How quickly did progesterone sensitivity show up?

[SameKeyThough]

Hi, I've been struggling with my mental health for the past year, very severe depression and anxiety. It's a lot better now, and I'm on quite a few meds which are helping, but I'm still not consistenly OK or back to my usual pretty cheerful self. So I have started on hrt - estradot 50 for the past 2 weeks, which seems to be going OK- and am due to start the utrogestan 200mg tomorrow. I'm going to use them vaginally to try to avoid side effects. I'm very scared that I will get changes to my mood and will go downhill again. If that is the case, do you think it will happen quickly or will it take weeks to show up? How did starting utrogestan make people feel? Thank you.

I'm on a half dose vaginally because of progesterone intolerance. I was advised this week that it is not as protective of the womb lining to use half (my private menopause doctor who prescribed the half dose had left and so their replacement was more cautious about using it in this way). It has helped reduce the mental symptoms that came with taking it orally and I have generally coped with it better. Sometimes the last few days of the 14 days I take it I start to feel a bit low. I was advised the other alternative treatment was hysterectomy. I have heard perhaps in other countries of women not taking progesterone but having regular ultrasound scans to monitor womb health. That may not be an option in the UK. Good luck with it.

@WarriorN do you still need to take it on an empty stomach if you use it vaginally? That didn't occur to me! I definitely didn't use it 2 hours after food, probably about an hour??

No sorry, I don't think I've been making sure it's a good 2 hours after food orally.

Though some women deliberately do so to absorb more.

@FelicityElectricity have you increased your dose then? Hopefully using the utrogestan vaginally will still help keep symptoms at bay, even at the higher dose?

I have heard perhaps in other countries of women not taking progesterone but having regular ultrasound scans to monitor womb health.

It's most definitely not an option in the UK @FelicityElectricity

No dr would be allowed to prescribe it.

The risk of hyperplasia on unopposed estrogen is 20% in a year. Out of that 20% of women, some will have developed endometrial cancer or atypical cells.

There is a case for less progestogen (off licence) and that is usually only offered privately so that women have to fund scans, usually annually. These cost anywhere from £200-£00 depending in the type of person doing them (ie a sonographer, or consultant gynae/ radiologist.)

@FelicityElectricity The dose is 12 days not 14. There is no need to use it for 14 days on a monthly cycle. The dose of 12 days is on the patient leaflet.

My dosage is 100mg on days 14-28 of my cycle and that was prescribed by Newson Health

One thing I've noticed is I'm absolutely exhausted today. Could that be the utrogestan already? Even though I'm using vaginally? I already feel like a zombie most days because of an anti anxiety medication I take, olanzipine, so I hope this doesn't get any worse. I'm feeling quite fed up today, why does it all have to be so complicated?

Yes, I am sure it was. The BMS has advised the dose to be 200mgs per cycle, or 100mgs daily.

journals.sagepub.com/doi/full/10.1177/20533691211058030

@SameKeyThough Have you considered stopping the other meds for anxiety and giving HRT time to work?

@JinglingHellsBells yes that's the plan - but I'm trying to only do one thing at a time, which is hard! The olanzipine has to be tapered off very slowly, as there's a risk of relapse, but I'm unsure about doing that at the same time as starting the hrt, as if my anxiety gets bad again I won't know if it's because of starting the hrt (mainly the utrogestan) or reducing the olanzipine. I'm very keen to get off the olanzipine as not only does it make me very tired, its caused me to gain 2 stone in 6 months 😟

@SameKeyThough I'm really sorry you are having such a tough time. :(

One thing that some specialists do, is suggest estrogen-only for a month to see how that feels, and get the dose right. I am not suggesting you do that, but it can be very helpful.

FWIW I have almost no 'brain effects' using Utrogestan vaginally. I've used it that way for some time now after years using it orally.

Orally, I'd feel tired for the morning but it would wear off by lunch. I'd also by the end of 12 days feel a bit sluggish - exercising was that bit harder.

Now though, I have only 1 side effect and that is feeling hot at night when I use Utrogestan. I try to override this by upping the gel a little for a few days.

