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

Deux I'm just puzzled, that's all :)
My consultant gynae divides progestogens into C19 and C21 types. The C19 are the androgenic ones and the C21 are the least androgenic. He says that C19 are the most likely to cause skin problems etc.

Progesterone falls into the C21 group. So yes, it's anti androgenic compared to the others. But ALL progestogens can cause spots and PMT side effects (as with our natural cycles.)

You're just going to have to experiment as you've said.

BB yes Oestrogel is the same as in the tablet you're taking.
Yes, there will be no lining to come away and that's good but if it goes too far the other way, you can get an atrophied lining which may cause spotting.
There is a HUGE ongoing discussion on Menopause Matters forum about Utrogestan and progestogens generally because a lot of women are possibly taking too much for the amount of oestrogen they are using, and having all the downside of HRT caused by the progestogens .

If you are taking a 1mg tablet, 50% or more could be lost in digestion. So you could simply be needing more oestrogen to balance out that amount of provera.

Thank you Polly, I am so grateful, and much clearer on things now.

I think my plan is 1) ask for a repeat pelvic scan
2) swap to Oestrogel equivalent to 2mg of Elleste Solo.

I'm not sure what to do about the progesterone, I'm tempted to stick with Provera as I know I tolerate it so much better than Utrogestan.

I will discuss this with my GP and see what he says.

Thanks again Polly, I'll let you know how it goes at the doctor's.

Maybe do it one step at a time BB? Not much sense in changing both hormones at once 'cos then you won't know which is the culprit if you don't feel so good. Get the oestrogen balance/ dose right first then maybe if that's all going well, think about Utrogestan and try it vaginally? (Usual dose is 200mgs for 10-12 days.)

Good luck

Excellent advice as ever Polly, thank you so much for helping me get things clear in my head. If I do try again with Utrogestan, I will try it vaginally.

Many, many thanks 💐

Polly - just one more question please, how many days should I really be taking the Provera, bearing in mind it's every three months? I'm not sure if it should be 10 days or 14?

Many thanks.

I don't know what the instructions say for it I'm afraid.

Is it on the leaflet? What did your dr say initially?

My consultant was happy / is happy for me to do 10 days of Utrogestan every 2nd month (I was on a 3 monthly cycle using 10 days but the bleeds were heavy) . However, I've increased it to 11- 12 days now because there is some evidence that this gives better protection against hyperplasia.

I think if you can tolerate 12-14 days it might put your mind at rest and won't do any harm. You could always drop back from a 3 month cycle to a shorter one too. Out of interest, why did your dr suggest a 3 month cycle? It's sometimes suggested during peri but post meno most GPs suggest going back to a 4 week cycle. (But consultants have different opinions and can suggest other options!)

I think the GP said 14 days every three months.

Thanks Polly.

When I was first prescribed the Elleste and Provera I was still getting natural periods, albeit irregular. They have dwindled a lot more now, the last proper bleed I had was May. I only get a brownish discharge now which is very scant.

The problem is I've found GPs don't tend to know a lot about HRT and all the different combinations, risks, benefits etc. I have never been offered the chance of seeing a consultant.

We decided on a three month cycle because I wasn't tolerating the progesterone which was Utrogestan initially. I do find Provera a lot more bearable though, so could maybe drop back to every other month.

I think the best plan is to get your oestrogen right - get off tablets- and feel better.

Then fiddle with the progesterone.

Provera is not one of the safest. I spent some time drilling down into the research papers (linked to I think through the NICE report if anyone fancies spending time reading) and there was a range of results for different progestogens and breast cancer. The one used in Provera showed the highest rate, followed by Norethisterone, then dydrogesterone. Utrogestan isn't included because it's not used a lot - or wasn't then.

In the short term, it's worth thinking about even though the actual numbers (of difference) were small. Personally having been on HRT for 8 years I want to go with the safest.

Bluebell, when I had Utrogestan it was prescribed by GP for 12 days. But the consultant has prescribed Provera for 10 days on a 3 monthly cycle.

