Too much progesterone not enough oestrogen?

[amethyst69]

Hi I'm on a regime of 1 spray lenzetto and 200mg utrogestan pessary only started a month ago. Im not allowed more lenzetto as I had simple endometrial hyperplasia (no atypia) in 2021 though it cleared without treatment and I've had 2 negative biopsies

The lenzetto initially made me nauseous and bloated but the nausea passed and i felt OK for the rest of the 14 days. I got to day 3 of utrogestan (inserted at bedtime) and woke up feeling depressed, completely out of it so much so I delayed my commute to work as I didnt feel safe driving. I sleep well anyway do dont need additional sedation! The aches and pains which are my main peri symptom came back in force, along with an awful spasm in the side of my head. This spasm and a 3week headache which ended up with an emergency appt. was what I had when I tried the mirena (along with a host of other unpleasant side effects like blurred vision).

My GP will neither increase the lenzetto or reduce the utrogestan so I've stopped both to clear my system before I look at next steps. That was 2 days ago. Today I'm bleeding which wasn't unexpected but feel energised and bright.

Is this a case of too much progesterone not enough oestrogen?

Thanks for any input!

Hello, my GP prescribed 1 spray (Lenzetto) and half a 200mg Utrogestan pessary so I cut it in 2 and insert only half each night. I have been on HRT for 5 weeks now and 2 days ago I started using 2 pumps of Lenzetto but don’t like how I feel on 2 pumps (anxious, tense and bloated) so I don’t know what to do now…. Go back to 1 pump or try to stick to 2 and wait until I see my GP again in 5 weeks.. argh I was told to use 1 spray for a month then up to 2 sprays then go back to see her (she’s away for a couple of weeks now).

I was prescribed 100mg of the progesterone and that’s not meant to increase. I am new ish to this but I read a lot about it and the Balance forum is amazing so maybe try asking questions there (I don’t remember ever coming across anyone on 200mg of progesterone unless it’s as fertility treatment, has anyone mentioned cutting the pessary in half? Best wishes.

You take 200mg over 12 days i believe if peri menopausal, still having periods. 100mg daily if menopausal, 12.months period free.
I dont get on great with utrogestan either, im on 100mg daily. But having a 3 day break to see if im any better off it and consider a patch from there

Thank you@MoniTW and @SamR36

Its interesting how the prescribing is so varied. No the dr was adamant it was 200mg or nothing and no increase to the spray. Is the balance forum on the app? I'll check that out

Having stopped after 3 days of the utrogestan I'm now bleeding quite heavily but feel like I've lost about an inch all over and half a stone!

@amethyst69 Unless your GP has reasons for suggesting 200mgs, he's wrong.

The cyclical dose is 200mgs x 12 days.
Combined continuous dose is 100mgs a day.

Re. the hyperplasia- was that HRT related? Were you using HRT when it developed? Were you having normal periods at the time and how was it treated?

If you were being treated by a specialist for it, they are the ones who should be advising on your HRT dose.

The latest advice is that women on high doses of estrogen should consider 200mgs daily, but a high dose is considered 3 pumps of gel and above, and a patch of 75 /100mcgs.

I don't think 1 spray of Lenzetto is considered a high dose.

@JinglingSpringbells thank you for your input. My cyclical dose is prescribed at 200mgs pessary for 14 days. No the hyperplasia wasn't HRT related. My periods had been regular, then got heavier and longer so they did a scan, lining was at 11mm so did a biopsy and polyp removal. That first biopsy showed 'very mild EH non atypical'. Treatment plan was to monitor. After that my periods went back to pretty much regular and subsequent 6 and 12 month biopsies were clear. The consultant wasn't clear why it developed.

I understand lenzetto 1-2 spray.is the equivalent of 1 pump of oestrogel or 25mcg patch. The consultant I was under for hyperplasia didn't deal with the HRT it was the newly formed meno clinic and their review point was 12 months (March 2024) with GP between. Since posting I've called the clinic and pushed for a review

Sorry- I misunderstood. I thought you were using 200mgs daily, every day.
The dose you're on is right and your GP is right not to reduce it.

I'm not 100% sure on the strength of Lenzetto BUT I thought I'd read it was stronger than gel and 1 spray was equal to 2 pumps of gel (which is 1.5mcgs estrogen and a medium dose.) 1 pump of gel is the same as a 25mcg patch.

