HRT help - cannot take progesterone due to the side effects

[Monr0e]

I'm 46 and started on hrt patches in January mainly due to the horrific night sweats I was suffering.

They have helped enormously with this however the progesterone tablets I have to take alongside are causing awful side effects, mainly anxiety, migraines and nausea, to the point I would rather suffer the night sweats.

Can anyone recommend anything that might help instead? I have spent most of the weekend wiped out with another migraine and can't function whilst taking the tablets.

Are you taking artificial progesterone or bio identical? I can’t tolerate artificial but find bio identical to be just fine. Speak to your GP. You can’t take eostrogen without progesterone is my understanding as you need it to protect your womb.

How about the bio identical HRT? I think it's a gel rather than patches. Friend was evangelising this the other day.

I found progesterone only contraception gave me terrible anxiety, BTW.

Are the tablets Utrogestan?

Could you try a Mirena coil? I was very reluctant for years but actually it suits me much more than Utrogestan.

Utrogestan is body-identical, though, so perhaps not what you’re on?

@RagzReturnsRebooted

How about the bio identical HRT? I think it's a gel rather than patches. Friend was evangelising this the other day.

I found progesterone only contraception gave me terrible anxiety, BTW.

@RagzReturnsRebooted All estrogen used now is BODY identical ( bio identical is not licensed and is something different.)

Utrogestan is the only body identical progesterone.

It might be worth trying a different progestogen. Utrogestan is the body identical one but, oddly, it doesn't suit everyone so some people may respond better to an alternative
Other options would be to try it vaginally rather than orally, as a Mirena coil or as a combined patch (although some of those have supply problems at the moment)

@Monr0e What are you taking?

If you use a patch that suggests it's estrogen-only and you are using Utrogestan too.

I’m about to have the mirena fitted as the tablets are giving me awful migraines too, and I’ll have gel or patches alongside for the oestrogen.

Which progesterone pill are you taking? I can only tolerate Utogestan which is micronised progesterone, the real natural deal. The others are synthetic and I can't tolerate them at all. I could never get on with the pill either regardless of which I tried, so it all makes sense.

Thank you for your reply

I was originally on Provera then the gp changed to utrogestan. I presume they are artificial?

She said the next step would be the coil which I absolutely do not want to do. I have never reacted well to hormonal treatments so I'm feeling really out of options

Sorry, lots more replies while I was taking ages to respond to the first message.

My fear with the coil is the permanency of it. I know it can be really difficult to get it removed once in and if I react badly I can't imagine being stuck with it for months.

I can tolerate utrogestan just about when used vaginally. The coil was awful for me.

Utrogestan is micronised progesterone and is natural (body identical.) It's made from yams and it's also the safest re breast cancer. it's worth persevering if you can. As PP says you can use it vaginally, off label. In Europe it's normal to use it that way.

How many days are you using it? Some GPs over prescribe. It's 12 days per calendar month, whereas some drs are saying it 14 days out of 28.

Some women use less under supervision of private specialists who can prescribe off label.

Try it vaginally and see.

It's prescribed for 12 days out of 28. After around day 7 the anxiety and migraines start. I still have the tail end of a headache which has lingered now for 4 days, I'm miserable and struggling with work. I'm an NHS keyworker working front line with patients every day. No option to switch off, I have to constantly have my game face on. I think I'd rather have the hot flushes at this point
Thank you everyone for your comments

@Monr0e

Sorry, lots more replies while I was taking ages to respond to the first message.

My fear with the coil is the permanency of it. I know it can be really difficult to get it removed once in and if I react badly I can't imagine being stuck with it for months.

I haven't heard that coils are hard to remove?

@JinglingHellsBells

Utrogestan is micronised progesterone and is natural (body identical.) It's made from yams and it's also the safest re breast cancer. it's worth persevering if you can. As PP says you can use it vaginally, off label. In Europe it's normal to use it that way.

