Progesterone - how?

[TriceratopsRocks]

I had to stop my normal HRT a few months ago but now need to start taking progesterone. I'm going to be offered a choice of either the mirena coil or oral tablets (I don't know yet which tablets specifically).

I've always been a bit nervous about the mirena, but don't know much about progesterone tablets. Can anyone here offer any experiences, or tried both to see how they compared for you? Is there anything I should know about, or research, before my appointment on Friday? Any advice is appreciated.

Hi
The consultant at the meno clinic told me that the Mirena was the best way of protecting the lining of my womb (sister died of endometrial cancer) but the GP put me off with a lot of teeth-sucking, ‘a GP ‘tag-team’ might be able to get it in’ 😱, ‘you’re 58 …’ GP was very reluctant so I’m now on 200mg Utrogestan every day to oppose 4 pumps of Estrogel.
There’s a Mumsnet thread ‘Mirena, is it worth it’ that contains a lot of useful evidence for you.

Thanks I'll take a look at that. The gynae consultant at the hospital is the one recommending the mirena but she's definitely giving me a choice. What I've seen so far is that some women love it and some have an awful experience with it. Not knowing which camp I'll be in is what's worrying me. But I know nothing at all about the tablet form, partly because I don't yet know what specific drug she's got in mind. It might be utrogestan but maybe not. Are you able to say how you find it? I'm guessing it's not straightforward when taking other things too.

Hi , I’m on the mini pill to stop periods . I was offered the coil , but I hated the idea of having something inside me , that I couldn’t remove if I didn’t get on with it . With the mini pill , I had four months of spotting , but it seems to have calmed down . I’m 50 btw.

I think I’m fine with the Utrogestan and I’m on 200mg daily.
I’m still getting occasional bleeding but had internal and external scans last week and all is fine 🤷🏼‍♀️
I’m still fatigued and lacking in motivation but had this before I started on Utrogestan - testosterone has improved my stiffness/libido.
I have 4 pumps of Estrogel daily and having the increased amount has helped all my symptoms.
I find HRT efficacy confusing to figure out - what helps what! All I can say is I’ve always felt better whenever I’ve added something/increased dose and I would happily increase Estradiol and testosterone but I’m at the NHS max!

I've had several years on HRT and it really did change my life (I should have been on it years earlier). But I was told I needed to stop taking it due to endometrial hyperplasia. The progesterone is to reduce the risk of that developing into cancer, so it's all I'll be taking. I really appreciate all your responses - I'm just trying to gather as much information as I can before Friday.

I can say that 200mg of Utrogestan is fine for me but the meno consultant would have preferred me to have the Mirena to protect against cancer
Given your history @TriceratopsRocks is a hysterectomy an option?

I used to use two pumps of Oestrogel and I x Utrogestan tablet and I developed a thickened womb lining plus a polyp which needed to be removed. They offered me a Mirena coil at the time saying it was the best way to protect the womb lining. I declined and carried on with the tablets. Fast forward to last December and I was diagnosed with atypical hyperplasia and pre-cancerous cells. I will always wonder if I could have prevented this by using the Mirena. Perhaps you should give it a go OP. You can always get it removed at the GPs if necessary.

Sounds like we're in a similar situation. I hope all stays well for you. I've been down the 2 weeks pathway 3 times now in 10 years. This time I had the hyperplasia, pre cancerous cells, a large polyp (had them before) and a cyst that had to be removed. One thing we realised this time was that when my GP doubled the oestrogen in my HRT last year, he didn't increase the progesterone, which caused loads of bleeding and it took me 6 months to get that checked out, because for me that was just going back towards my old normal. Not sure if the dodgy HRT dose affected things or not.

@Wid it has never been suggested to me, but at my old GPs I think it should have. I had 8 years of bleeding 20 days out of 30, accompanied by migraines. HRT at my new surgery fixed this for a few years, which was wonderful. But I'm 54 now, so I keep figuring it can't last much longer! I'm guessing that a hysterectomy at this point is shutting the stable door after the proverbial horse. But really I have no idea. At the moment it seems like the progesterone is the next step, so that's what I'm looking into.

