Progesterone and mental health

[Nicecupofteaandabiscuitor2]

45yo, perimenopausal, I started HRT to try to improve my mental health but I’m just not getting on with the progesterone.
Started on Evorel Sequi in Jan. The progesterone half of the month found me murderous, contemplating divorce and/or jumping off a bridge. However it improved my night waking and stopped the night sweats. Getting more sleep was a big boon.
From March, moved to Utrogestan which I hoped would be gentler as it’s the more body-identical one. Oestrogen has been slowly upped to a 100 patch. Increasingly I am finding the Utrogestan period dire. Really not good for my mental health. Black suicidal thoughts and unstoppable weeping.
I daren’t try the Mirena coil because if that has bad effects I can’t remove it immediately. Will try the Utrogestan vaginally this month, though I feel weird about inserting it (how?), using it off-label (though I know it’s used like this in Europe) and the fact that my cycles aren’t fully synced, so the last few days I am likely to be menstruating heavily (presumably it’ll be washed away from the spot).
Has anyone had any luck with this method, or any other suggestions of how to improve it for someone who is clearly sensitive to this hormone? I had very bad PND which I’m starting to suspect was hormonal. Any specialist recommendations? Thank you so much for any advice.

I am horribly sensitive to progesterone and have a mirena with zero side effects - I absolutely love it and my mental health is so much better. It's now part of my HRT but I had it before that due to hormone issues - I don't know if that makes a difference.

(I had the terrible PND too!)

Thank you Bruno, that’s so interesting to hear. I wonder if it I should try it but I’m so worried about it going wrong.

Bruno how did you find out you were sensitive to progesterone, if you don’t mind my asking? I’m just guessing for me, but it does seem to correalate.

@Nicecupofteaandabiscuitor2 I'd give the vaginal route a try to be honest. It may be the answer! If you bleed before completing the dose, take the rest orally. (if it's just for a few days and you can cope.)

You just insert them with your finger, as high up as possible, last thing at night. They do leak a bit and you may need to wear pants in bed.

Other options that you could do under a menopause specialist include just 10 days per month, longer cycles where you use it only every 2nd month, or (from your GP) the brand Tridestra which is a 3-month cycle (not body identical, so it depends how you feel on that.) the 3-month cycle means the progesterone used for 2 weeks in 12.

If you don't get on with Utrogestan there is the tablet form HRT Femoston. This has a progesterone similar to Utrogestan (almost as body identical) so that's worth thinking about.

p.s. The reason for the above being from specialists is that it's off-licence prescribing, and sometimes comes on the understanding that you will have a scan every year or so to check the womb lining (as an MOT.) That isn't covered on the NHS unless you had symptoms requiring a scan.

Hope this helps.

Thank you Jingling that does help. I’ll give the vaginal route a go. There seems to be dispute about whether to 100 or 200mg per dose vaginally but I guess I’ll do 200. Hope it helps.

I’ve just been reading a paper by Nick Panay and wondering if I should give the coil a go. It’s so hard to know. www.researchgate.net/publication/13933740_Progestogen_intolerance_and_compliance_with_HRT_in_menopausal_women

The vaginal dose is the same as the oral dose. (British Menopause Society confirmed this recently and Dr Newson needs to update her advice/ website.)
I've used it both ways for years and my consultant has never said reduce the dose vaginally and he would if it was the case.

Again, this comes with the proviso that a consultant may well allow a lower dose but you'd be forking out for a private scan now and then to check all was ok.

Bear in mind that the link you left is from 1997 when micronised progesterone was not used as part of HRT (and it's still not licensed to use vaginally, in the UK.)

I didn't find a huge difference in mood using Norethisterone compared to Utrogestan, but I did get a PMT type monthly spot on my face with it.

The one surprising thing I found from the Mirena was that it reduced my rages.
It’s massively reduced my heavy periods, and I wouldn’t be without it now.

You might like the Mirena as you would not be cycling.

My menopause doctor identified that I was very sensitive to the changes in hormones from a cycle so it was important for me not to be ovulating.

I'm on Cezarette plus Utrogestan and honestly didn't notice the difference from adding Utrogestan.

Anyone with a history of PND (and yes, it's definitely caused by hormones for those women who cannot tolerate progesterone and/or hormonal fluctuations) is at far greater risk of developing severe anxiety/low mood during the peri menopause. I know this because I was one of them - and had this explained to me by a top consultant gynaecologist who specialised in what he called 'reproductive depression'.

