People with progesterone intolerance - is it worse on the days you take it, or the second half of the month? Please help, really struggling

[Ohdearhandbag]

Hi All, I don't know for sure but I think I'm progesterone intolerant, manifesting in extremely dark thoughts (suicidal, but I won't do it), and I'm trying to figure out what the hell is going on.

I take oestrogen (Sandrena) 1.5 sachets every day, and have been varying my amount of progesterone (Utrogestan) to try to minimise the terrible dark moods.

Have been taking it vaginally rather than orally, and this month I used 2 tables/day for 10 days. This is more than usual. My mood is always ok until the second half of the month, when I'm not taking it. This month it's worse than usual and continuous for 14 days now.

This pattern doesn't make sense unless there's some kind of delayed reaction/build up in my body.

Please can anyone tell me if they've had a similar reaction, or conversely if they know this can't actually be progesterone intolerance and something else is going on.

Really appreciate it, am losing the plot and my dc need me to function.

P.S. Am 47, been in peri 7 years, still got uterus, and sorry for the silly username!

When you stop taking it each month are you having a withdrawal bleed?

As you are quite young still, is there a chance that you are having a double whammy of your HRT cycle, then your own progesterone as well? (This won't really apply if the HRT cycle is complete, with a bleed after the 10th day on Utrogestan.)

You are allowed (NICE guidance) to do a 3 month cycle especially as you are in peri. This means 14 days of Utrogestan every 11/12th week, so you could have 10 weeks of only estrogen.

Why not try that and it will at least rule in/ out any reaction to progesterone?

The other option is to use more estrogen as well.

1.5mgs is what 2 pumps of Oestrogel gives. This is the starting dose for most women, but there is also the option to increase it to 4 pumps=3mgs.

So for someone your age, (as opposed to much older women in their late 50s or 60s using hrt) you may simply need more.

Have you thought about that?

Thanks so much for answering. Yes I do get a withdrawal bleed a few days after stopping the progesterone, but it's lighter than a normal period, and unlike before peri, I don't get that lifting of mood once the bleed's in full swing. It kind of doesn't get in full swing and my mood doesn't lift.

I'd thought that maybe I'm also getting the low mood effect of my own progesterone, but are you saying that's unlikely as I have a bleed?

I really like the idea of progesterone only every 3 months, but I do worry that's not enough to protect my uterus.

I also like the idea of more estrogen as a counter-balance, but I see a private menopause specialist and she said that when I was on 2mgs/day that my level became "too high" so I went to 1.5. Not sure what the problem is with it being higher, do you know?

The 3-month cycle has been around for a long time but it has never been well-publicised even though it's on a GP Notebook training course (online.) It says progesterone should be used at least once every 84 days (which is 12 weeks.)

I used that regime for 6 years under a private specialist (who is highly qualified as a consultant gynae in menopause) and only dropped to a bit of a shorter cycle as I did find the bleeds rather heavy. If you are worried, you can always opt for a uterine scan every year or 18 months to check.

My own dr would not agree with your dose being too high on 2mgs. I was told recently that blood tests are not accurate for estrogen levels because the level changes all of the time over 24 hours, and that the test is if your symptoms are controlled by the dose.

That's wonderful news, thank you. I will move to 14 days out of every 12 weeks.

Do you think 1 capsule (100mg) of progesterone each day for those 14 days will be enough?

Might do the uterine scans too. Also perhaps increase my estrogen a bit especially if my mood is still low.

I feel relieved already!

Do you think 1 capsule (100mg) of progesterone each day for those 14 days will be enough?

No.

You must use 200mgs ( 2 capsules.) If you find you get breakthrough bleeding it may be that 12 weeks is too long and you could think about reducing it to 10 or 8 weeks.

Just to reassure you, there is a tablet form of HRT called Tridestra, that's been around for ages and it's a pack for 3 months, containing 14 days of progesterone.

It doesnt have body identical progesterone so I'm not saying try it, just that it does exist.

Got it, thank you. I feel very reassured, going to start this approach from now on.

I'm afraid I feel almost instantly better once I stop taking it. I take 2 capsules vaginally for 12 days - I don't get depression though, I get PMT type symptoms of rage and impatience.

That's really interesting, thanks. Must be hard for you to make yourself take it.

My low mood is like the PMT I've always had, though more extreme.

It could potentially be unrelated to hormones, but there seems to be a pattern. I guess moving to a 3 month cycle will prove if that's the case or not.

Same here, without it I’m myself again. I’ve come off HRT altogether for the second time, as the only way to counter the impact of progesterone intolerance was to increase Oestrogen which then made me feel like hell, my body looked and felt in early pregnancy and I was an emotional mess. The progesterone sent me to a dark place, I would also wake in the night halfway through a panic attack feeling. A few months off HRT my cycle is back to normal, monthly bleed which is always ‘on time’ (only 2 days long now, so I’m guessing this will stop all together soon?) and I’ve lost the weight I seemed to gain overnight when oestrogen was increased, so I feel much fitter and healthier too. The biggest improvement is in my mental health, I now just tolerate and manage to live with all the other physical peri symptoms, as they are mild in comparison to the impact of progesterone intolerance on my MH 🤷‍♀️

Gosh that's a lot to deal with. Glad you've found the best approach for yourself.

How did you - or are you able to - tell the difference between the emotional mess from too much estrogen, and the dark place from progesterone?

I'm trying to unpack what causes what, it's tricky.