You’ve certainly had your fair share of worry.
I’m sorry if I’m being alarmist but my oldest sister died aged 70 with endometrial cancer 😢 I’m 58 and if I were offered a hysterectomy because my bleeding continues, I’ll jump at the chance.

One reason doctors push Mirena is that it means perfect compliance, whereas some women taking daily Utrogestan can forget to take it or take the wrong dose. If you know you won't be one of them, some of the benefit of Mirena over Utrogestan falls away. In your shoes I would start on Utrogestan/Gepretix and see how you go- if you get side effects you can always switch to Mirena whereas switching the other way is more faff.

Please don't worry about alarmism, and I'm very sorry to hear about your sister. I've just never been offered a hysterectomy. My old GP surgery was hopeless. They sent my down the pathway twice (so it's must actually be 4 times I've been on it now), but when I got the all clear from that, it was just "you're all fine, carry on". I changed surgery 5 years ago, they did the 2 week pathway again and put me on HRT once I got the all clear. If that hadn't worked, then surgery was discussed as a 'last resort'. But the HRT was great so it was never raised again. I'm going to be on 6 monthly hysterescopies for the forseeable future so they're keeping an eye on things. If they ever offer a hysterectomy I'll say yes. But it's not been mentioned. Maybe I should ask about it on Friday.

That does make sense, tbf. I know that I sometimes forget to take my other medication when I get up, but it's not a problem if I miss the odd day here and there - I don't need to be scrupulous about taking it each day so I'm not. Do you take Utrogestan before bed (have I read that? not sure)? If so I'm much more likely to remember it at that time. When I forget in the morning it's because I've overslept and am rushing about.

Not to spook you but I ended up having a total hysterectomy in January and the histology did find early cancer cells. Its all clear now though and I have recovered well. It sounds like they are keeping a very close eye on you so that's good.

I'm a big fan of the Mirena. I was very nervous about getting it but now I wish I'd done it years ago. Once it's in and settled, you can just forget about it.

I’m peri and couldn’t take Utrogestan as it made me feel depressed. I have been on Microgynon since January and been ok but for longer term I’m having the Mirena in a couple of weeks. I’m almost 48. I am also worried but been reassured if I don’t get on with it they will remove it quickly.

Hi OP.
I started on HRT 15 months ago. I took utrogestan orally for three months, then vaginally for three months and then had a coil fitted at the end of month 6.

I changed because the utrogestan made me sob all the time and feel suicidal.

However, I saw a gynae this year about some other issues and on questioning I said that yes, I did have the odd spotting every now and then, many months after my mirena went in.

I had a hysterocopy D&C and had my endo lining removed. It was very thick, (US showed not too thick) thicker than was expected and I'm waiting for biopsy.

Perhaps the utro wasn't enough to counter balance my high oestrogen. Maybe taking it vaginally (using a 200mcg pessary) wasn't sufficient. But clearly in the space of 12months my uterus got happy and full!

In your shoes, I'd be asking for a hysterectomy and then you can have the oestrogen too. It would totally suck to have to be progesterone only if there's an option.

Assuming my biopsy comes back clear, I will stay on HRT and consultant happy that the mirena will control the lining adequately from now on.

And I have had no other issues with the mirena. To have stopped peri flooding was a total blessing.

I'm incredibly grateful for all of these comments. You are swinging me to trying the mirena (as long as I get reassurance that I can get it out fast if necessary), but I am also going to ask about hysterectomy. I honestly think if I'd explained myself better, and been listened to, I would have had one at least 8 years ago. It's just because I am still so much better now than I was before HRT that I wonder about the point of a hysterctomy now. I don't need one for my current day to day symptoms - the concern is that pre-cancerous stuff when I've already had so much other weirdness. Part of me would love to just get rid of it and hope that fixes other stuff that's going on down there too.

@Droolylabradors I really hope your biopsy comes back clear, and quickly. I had to wait 7 weeks for my latest when previously they've only taken 2-3 weeks at most.

@Saturdaysleepday good luck with the mirena! Fingers crossed it suits you :)
@TheDogsMother that all clear must be such a relief. I hope your recovery went/is going well.

@Droolylabradors I had exactly the same experience with utrogestan my MH was so bad I thought I was going mad.