I think you asked in an earlier post what estrogen I was on. I'm using patches and gel.

I'm currently on Estradot 75 mcg patch and Sandrina 1mg gel on waking and early evening. With the option to increase if I feel the need and to increase at the end of the progesterone phase. The Sandrina comes in individually wrapped small sachets rather than a pump. And also Vagifem vaginal estrogen 3x a week.

I will definitely tackle the oestrogen first Polly, I am desperate to feel more human again. I have put all my symptoms down to the loss of my husband and grieving, plus the stress and anxiety of everything. I do wonder now if it could be insufficient oestrogen.

That's not very encouraging that Provera is the least safe. Is dygrogesterone still available in this country? I just googled it and it says it was discontinued in th UK in 2008.

Deux - thanks for the info on your Provera prescription and the details of your oestrogen. Do you mind me asking how old you are and if you're still having regular periods please?

Deux That's quite a unique regime. I've never come across anyone doubling up on patches AND gel. You're on a very high dose - patch plus 2mgs Sandrena? (Though I think someone on another meno forum was on that- perhaps prescribed by a dr in Surrey???)

Out of interest why are you on a patch and gel, rather than for example 4 pumps of oestogel which would give you 3mgs oestrogen?

I'm interested to know what kind of bleeds you're getting with that amount on a 3 monthly cycle because mine on half that amount of oestrogen were pretty awful, which is why I've reduced to a 6-8 week cycle.

BB Dydrogesterone is not available on its own- only as part of a tablet- think it's Femoston. NO progestogens are perfect. I think I felt better on Norethisterone - more grumpy perhaps as it's more androgenic- but less sleepy/ lethargic than with Utrogestan. But I'm balancing risks with it all and accept some side effects for better safety. Not easy is it?

It's certainly not Polly! May I ask you exactly what combination of oestrogen and progesterone you take please?

There are going to be risks with whatever we take, but I think that has to be weighed up against quality of life, and mine wasn't worth living until I went onto HRT. However, two years on, I do think it needs tweaking.

I am using a bit less than 2 pumps of oestrogel ( so a full one in the morning and not quite a full one at night ) which should give something like 1.5mgs or 1.25mgs oestrogen.

I am doing longer cycles. I was on a 3 month cycle but changed to a shorter cycle on Utrogestan. I am doing a 2-month cycle ie Utro 1Jan then 1 March, but sometimes I move it forward a week or so, so the cycle is shorter if I don't want the bleed to coincide with social and work commitments. I've been advised that 10 days progesterone is enough but I'm happier on 11-12 days (though not feeling too good by the time I reach the end of it.)

I'm a lot older than you though and many years post meno.

Thanks for that Polly. Do you plan to stay on it for a while longer? I feel under pressure, probably just from myself, to get off it. I think because of the loss of my husband to cancer, I am acutely aware of it.

That being said, I do know I couldn't function if I went back to being the way I was before I started it. Unless you try coming off it, how do you know if your symptoms are still there? It really is a minefield!

By the way, I think one of the first progesterones I tried was Femoston and I couldn't tolerate it, so it's looking likely that my only option progesterone wise is Provera.

I'll Pm you BB.

Oh how odd. Has the PM facility gone or just mine?
Anyway- yes, will stay on it as long as I can unless anything medical comes up which changes that.

I think it's easy to worry ourselves silly over it all but other things like obesity and drinking 2 units a day are higher risk factors for B cancer.

Might be worth you looking at the site Menopause Matters and the Risks part of HRT.

Will try to link it here for you.
www.menopausematters.co.uk/pdf/Understanding%20Risk%20of%20Breast%20Cancer.pdf

and here

www.menopausematters.co.uk/balance.php

Polly, my regime has evolved that way. I'm only using 1mg of Sandrena with the 75mcg patch when the patch is coming to the end. I would only use all that if I wasn't getting symptom relief. So my regime is patch plus up to 3 x Sandrena to get symptom relief.

I started with Sandrena via GP then had a trial of patches which I loved but found symptoms returning at the end of the patch (25mcg) so used Sandrena if symptoms occurred.