How many days are you using it? Some GPs over prescribe. It's 12 days per calendar month, whereas some drs are saying it 14 days out of 28.

Some women use less under supervision of private specialists who can prescribe off label.

Try it vaginally and see.

Try using it vaginally.

Or swap to the Mirena. I had that option (didn't want it) but my dr said after 3 months if I hated it, he'd remove it.

You can also stretch to 12 days out of 30 rather than 28.
OR with medical supervision some women use 10 days, or less than every 4 weeks. These are the options consultants can offer off label, compared to GPs.

I’m progesterone intolerant (suicidal level PMDD) and Utrogestan made me feel very ill indeed. I compromised on the Mirena, had it fitted under a GA (alongside a hysterescopy) and have been OK with it.

I always reacted badly to progesterone - could never handle The Pill, etc. But I had a Mirena fitted and I’ve been absolutely fine in it.

There's a thread going on Menopause Matters about another alternative to utrogestan: Lupigest.

www.menopausematters.co.uk/forum/index.php/topic,58038.0.html

Seems to be some debate as to whether it's available on the NHS or just privately, but might be worth reading.

I meant hard to remove as I difficult to get an appointment and arrange for the procedure once it is inserted rather than a procedure to perform

I don't think a shorter period would work, I start to feel the effects within a week

Thank you for all the advice, I do appreciate it.

@JinglingHellsBells

Utrogestan is micronised progesterone and is natural (body identical.) It's made from yams and it's also the safest re breast cancer. it's worth persevering if you can. As PP says you can use it vaginally, off label. In Europe it's normal to use it that way.

How many days are you using it? Some GPs over prescribe. It's 12 days per calendar month, whereas some drs are saying it 14 days out of 28.

Some women use less under supervision of private specialists who can prescribe off label.

Try it vaginally and see.

Do people just use the oral capsules vaginally or does it have to be prescribed as pessaries?

My GP said the directions are "day 15 to day 26" which, as you say is 12 days but Louise Newson says it can be taken for 14 of 28 and she is a menopause expert

Sorry posted to soon. That was meant to be a question, why would a menopause expert recommend 14 days if that is over-prescribing? Is it just what suits the individual or is the 12 days better?

@bobsgirl I'd have to read her page to see that. I have no idea.

This is what the C&W menopause clinic says and it's what used to be on the patient leaflet (12 OR 14 days)
www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause-and-pms-clinics/links/ProgestogenandProgesteroneRegimensinHRT130518AGREED.pdf

This is the bit you need:

Progestogens or progesterone should only
be taken following the regimen advised by
your specialist.
Continuous combined HRT regimens:
• Norethisterone 5mg, every day
• Utrogestan 100mg every night
Sequential combined HRT regimens:
• Norethisterone 5mg twice daily, for 12-
14 days every month
• Utrogestan 200mg (2x100mg capsules)
at night for 12-14 days every month

That leaflet will have been written/ okay-ed I assume by Nick Panay who heads the clinic and is one of the best menopause gynaes in the UK (as is my own!)

(I use it for less than 12/14 days a month on a tailored regime.)

Yes, you insert the capsules vaginally. There is a 200mgs capsule that comes with an applicator but it's not now available on the NHS as HRT. It used to be, but now it's a case of using 2 x 100mg.

I'm exactly the same, the progesterone is making my life miserable and I only take it for 10 days out of 30/31 (the 15 to 25 every month). I too am scared to have a coil fitted because it seems so permanent, my consultant thinks a hysterectomy would be very extreme, i on the other hand think I have hopefully another 30+ years of living to do and don't want to be debilitated for a third of that.

I discussed using vaginally with my private consultant but he said no as I'm on too high a dose of estrogen - 75 micrograms. So we're now trying Testosterone to see if that helps. I just dread taking the progesterone every month as I know I'll have migraines, severe anxiety, I don't want to go out or see anyone, loss of appetite, extreme fatigue.....so I'm now on the 3 month waiting list for Dr Newsom