Conflicting advice re HRT/Progesterone only

[Reallysad123]

So.... I seem to be having rapidly escalating menopause symptoms (I'm 47), the one that bothers me most is truly awful insomnia, but also have shorter, lighter cycles, anxiety, fatigue, more UTI's, spotty skin etc.

I asked a private dr about this and she is adamant I need progesterone only as this drops first (despite being in balance with oestrogen on bloods). She says I don't need oestrogen as still having periods.

Also asked my GP as wanted her to prescribe bioidentical if possible, and she was v accommodating and suggested Sandrena gel and micronised progesterone (utrogestan) 100mg for 21 days then stop for bleed.

Completely conflicting advice and not sure what to believe, although on the plus side I've got plenty of hormones on prescription now so can experiment to see what works. I thought the progesterone only/oestrogen dominance theory was a bit discredited. Has anyone tried progesterone only and has it helped? I've tried progesterone cream (not the online stuff, from the private dr), which didn't help whatsoever, so the response from them was to try it orally in higher doses.

Seems hard to get decent consistent advice on this subject.....

Presumably the dr who wants to offer progesterone only is offering you unlicensed drugs? These are not safe anyway as they are not regulated drugs and the treatment for your symptoms is estrogen. Having periods does not mean you don't need estrogen. she sounds like a quack.

To my knowledge, progesterone is not available as drops. if it were, lots of women would use it. I've not heard of anyone. Which dr is this?

Your GP is better but it's still not the right dose. Using Utrogestan for 21 days only is not an option for anyone still having periods and she ought to know this!

There are two methods (I've used it for years from a top UK menopause gynae)

1 For women post menopause, it's 100mgs daily every day or 25 days a month to allow 3 days for a possible bleed.

2 For women in peri the dose is 200mgs for 12 days out of a 28 day cycle. You can start on any day but stick to that day- ie 1st each month OR time it to start on the middle point of your natural cycle.

Yes, the estrogen dominance stuff is rubbish- no basis for it except to sell progesterone cream which doesn't work.

Sorry- thought you said the progesterone was taken as drops.

She still sounds like a quack.

We only have progesterone after ovulation, so it's not a case of it dropping first. That's incorrect. Unless you ovulate you don't produce progesterone. So adding in extra makes no sense at all. Post menopause women have none at all.

It's not hard to get the right advice- the dose for Utrogestan is on the leaflet in the pack- your GP needs to read it!

The doctor is a private one, but is registered with the British menopause society. She's suggesting utrogestin at 100mg/day. I wasn't sure as had bloods done and hormones appear fine despite having symptoms. Yet the dr said she doesn't believe that my progesterone is as high as the bloods suggest. This seems odd as she's saying she doesn't think I need oestrogen based on bloods but do need progesterone, it doesn't make sense. I've read all the general guidance on HRT and progesterone only is never mentioned. Doctor reckons if I'm still having periods I still have oestrogen and don't need to supplement it. But there are loads of women on HRT still having periods (and having menopausal type symptoms) from what I can see.
Maybe I'll change to a different private doctor. My GP is supportive but not at all confident which doesn't inspire confidence in me. Maybe I just need to experiment with what works for me?

She's talking nonsense. Care to name her - or by PM? I know of most private gynaes as I'm a health writer and talk to a lot of them. (But sure I've never come across her.) Taking Utrogestan daily is likely to make you feel pretty awful if you are not having estrogen as well. I felt awful on it daily WITH estrogen!
Yes, HRT is for women still having periods. Symptoms are caused by loss of estrogen not progesterone. I've never known any dr supplement with progesterone only .