I suggest you really try not to predict things that may 'go wrong' as there is a very strong 'nocebo effect' (opposite of 'placebo') where you can end up having side effects as you expect them.

Also, although Utrogestan has become the go-to progestogen now, it was rarely used in the UK until a few years ago. It's all a bit 'new'. It does have advantages- for long term use it's supposed to have less risk of breast cancer. But there are other types of HRT that women can take that may suit them better.

For example, Femoston ( tablet form of HRT in a pack) has a progestogen that has the same safety profile for BC as Utrogestan but many women find it has fewer side effects.

I'd not get hung up on using Utrogestan if it doesn't suit you. be prepared to try other types and discuss with your GP after doing your own research.

@JinglingHellsBells thank you, that's very helpful. I'm definitely guilty of having a 'nocebo' effect at times! I'm trying not to let that happen with the utrogestan.

I have a very long history of anxiety and a recent experience of severe depression. The depression was brought on (or maybe just exacerbated by) starting HRT - Estradiol and oral Utrogestan. The reaction (anxiety, panic and depression) was huge and debilitating.

I changed to taking the Utrogestan vaginally and the difference was incredible. No negative emotional side effects at all.

I also had terrible progesterone sensitivity when I had periods - I now know it was PMDD.

@MWNA thank you for your reassuring words. I'm sorry to hear that you had such a bad experience initially- that has been my fear about starting hrt. I've been nearly a year now trying to get better, I'm really hoping hrt is the missing piece of the puzzle.

HRT and the right dose of Escitalopram for my anxiety and depression have changed my life for the better.

I really hope you can take the plunge and feel similarly.

Another update - 2 days into the utrogestan and I think I feel OK, although I am still very tired. I'm tired anyway as I said because I take another medication that causes tiredness, but it seems to have gone up a level. I also feel rather down, but that might be because I'm so exhausted.

@MWNA @SilverGlassHare @WarriorN @TriffidInMyShower can I ask how long it took for any mental symptoms to improve on hrt? I'm feeling quite down today, I don't think it's necessarily the utrogestan as I've not been happy for a long time, but I'm a bit despondent thinking hrt might not be the magic bullet I was hoping for. I've only been on it 2 weeks so early days I know....

@SameKeyThough hmmmm. I’d say my overall mental health is better now I’m on HRT. I’ve been on it for 2.5 years or so, but it took ages to get the dosage right so it definitely wasn’t a ‘Wow, now I feel great!’ 2 weeks or a month after starting. I’ve only had the progesterone sorted for the last year or so.

I still get bad days, though, but definitely no longer term depression. My brain fog has improved a bit. TBH I haven’t found HRT to be the wonder drug some women find it to be - I’m taking it mainly because I started menopause prematurely and I want to protect my heart and bones etc. I certainly never feel/felt ‘buzzy’ on HRT,. unlike a previous poster.

It took longer than other symptoms certainly. Possibly a month to 6 weeks? Mainly the brain fog improved then. But I have since gone down hill as I needed more - if it's not enough for you it may not impact. Covid affected my mh and brain fog hugely for a while.

Some women say that it was testosterone that really helped there but nhs prefer you to have had a really good go at maximising hrt first, and then only prescribe for libido. But women report better cognitive effects too.

Had a bad night last night with anxiety. Not sure what to do for the best. I'm so exhausted by this, I'm not sure I can take much more.

Also, although Utrogestan has become the go-to progestogen now, it was rarely used in the UK until a few years ago. It's all a bit 'new'. It does have advantages- for long term use it's supposed to have less risk of breast cancer. But there are other types of HRT that women can take that may suit them better.

I started Estrogel & Utrogesten last year, stopped due to high BP, and now that's controlled the gp said he was happy for me to restart hrt. Since taking Utrogesten for a few days I am experiencing* *very bad breast pain like someone has stabbed them with a hot poker! I'm terrified about the risk of bc since my mum died of it so really want to stop again. I was on it for 2 months before and never had this. It's very unsettling.

www.nbcnews.com/id/wbna33292706

This article has really freaked me out!

That's oral oestrogen not transdermal and not body identical hrt.