Consultant isn't a big fan of patches as she thinks the absorption is too variable and you can end up receiving a lower dose. It definitely runs out of steam early on for me so I suspect I absorb the Sandrena much better.

The consultant upped the patch dose as previous patch at 25mcg wasn't sufficient plus not enough estrogen to protect bones. I have 50 mcg ones to try next but I suspect I'll settle with just the gel and probably Sandrena as it seems to suit me.

Bluebell, I'm so sorry you're having such an awful time. Anxiety is awful and I can see why you'd be worried about the risks. There's a lot on just your shoulders. My GP told me I was more likely to die from heart disease than cancer from HRT.

I'm 51 and had my last proper period in May this year. They had been alarmingly regular till then and I have an unremarkable gynae history. I'd had peri symptoms for a number of years though. The flushes started July and arrived full force. I only managed 2 weeks before getting some estrogen.

Have you tried using Kalms as a sleep aid? It was suggested to me by a pharmacist eons ago when my DH was gravely ill and fear and adrenaline was stopping me sleeping. He said to take 2 or 3 at bedtime. Just a thought.

Polly - thank you for sharing not just practical advice, but also your own personal thoughts and opinions, I really appreciate. I am well within my ideal weight, have never smoked and rarely drink alcohol. I will look at the Menopause Matters links.

Deux - thank you so much for your support and understanding, it means a lot to me. I have been up since 4.00 am again, after about three hours of very broken sleep. At this point I just don't know how I'm going to get through the day that is stretching ahead of me.

Thank you for the advice about trying Kalms, I will definitely give it a go. I am currently trying magnesium, melatonin and L-Theanine. I have been doing this for a week now with zero success.

Look forward to continuing to compare notes with you. Good luck!

Hi Polly, just checking back in to up date you on my doctor's appointment.

He has swapped me from Elleste Solo 1mg to Oestrogel, it's actually called Oestrodose. I'm unsure how many pumps to use though, the GP wasn't very clear and the label from the pharmacy isn't either. It says each metred dose contains 0.75mg of Estradiol and the usual dose is 2-4 pumps. As I was on 1mg of Elleste, I'm guessing 2 pumps, would you agree?

On the subject of the pelvic scan, my GP had written to a gynaecologist for advice and she has advised a repeat pelvic scan so I am being referred for this.

Thank you in advance Polly.

Bluebell.

Hi My understanding is that 2 pumps= 1.5mgs. This may give you slightly more than a 1mg pill as some of the pill will be lost in digestion.

The starting dose with gel is 2 pumps bt I was advised by my consultant when first starting HRT to begin with 1 pump for a while and see if it controlled my symptoms. It didn't completely so I increased to 2. Now I use roughly 1.5 pumps.

Oestrodose is the same thing- just another trade name which seems to be easier to get hold of than the oestrogel- not sure why. I've had / had both.

The answer to your other question re provera and progesterone is you ask the dr for Utrogestan- that's the trade name- Mic. progesterone.

Thank you so much Polly, I really appreciate all your help and advice. I'll keep you posted!

Hope you get on okay! I suggest you give whatever dose you try, around 2-4 weeks to see how you go with it.

Will do Polly, thank you. I've started this morning with a pump on the top of each arm. Can I just clarify Polly, is Provera every three months enough when I'm using oestrogen every day? I'm torn between the risks of taking Provera but don't want my womb lining to build up. I am finding this all very stressful on top of everything else, I wish I could get referred to a specialist as my GP isn't very well versed on HRT.

Thank you, Bluebell.

Im confused now Bluebell- thought you were swapping to Utrogestan?

If you are going to carry on with long cycle HRT having a bleed only once every 3 months, this is usually only done under a consultant OR if your GP is happy to put you forward for a scan every 12- 18 months. This is because there is a slightly higher risk of endometrial thickening with long cycle HRT if used long term .

You can go for a scan yourself privately- there are places across the UK who provide there with no referral.

I've used long cycle for 8 years but have had scans (arranged by my consultant but I have to pay) .

I hope this helps.