Hormonal fluctuations are extreme during the peri menopause, and for those who are progesterone intolerant it can feel like Hell on Earth. I spent many times in a very dark place that I never want to go back to.

Very few GPs know anything about reproductive depression - I saw three different GPs who all told me I couldn't be in peri menopause because my periods were still fairly regular and I was only 43. They also refused to draw a link between my well documented history of severe PMS + PND and me suddenly experiencing the exact same PND symptoms during peri menopause (although both my babies were teenagers by this point).

You really need to see a specialist. They may well increase your patch and lessen your dose of Utrogestan to see if that helps. I could only tolerate 100mg of Utrogestan for just 7 days per month and my consultant was perfectly happy with that. But you won't find a GP prepared to advise you to do this.

Thank you peaceanddove. If you’d recommend your consultant would you mind PMing their details, I’d be so grateful.

I do have very heavy periods which is a point in favour of the Mirena.

Mine was at Spiced Pear and gave the same advice which was a huge relief after my GP had totally failed to grasp what I was getting at.

Thank you Anna, just looking them up, never heard of them.

I was thinking of Nick Panay, as he's the name that often comes up re PMDD. Not that I know I've got that, but he seem to be interested in female hormones and mood.

My HRT doctor has suggested I increase oestrogen to 150 by cutting a patch in half and wearing one and a half at a time. I feel a bit weird about this -- it all seems so DIY! And if you were meant to be on 150mg, wouldn't they make 150mg patches? But I suppose all medicine is a bit DIY once you get under the bonnet.

I am currently doing DIY cutting my Estradot! Not really got the knack but they are working.

I found them from the BMS website and they were great.

Of course. I saw Prof John Studd. If you Google him his website will come up.

Thank you so much. Gosh his website looks fantastically informative.

Progesterone intolerance is not uncommon. I cant seem to get on with any of the progestogens,not even utrogesten. Not even the mirena.
Eventually I managed to convince doctor to let me try livial tibolone which works differently. Its only supposed to be for post menopausal because can cause irregular bleeds, but its been a gamechanger for me

I use utro vaginally and find it great. But I've also considered mirena to stop fluctuations. I'd prefer to use utro continuously though but not sure about vaginally. (Remembering!( In considering trying oral now I'm on higher levels of oestrogen

If using higher oestrogen levels, it's important to oppose them to avoid over thickening if the womb lining.

Utrogestan is same dose vaginally or orally

I saw a specialist privately (now retired). He didn't even do blood tests - he said from my history of hideous periods, PND, flooding and then HORRIBLE side effects of progesterone supplements I was given to stop the flooding, it was obvious - he'd seen it a thousand times before. He had to really persuade me to try the mirena once I heard the word progesterone, but it was (and still is!) life changing.

Please don't be put off by googling - very few people take the time out of their day to post about how their contraceptive is "pretty good really"!

My consultant told me exactly the same. He told me my history of severe PMS + PND was sufficient for him to correctly diagnose what was wrong with me. He said I was a 'poster child' for what he calls 'reproductive depression.'

In women who are progesterone intolerant, it's pointless doing blood tests because they only show a tiny snap shot of what's going on, in that particular minute. And it's the fluctuations that cause all the nastiness. A blood test cannot track hourly fluctuations.

@peaceandove Prof Studd died some time ago. (think it was the summer of 2021.)

I know some people rated him highly but others felt he was too rigid in his treatment (all women ended up on the same thing) and there were also some women who ended up with hyperplasia on such low doses. (I think one of them posted on another menopause forum.)

You are right that consultants can vary the dose in ways GPs can't.

Yes, I think I read he had passed away? His clinic still operates though under consultants who trained under him, I think? He was a remarkable man and a huge champion for women's health in a time when it just wasn't the 'done' thing to discuss periods/menopause/PND etc.

I do know that he tended to prescribe a blanket-type medication regime, but I honestly think that was because it worked brilliantly in 95% of cases. When I was on his regime I had a yearly uterine scan to keep an eye on my womb lining (it was always fine).

But, to be honest I would have very happily risked my womb lining becoming far too thick and the resultant treatment - because that could be treated. Killing myself because my mood was so dreadfully low and the anxiety so severe......well, there's no treatment for a successful suicide. He saved my life.