Feeling awful whilst taking utrogestan - can anyone help me understand why?

[Wigglypasta]

I am on my 4th month of HRT. Prior to starting HRT I had irregular periods but they were making me increasingly ill each time I had one (one sided headache, nausea, exhaustion and feeling emotionally drained were main symptoms). 3 months before starting HRT I developed hot flushes and night sweats - the hot flushes were all day every day and night sweats every 2 hours through the night so my GP started me on oestrogel and utrogestan. I am on 3 pumps of oestrogel and take 2 utrogestan orally days 15 - 26.

1st month I had no bleeding and felt no effects from the utrogestan. 2nd month about 6 days after starting the utrogestan I got my period and felt pretty rubbish, much like I had done during my period prior to starting HRT and the flushes and night sweats returned although much milder than before I started HRT. 3rd month same thing happened about 6 days after starting utrogestan I started to feel really unwell - the one sided headache that won’t go, nausea, dizziness, exhaustion, emotionally miserable and the hot flushes but this time i had no proper bleed - just one day of what seemed to be the start but then nothing. And so here I am on month 4, again on day 6 of the utrogestan with the headache, nausea, exhaustion, hot flushes and feeling totally shattered.

What is making me feel like this? It is the same symptoms that I had prior to HRT but definitely seems to be caused by taking the progesterone. I am trying to understand if it is too much / too little progesterone or maybe too much oestrogen or my own hormones causing issues? I don’t know! Can anyone help me understand what all the hormones are doing and if there is anything I can adjust / change to stop feeling so rubbish every 4 weeks. My googling just tells me that all my symptoms are caused by fluctuating hormones which doesn't help me understand what exactly is going on. Thank you.

Not everyone gets on well with Utrogestan.
It's become very popular because it appears to have less risk for breast cancer, when used long term compared to other progestins.
But not all women get on with it and my consultant said it's a love/ hate' thing.

You could try using it vaginally- just pop in 2 capsules at bedtime. That may reduce the symptoms.

If you still find it's not suiting you, try another type of HRT.
Femoston (tablets) have pretty much the same safety profile, although for older women (60+) it's better to use gel, but for younger women, tablets are fine.

Don't struggle on if it doesn't suit you. It's only very recently that GPs have started prescribing it as the 'default setting' !

I didn't like Utrogestan at all - it was like a return of all my peri menopause symptoms for the time I was taking it.

I now use Duphaston (I think I remember from another thread that it's not prescribed in UK - I'm in Ireland - but I might have that wrong). No problems at all when using that.

Duphaston per se doesn't exist in the UK but maybe @EarringsandLipstick you could google it and get the generic name/alternative UK brand name and that might help the OP?

Thank you for the advice. When you say take the tablets vaginally - do you mean these same ones that I am taking orally (utrogestan 100)? I have seen people talking about this on here before but I was never clear if it is the tablets I already have as the leaflet makes no mention of it. Another option I suppose could be the mirena coil but I am not very keen on having that at all really.

I think I was hoping that it would all settle down but it just seems to be getting worse each cycle. I have never had a bleed at the end of the utrogestan either (just the one period which came mid cycle the second month I was on HRT) but I think that is ok isn’t it as not everyone has the withdrawal bleed.

In the UK, Utrogestan is not licensed for vaginal use except for fertility treatment. However, it is in the rest of the world! It's nothing to do with safety, as most meno gynaecologists prefer vaginal use as it avoids the side effects you have. It's the same capsules. You push them up as far as you can so it's absorbed through the cervix.

I don't know why you aren't bleeding. Are you following the instructions re. Utrogestan and taking it at night?

Thank you @JinglingHellsBells . Yes I take the utrogestan at the same time each evening just before I get into bed and have not missed a dose at all. I take it for 12 days on and 16 days off.