Sorry OP, enough about me🤣 Everyone is different, but I particularly felt the physical changes. I also used a symptom tracker too so I could see how it had impacted over a 12 week cycle.
Also had review appointments with GP, who agreed that it was not benefitting me.
It really is trial and error finding the right dose, but that messaging can sometimes get lost amongst all the glossy success stories and celebrity menopause chat. Hope you can find what works best for you.

I had a friend who is really progesterone intolerant (even her own pre- peri). Suicidal/mruderous/migraines - everything

She can however tolerate the patches...sequi ones I think it is. Because it is transdermal. Is it worth trying that?

Hi op, this thread has been helpful for me too. I’m also sensitive to progesterone and always had raging pmt even with my own hormones! Not as severe as you, but no you’re not alone. My consultant said it’s really common. I too felt shit in second two weeks (I do 2 weeks oestrogen then 2 weeks both). I went from patch prog to pessary which has been better for me but still a bit ‘meh’, listless, zero patience. Doc recommends coil but can’t face anything going in or out of my cervix ever again, but may be the only real answer.

This is exactly how I felt and felt like a total depressed suicidal zombie on the days I was on utrogestrone, could not think straight, was bloated, acne which never had in my life, just a mess and could not function. It only clicked the day I stopped it and could actually do paperwork and think straight. Did lots of research and I also always had pmt/pmdd and most people who do are sensitive to their own progesterone so flooding our bodies with all that progesterone for 2 weeks is what makes us so depressed. Like you I started using it vaginally and was better but still felt awful. I spoke to a pharmacist who told me because I have been on hrt 2 yrs could change to continous, am 54 still having periods so sick of it. So I did just that and take 100 utrogesterone daily and changed from sandrina to Oestroge pump gel which I think is better so take 2 pumps of this and sometimes 2 and a half as have to balance with progesterone. The 1st 2 months on it did bleed twice a month and that can happen for few mths until hormones settle but do not have that surge in hormones like pmt/pmdd as continuous. Also am having a scan oct to see lining of my womb ok as 54 having periods to put mind at rest and they will also bring me into do internal under ga as cannot handle pain. This month have not bleed yet 3 weeks so hopefully is settling.
I also felt exhausted never felt like this in years so got full bloods done and have thyroid issue so on meds for that and is helping now.

Hope this helps somewhat and I do totally understand how you are feeling as I just felt like a big mess. Talk to doctor and see can you change to continuous if you have been on for few years. Wishing you well and sending hugs as know how hard it is as feel so isolated and takes over completely. I am so much more positive now as out of the black hole of progesterone. Get full bloods done also with thyroid tests. keep us updated.

@BOOTS52PollyPrissyPants Why are you having a scan and a hysteroscopy (assume that is what you mean by an 'internal) Or do you mean a transvaginal scan?

Your GP should know that bleeding for the first 6 months on continuous combined HRT (using progesterone daily) is to be expected.

If as you say here, you have only used this regime for 2 months, you shouldn't need a scan, at 54 or any age, because it can take 6 months for the estrogen/progesterone balance to settle down.

Maybe I have misunderstood what you wrote, but if not do question these planned investigations in case your GP is confused over the timeline when swapping to a combined continuous regime.

I’m glad I’ve seen this post as it explains a lot! I started on HRT about 6 mths ago - am 42 - and the days 1-12 I take two capsules of progesterone I feel like a zombie with low mood. I just thought it was cyclical and had to be tolerated. I sometimes get a withdrawal bleed and sometimes don’t. Could taking it vaginally help reduce these symptoms?

Hi Jinglingspringbells The doctor I see who has helped me with hrt at wellwoman clinic/family planning as own doctor would not give me hrt in my late 40's or in my early 50's. It is because I am still getting periods at 54 and just checking all is ok as was having very heavy periods so I think more for me to have peace of mind that lining of womb not too thick. Check there is no fibroids etc. Lots of your posts have been so informative and helped me a lot in the past so thank you.

You can just take one a day, with no break.
or have the mirena coil.

@BOOTS52PollyPrissyPants

It is quite normal to have periods at 54. It's not usual to have an invasive investigation under a GA just because of heavy periods at 54, because a scan if done by a consultant should show enough. And, to be honest, if you are still having periods it will be very difficult to show the lining is thin because it will be growing at every cycle. You'd need the scan to be done immediately after a period.

The main reasons for scans and investigations are bleeding post menopause after periods have stopped for a year or more.

Anyway...I hope you get on okay and all the best!

Ask the GP if you can try a different type of Progesterone. I couldn't tolerate Utrogestan so switched to Provera, which I take on day 12 for 10 days. No side effects whatsoever.

Thanks Jinglingspringbells, yes if scan is ok then no need for other procedure but if there is anything then it was me who asked for ga as I have sensory issues and even having a smear test is really difficult for me as cannot relax and feel such pain so hopefully all will be ok and no need for intrusive investigation. Thanks for your feedback and you always offer great advise and help to the women on here and appreciate that so much.

Thanks everyone, I also appreciate the help on here very much.

I'm still not completely sure if my low mood is due to progesterone as it's worse in the 2 weeks I'm not on it! But will move to a 12 week cycle (2 weeks with progesterone and 10 without) which ought to prove it one way or the other.

If it is progesterone intolerance then I think I'll ask for Provera instead of Utrogestan, and if that still doesn't fix it I might take progesterone continuously and see what that does.

Best of luck to anyone else struggling with this.

I felt awful on the no progesterone days. Went to continous 200mg (on 100patch) and feel great. Seems a bit bonkers (sorry) to think the progesterone is causing you issues when you feel better on it....