Utrogestan woes, again

[MorvernBlack]

Actually Gepretix not utrogestan, but the same.
This is my third attempt at it. I'm fine with Evorel combined, but I need a bigger dose.
I'm on half my dose at first - 100mg, I've done a week vaginally, but I'm bleeding, it was all a bit messy and I was sore so I switched to orally. Now I'm so bloody anxious. It's been about 2wks.
Last time I tried it I felt so sedated.
Will the side effects settle? I keep getting told I'm not giving it enough time, but I can't cope with anxiety and I don't think I can double the dose.

It was awful for me orally in that the sedative effect was relentless, even on an empty stomach as prescribed. I switched to vaginally after the first month and then at my check up told the GP that’s what I’d done - she was fine with that and said many women take it that way even though it’s off licence in the UK.
She said there were alternatives if I found it too messy etc, one of which is the Mirena coil. Mirena not for me at the moment, apologies if it’s not something you want to consider.
Could the bleeding be your natural cycle breaking through? My dose is timed so the withdrawal bleed is when my natural period would be, as I’m still having regular periods.

I'm on half my dose at first - 100mg, I've done a week vaginally, but I'm bleeding, it was all a bit messy and I was sore so I switched to orally. Now I'm so bloody anxious. It's been about 2wks.

Can you elaborate a bit?

Where are you in menopause? Still having your own periods or all over for at least 12 months? Or aged over 54?

Evorel combined- was that the continuous combined, or a sequential type?

Are you trying to use Utrogestan continuously as 100mgs a day every day?
Or are you using it sequentially- 200mgs x 12 days a month?

If you are not post meno and using only half the dose on sequential, it's probably not enough and that's why you're bleeding- it's either breakthrough bleeding as the womb lining is thick, or it's your own cycle ( a period.)

If you are post meno, then the advice is it takes 6 months for combined continuous to settle down.

@JinglingSpringbells

Sorry, left a few details out there!

I'm 54, was having regular periods until September last year, had a couple of periods since. The bleeding with the utrogestan I'm pretty sure is just my natural cycle.
I've been on HRT for 3yrs. I was on a 50mcg Evorel combined patch and a 25mcg estrogen top up patch for 2yrs. I was happy with that dosage, taking it sequentially. I didnt have a withdraeal bleed, but bled every cycle. Then the guidelines on proportional progestogen changed so we had to rethink.

I dropped the extra 25mcg patch and went to continuous patches. Still bled once a month, some menopausal symptoms came back. So the aim is 75mcg estrogen patch with 200mg utrogestan continuously. I'm starting out on 50mcg patch plus 100mg Utro continously. I can't take utrogestan sequentially because I get horrendous panic attacks on the first few days after I stop it.

Sorry, that is long and confusing.

I think you've just got to accept that when women aren't truly post-menopause, trying to use combined continuous often doesn't work- and bleeding occurs. The fact that you bled once a month on continuous combined seems likely to be your own cycle.

Have you thought about a mirena coil?

Or the other options for progestogen- Norethisterone can be prescribed as a tablet alongside estrogen only patch/gel, or some brands of the mini pill (you'd need two or three pills a day) or the newer tablet Bijuve which is tablet form of micronised progesterone and estrogen (only comes in one strength of estrogen.)

@JinglingSpringbells isn’t provera an option too for progesterone? X

Yes but it's not body-identical (as are none of the others either.)

I'm not particularly bothered about the bleeding, I just don't like using the utrogestan vaginally whilst I am bleeding.
I can't cope with the anxiety and sedative effect though. Certainly not 6 months of it.

Mirena isn't an option.

I had pondered one and a half patches of Evorel 50 combined. That would give me the 75mcg of estrogen with a proportional amount of norethisterone. I'm just wary of taking a higher dose of synthetic progesterone.

I'm not particularly bothered about the bleeding, I just don't like using the utrogestan vaginally whilst I am bleeding.
I can't cope with the anxiety and sedative effect though. Certainly not 6 months of it.

There is no point using Utrogestan while you are bleeding.

Why is a Mirena not an option?

I suggested you might try sequential- it sounds as if you are too young/not at the right stage for combined continuous.

I'd prefer sequential, but I can't come on and off utrogestan because I have panic attacks for the first few days off them. Plus wouldn't that mean 400mg of utrogestan to balance a 75mcg patch? I can't even manage 100mg atm.

Mirena, the thought of it makes me feel sick, not worried about the insertion, just the fact that it's there. Also I would worry about not being able to get it removed if I have side effects. My sil had to remove her own because she couldn't get hers taken out.

It just feels like Hobson's choice.

What's going on with the panic attacks? Did you have those before HRT?
I know Utrogestan is a sedative but you shouldn't be having PA when stopping it.

If you can afford it I'd suggest you see a menopause specialist because there are many things your GP doesn't seem aware of.

I've been on HRT for 3yrs. I was on a 50mcg Evorel combined [sequential? ] patch and a 25mcg estrogen top up patch for 2yrs. I was happy with that dosage, taking it sequentially. I didnt have a withdraeal bleed, but bled every cycle. Then the guidelines on proportional progestogen changed so we had to rethink.

The BMS guidance for more progesterone is just that- guidance. It's only put into practice if women bleed at the wrong times and a scan shows a thickened lining. If you were bleeding on regular basis - not at odd times during a month- that's not necessarily a reason to change anything.

I'm a bit unclear when you say Evorel Combined- do you mean Evorel Sequential or Everol Combined Continuous?

As I mentioned in my previous post, you could use any dose and type of estrogen- patches or gel or tablets- and a separate dose (tablet) of Norethisterone.

I did that for 6 years- gel and Norethisterone for 12 days every 3rd month. This was with a private consultant.

Panic attacks - No, not since I had awful PND which was 18yrs ago, which was why it worried me so much, I don't want reminding of that time.

The HRT I was happy with was Evorel Sequi 50, with a Evorel 25 top up. I mentioned combined because for 14 days the Evorel Sequi 50 patch was estrogen/progestogen combined, but the 25 patch was always just estrogen. We came to this solution because there is no Evorel Sequi 75 or Evorel Sequi 25.

Private consultation is not an option, I do have health insurance, but it doesn't cover menopause.

I know I can take oral norethisterone, but I worry about the risks of using a higher dose of synthetic progesterone. I really wanted to get used to the utrogestan.

Not sure whether to just go with Evorel sequi 50 and accept that I'm not going feel as good as I did on the 75mcg dose, I did at least feel better on 50mcg than I felt before HRT.

GP won't prescribe against the guidelines and I'm wary, I did have a scan last year and surgery for a polyp, womb lining was slightly thickened on the scan, but no evidence of it when they operated.

I've got lot on, disabled child, another about to do A levels, parent with dementia, usual stuff😅. I need to be functioning optimally.