Your hyperplasia diagnosis is interesting because in peri, and between periods (ie not immediately after a period) the lining can be as thick as 16mm and be totally normal.

You might be one of many women who just don't get on with utrogestan- that's really common and it's not really talked about as much as it could be. Utrogestan has now become the 'default' progestogen yet it really doesn't suit many women. There are other options which are available .
The benefits of Utrogestan are mainly long term (re. breast cancer) as it appears to be safer (but the evidence is only based on 5 years' use, not longer term.)

I hope you find a solution.

Thanks @JinglingSpringbells. I've stopped both for now to go back to my own cycle and see what the clinic say. The lenzetto is definitely weaker than the rest which is why they prescribed it. I understand when the gel was in short supply many ladies were switched and struggled with symptoms returning. It's a minefield!

I agree re the progesterone intolerance. I was never able to take the pill and my brief relationship with the mirena led to an A&E visit with 3 week long pressure headache! I'm beginning to think I might just ride it out solo! Thank you for taking the time to reply.

Before you give up on it, consider Femoston (it's tablets) which are almost as body-identical is Utrogestan. Or NICE says 3-monthly cycles are possible for women with progesterone intolerance.

You might not want to go a full 3 months with no progestogen if you had hyperplasia (still questioning that, if you were tested in peri) but variations on the usual 4-week cycle are possible and certainly used under consultants.

Thank you thats really useful information. I'll check put the NICE guidelines and print off for the clinic.

Are femoston tablets you take orally @JinglingSpringbells ?

I posted in July about stopping lenzetto 1 spray and utrogestan vaginally after side effects on the progesterone part. My GP refused to discuss anything as it had been prescribed by meno clinic so I waited for an appt which was yesterday.

Consultant advised my last biopsy showed disordered proliferative endometrium, despite the letter I received stating 'everything is clear which is reassuring' and he would only prescribe lenzetto 1 spray and the pessary every other day. I asked about bleeding which he said was likely but I've since read up on this regime and seen its for post meno only. I'm only at 3 months without a period.

@JinglingSpringbells you were incredibly helpful last time. Is this a usual pathway for in peri? He said it was unlicensed and I would need 6 monthly biopsies. I'm due one in March anyway as an annual follow up. Advice from anyone else who is on this regime welcome!
Thanks

Hi @amethyst69 TBH I'm really confused about what you have just posted.

I suggest you ask for a copy of the report on your last biopsy. It's not acceptable to be told two different accounts, one saying all ok and the other disordered proliferation.

I'd ask what 'disordered' means.

What are the 4 types of hyperplasia?

Endometrial Hyperplasia

• Simple.
• Complex.
• Simple atypical.
• Complex atypical.

Usually the treatment for any type (other than 'simple' in women in peri with irregular periods) would be the Mirena coil or several weeks of Norethisterone (the same progestogen that is in HRT patches and some tablets.)

Aside from this, the dose of Utrogestan is one x 100mg capsule daily, not every other day. And this is for women post menopause.

Is this a 200mg or a 100mg dose?

Although 1 spray of Lenzetto is low, if you have hyperplasia, it's odd they are suggesting a lower dose than normal for Utrogestan.

I'm sorry I can't be of more help but I'd be asking for another appt, maybe even going privately if necessary with a consultant experienced in this, and getting to the bottom of it.

Thanks. My first biopsy showed simple EH no atypia. 2nd disordered proliferative endometrium only 3rd as per letter clear. It is unacceptable to be told different and i am calling the Secretary Monday.

The dose is 200mg pessary every other day which was my query as that seems to be continuous and I'm not post meno.

I think private might be the best option!

I'm sorry you are going through this.

My 'guess' is that the consultant is hedging their bets and suggesting alternate days because of your progesterone intolerance.

It's not actually combined continuous you are on, because that is every day (not alternate days) but you have been given an off-licence variation.

I think you need clarity on the results of the last biopsy then take it from there. If you biopsy shows benign changes, then a 3-month cyclical regime is one you don't seem to have tried.

I hope you get some answers.

Hi @JinglingSpringbells

Eventually got a response - I'm not on HRT at present. Just finished a period so decision time as to whether I give the day on day off utrogestan a go. One downside would be 6 monthly biopsies and I have them under general. Its weighing up the plus (help with aching joints) against the negative (progesterone makes me an angry bloated and constipated woman!!)

The biopsy from March is within the limits of normality. If you were not on HRT, we would not require any further vigilance