "natural" progesterones there are? Are they usually creams which you apply on the skin?

TIA

[PollyPerky]

Bluebell There are no transdermal types of progesterone (creams) that work or can be used as part of HRT. Utrogestan is micronised progesterone. It's the only one.

What happened when you tried Utrogestan? Have you tried using it as a vaginal pessary which can reduce side effects?

[Deux]

Polly, Utrogestan is considered to be "slightly anti-androgenic". My consultant thinks based on my experiences that for me it is quite androgenic hence a switch to Provera for the next bleed to see if that's better.

She did also suggest upping the dose of estrogen when coming to the end of the progesterone phase to reduce androgenic effects of progesterone. She's also ruled out Mirena for me too.

Bluebell, there are several different forms of progesterone. Another one is Cyclogest which can be used as a pessary or suppository. There's a section on the Menopause Matters website that lists all the progesterones available for HRT and where they're derived from.

I'm also wondering if you'd benefit from a slightly higher dose of estrogen to maybe help you sleep better. is it a tablet you're taking? Maybe taking it at night time would help? The lady I saw said that night waking at Menopause, when you wake up with a start, is caused by a drop in estrogen which triggers a surge in adrenaline that wakes you up, so estrogen at bed time can level that off.

I agree it would be good to keep updating this thread to compare notes. Date for your diary - I'm scheduled to start my next progesterone cycle on 1 December. Will report on my Provera experiences. 😀

[Deux]

Oh, and another thing , my own self-generated progesterone was and always has been quite androgenic for me eg spots/mild acne in the "beard" area. So no real surprise that I experienced similar on a manufactured version. I'm going to work my way through them all till I find a least-worst option.

[Deux]

And another thing! Just reading back my post above. Consultant suggested upping the dose of estrogen during the progesterone phase not just to help with androgenic side effects but side effects in general if you're intolerant/sensitive to progesterone.

[Bluebell66]

Polly - they symptoms I had on Utrogestan were severe PMS type symptoms, dreadful mood, anxiety, anger, headaches, constipation. I have only tri d it as a tablet.

Deux - I have wondered if I need a higher dose of oestrogen, 2mg instead of 1mg. I will discuss it with the GP, but because I lost my husband to cancer, it is a very real fear for me. I am acutely aware every day that I am the only one now to care for my children.

It is for this reason I am very anxious about being on HRT at all, let alone increasing the dose, even though I think it could help me.

I am worried about the lining of my womb following the last scan I had several years ago.

However, I do have a lot of symptoms of low oestrogen, headaches, joint pain, fatigue, not to mention virtually nonexistent sleep. What dose of oestrogen are you on Deux, and which one are you taking?

I am in complete turmoil at the moment.

My next course of Provera is due to start on 29th December. I'd love to check back in with you and see how we get on.

[Bluebell66]

Forgot to mention, I just read on Menopause Matters website, 1mg of Elleste is classed as a low starting dose, going up to 2mg. I am very tempted to try it as I am desperate to feel better, but am so terrified of the risks of breast and endometrial cancer.

[PollyPerky]

Utrogestan is considered to be "slightly anti-androgenic". My consultant thinks based on my experiences that for me it is quite androgenic hence a switch to Provera for the next bleed to see if that's better

Sorry but this is a complete contradiction! If something is 'anti-androgenic' then it can't be 'androgenic' in a single person. Natural micronised progesterone is the same hormone we'd produce in huge amounts when pregnant. It's not androgenic (ie male hormone.)

The acne and spots that occur with HRT are usually down to using the more androgenic types of synthetic progestogens- but micronised progesterone isn't one of them.

Some women do find that during the progesterone part of a cycle (on HRT) they 'lose' some of the benefits of oestrogen because the role of progestogens is to oppose oestrogen receptors in the uterus. So if using gel,it's quite possible to increase the dose slightly.

Bluebell many women I know of use utrogestan vanginally and it avoids most of the side effects. My consultant gave me the choice of how to use it.
1mg is oestrogen is very low especially as it's a tablet- a lot is lost in digestion. The whole point of HRT is to reduce symptoms so if yours aren't going then you will need to try a higher dose.
The reason your lining may have been thicker (do you know the measurements?) was perhaps- without knowing all your details!- due to peri meno when the lining isn't shed regularly every month- a really common experience.

If you're going to 'go' for HRT do it in a way that gives you some relief and try not to worry :)

[Bluebell66]

Polly - thank you so much for your informative, very helping response. I am so grateful to you.

When I had the last pelvic scan my periods were still regular, but it was very soon after that, that my periods starts to become very irregular. It's difficult to remember the dates, even years. With the loss of my husband everything around that time is a blur, as I was purely focused on him and the children.

I've booked an appointment with my own GP for 5th December. I am going to request another scan and the possibility of upping the Elleste to 2mg.

Thank you again.

[Bluebell66]

Sorry for the typos 😳

[PollyPerky]

It can take a while to find the right 'fit' with HRT. I was lucky as my dr suggested gel from the start and it's been great.
I'd try to put the last scan out of your mind. If they were worried then, they'd have done something about it. presumably they thought it was 'normal' for someone of your age /stage of peri?

Going back to your first post- sorry if I'm repeating anything here- the reason you are not getting much of a bleed is because you are having so little oestrogen and the provera is counteracting that meaning there is no lining to come away.Around 15-20% of women don't bleed at all , my dr told me.

Might you think about changing to gel or patches? They are much safer re. blood clots and with gel you can increase the amount yourself so you get relief from the symptoms- it's really wonderful stuff!
Have a think on it.

[Deux]

Polly, a fully qualified meno specialist gynae told me this and has actually put it in writing to my GP. So I'm assuming she knows what she's talking about so I'll take her word for it. Remember though, my experiences are mine and mine only.

Utrogestan can have androgenic effects hence it is only considered "slightly" anti-androgenic. Provera may prove even worse for me, who knows.

[Bluebell66]

Thanks so much Polly. That obviously makes sense, the reason I'm not getting a bleed is because there is nothing to come away. I hope I'm not being too simplistic, but could that be a good thing as far as thickening of the womb lining goes?

I am definitely going to speak to my GP about changing to patches/gel and upping the oestrogen to see if it helps my symptoms, fatigue, chronic insomnia, muscle pain, headaches.

Could I get the same oestrogen which is in Elleste Solo in a gel or patch do you know?

Thank you again Polly, you really are a huge help and support.