200 mg progesterone daily

[Verite1]

Hi. Has anyone been prescribed 200 mg daily? I was on 100 mg daily with a 25 mg patch but my doctor (who is a menopause specialist - consultant gnaecologist) increased patch to 50 mg and said she needed to increase the progesterone to 200 mg daily. This seems unusual but I presume she knows what she is doing. Anyway - I am having terrible side effects from (I think) the increased progesterone - bloating, wind, nausea etc and want to know if I can decrease back down to 100 mg. I know I really need to check with my doctor, but she is away for a week and a half and the side effects really are awful.

That's very unusual @Verite1 because the guidance from the British Menopause Society says that a higher dose should be considered for women on higher dose of estrogen.

(Regardless of her qualifications she seems to have misread the guidance.)

A 50mcg patch is the same as 2 pumps of estrogen gel (approx) which is a medium/ starting dose.)

If you were using a 100mgs patch or perhaps a 75mcgs patch (and that's the same as 3 and 4 pumps of estrogen gel) it would be a consideration.

Again, this is not mandatory from the BMS- they act as a guide and it's down to each doctor to make the call on their patient, for example if they are having erratic or heavy bleeding on their current doses. Women respond differently and there are women on the same dose whose linings stay thin, others have more heavy bleeds.

The BMS guidance has been linked to several times here. If you put the search words into the search facility you should find it- something like 'BMS guidance on progesterone with HRT'.

I'd find the guidance and query her on it.

It's not clear from your post if you are on 50, 125 or 150 of oestrogen patch.

I was told at 100 oestrogen patch the progesterone had to increase. I wasn't keen but it's been fine - are you taking yours orally or vaginally? The latter is supposed to have less side effects.

but my doctor (who is a menopause specialist - consultant gnaecologist) increased patch to 50 mg

I think the OP is using 50mcgs (not 25 +50 because if so she could use a 75mvgs patch.)

I’m on continuous 200mg daily and have been since Xmas. It’s fine for me but I still bleed and recently had scans.
The GP increased my oestrogel to 4 pumps last year but didn’t increase my Utrogestan - the meno clinic spotted that the oestrogen wasn’t being opposed and said either Mirena or 200mg of Utrogestan.

Yes. My patch is 50 mcgs which I also thought was a medium level so I was surprised that progesterone was upped to 200. I have sent an email asking if I’m ok to reduce.

Just re-reading the messages above - my last period was incredibly heavy - I flooded through all my clothes. That was when I was on only 25 mcgs. Perhaps that’s why she felt I needed an increase in progesterone if patch strength increased

Your heavy periods might be why they’ve increased your progesterone but it’s good that you’ve queried it.
I’m 58, been on HRT for 5 years and I still don’t think I’m balanced and that’s because for the first 4 years I never queried anything.

My GP increased my progesterone to 200 daily but I am on 100 patches. I asked to decrease it but she said it's the new guidelines and refused.

I have progesterone pessaries though so instead of inserting it just before bed and retaining it through the night I know insert it a couple of hours before bed so a large portion of it is (ahem) expelled when I go to the loo before bed. It suits me better and as long as I am not bleeding the GP is happy.

@Verite1 Can you explain a little more...if you had a period, why was that? Taking progesterone every day is the no-bleed regimen.

Women on combined continuous (estrogen + progestogen daily) are either age 54+ or haven't had a natural period for 12 months or more.

This link to a medical site explains it well.
https://www.menopausematters.co.uk/postmeno.php

POST MENOPAUSAL -
Continuous combined therapies.
"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age. The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved. When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin. Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy. Start with low dose preparations and increase as necessary for symptom control. The products marked * are licensed for osteoporosis treatment/prevention.
See below: WHY AND WHEN TO OFFER CONTINUOUS COMBINED THERAPY.

If you are bleeding, are you post menopause?
How old are you?

Perhaps you should be on sequential HRT with a regular withdrawal bleed each month.

Also, you're seeing a consultant- is there a reason for this (were you having problems) or is it private and your choice?

I'm using a 50mcg patch with 100mg utrogestan daily. I really need a 75mcg patch, but can't cope with the 200mg utrogestan required daily for that. But a 50mcg patch only requires 100mg daily utrogestan, you don't need more.

You can use the utrogestan vaginally, which can limit the side effects. I just find that it's awful stuff.