Progesterone intolerance, what worked for you?

[abouttoturn50]

I'm 49, I have tried HRT twice, the oestrogen part made me feel great but I'm having issues with the progesterone side. Firstly I tried Evorel Sequi which was great until the progesterone part which made me feel anxious and my mood was very low so I had the coil fitted and that was horrendous, the anxiety and dark thoughts were unbearable, I had it removed after only 2 weeks as I was going into a very dark place! I've gone through a cycle with no HRT, I'm 4 days before my period and I feel shit! Headaches, fuzzy head, fatigue and apathetic so I'm pretty sure I do need HRT! Should I have maybe tried longer on the Sequi? Just looking for suggestions before I speak to my GP really. Both times I was just told to stop rather than being given an alternative.

Probably because Evorel has progestins rather than bio-identical progesterone. I'm having similar issues on Evorel Conti but I am pretty sure I'll get nowhere asking my GP for a change up.

Mirena worked for me. Am super progesterone intolerant and afyer fitting, I had two cycles with my normal PMT (two weeks of suicidal thoughts, crying, massive breasts) and then it settled in and there hasn't been a problem since.

I sympathise, utrogestan made me suicidal as did the contraceptive pill.

I'd had the coil before and been okay but this time I honestly couldn't continue with it in as I pretty sure I would have ended up being sectioned! 🙈

I take Evorel Sequi BUT do it one a 3 month cycle.

Did this for 2 years waiting to speak to the specialist who has now officially approved using it like that.

Some how every 3 months is more bearable and I can move it a bit so it doesn't clash with holidays etc.

I take the utrogestan vaginally as recommended by a menopause specialist at one of the Newson Clinics. It’s made a big difference to my mood

I am on continuous HRT, oestrogen and progestin in one tablet to be taken every day. I am also progesterone sensitive and on day 4 I would head downhill. I found if I take it for three days and then have a day off it keeps the depression at bay.

@RandomMess I've heard of this method. So you have the straight up Evorel for the majority of the time? How many weeks out of the 12 do you have the Sequi patches?

I do 10 weeks then the 2, well that's the aim.

But I time the 2 weeks for when it's most convenient for me! So avoid stressful times at work, going away with friends etc.

@ShinyBandana does this keep the progesterone from entering your system? Just keeping it localised? And is that for a certain amount of days a month? Sorry for all the questions 🤣

Presumably you're under ongoing care of a private clinic who are scanning you once or twice a year? This regime isn't safe otherwise.

@notanotherrokabag nope NHS care at the menopause clinic.

@notanotherrokabag The 3 monthly cycle option is in the NICE prescribing guidance ( available online.)

I do 3 monthly.
Vaginally.

The 3 monthly option has been around for some time (I started it 16 years ago in late peri through a specialist.)

The downside is that if your lining responds to estrogen well (?) you can end up with a mega withdrawal period every 3rd month.

I gradually reduced the 12 weeks to less as the withdrawal bleeds were too much.

Not everyone reacts that way. I know someone else who does extended cycles and they hardly bleed much at all.

I know. But the BMS and most mainstream experts feel that it's unsafe without 6 or 12 monthly scanning. NICE have been asked to remove it as there's no evidence that it's safe for the endometrium.

With at least annual scans?

@BlackStrayCat is that with the Utrogestan tablets?

@notanotherrokabag there has been some guidance on this in GP prescribing for a long time. But many GPs don't appear to know about it and it often only comes to light if someone is referred to a clinic or sees a specialist privately.

It's not well known about but the minimum progestogen is 14 days in 84 (12 weeks.)

Scans are not offered routinely for this. There has to be awareness of erratic bleeding when not expected and then a scan would be suggested.

It also depends on the dose of estrogen as women on a higher dose may be advised to use more progestogen ( a higher dose.)

@notanotherrokabag unlikely seeing as though I waited 2 years for a phone appointment!

I had the Mirena an£ it’s fine, took a while, 2/3 months maybe, buy gynae said she had patients who just reduced the progesterone they took…

I’ve been on hrt for 10 years or so and at 55 have had to come off it, breast issues, and it’s fine, but I’m not sure what I’d have done if I couldn’t have taken it at height of peri menopause. So you have my sympathy.

https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

"Studies suggest that women taking sequential HRT with less than 10 days of progestogen each month are at increased risk of endometrial hyperplasia and endometrial cancer."

"Studies have shown that shorter durations and lower doses of progestogen intake are likely to be associated with an increased risk of breakthrough bleeding, endometrial hyperplasia and endometrial cancer."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039145/

"There is evidence that progestogens must be taken for at least 10 days per month to reduce the risk of endometrial hyperplasia and carcinoma though some studies suggest that progestogens should be given for at least 12 to 14 days "

https://www.gov.uk/drug-safety-update/hormone-replacement-therapy-updated-advice

"In women with a uterus, use of oestrogen-only HRT substantially increases the risk of endometrial hyperplasia and carcinoma in a way that depends on dose and duration.[footnote 10] Addition of progestogen cyclically for at least 10 days per 28-day cycle greatly reduces the risk, and addition of progestogen every day eliminates the risk"

There's loads more like this.

@RandomMess
Ask your NHS menopause clinic why they are going against BMS guidance and, if they're not scanning you at least annually, on what evidence they are basing their belief that the regime isn't putting you at risk of endometrial hyperplasia/cancer. Ask them to put that in writing. I suspect you will find that annual scans start.

And sorry about the Mail link but lots of doctors with significant knowledge in this area have concerns about clinics, Newsom health included, which give lots of oestrogen and/or not enough progestogen

https://www.dailymail.co.uk/health/article-11927783/Is-Britains-foremost-menopause-doctor-risking-womens-lives-alarmingly-high-doses-HRT.html

Many GPs with a particular interest in menopause do know about this - they know that the evidence of safety for this regime is pretty much non-existent.

And this which is very new and widely endorsed

https://thebms.org.uk/wp-content/uploads/2024/04/01-BMS-GUIDELINE-Management-of-unscheduled-bleeding-HRT-APRIL2024-F.pdf

• A monthly progestogen dose, in proportion to the estrogen dose, is recommended in women with a uterus. •
• In women using sequential HRT (sHRT), offer a minimum of 10 days norethisterone (NET) or medroxyprogesterone acetate (MPA), or 12 days of micronised progesterone, per month.
• Tricycling HRT (quarterly progestogen) (listed as a minor risk factor for endometrial cancer if done for less than one year and a major risk factor if done for more than one year)
• In women over 50, who have no unscheduled bleeding and use medroxyprogesterone acetate (MPA) or norethisterone (NET) for 10-12 days of the month, the relative risk of endometrial cancer is similar to non-users. If these progestogens are used for less than 10 days, this risk is three-fold higher after six months use (RR 3.1, 95% CI 1.7-5.7).
• Tricycling (Long-cycle) Progestogen use and shortened progestogen regimens This is where estrogen is given daily but a reduced progestogen course (7-10 days) is given every three months. When compared to use of a monthly progestogen course – NET or MPA for 10-12 days – the incidence of endometrial hyperplasia and cancer is higher; 7.5% vs 0% at 12 months (p=0.005) and 11% vs 1.4% by 36 months (p=0.01).(26, 27) The risk of endometrial cancer when tricycling incorporates moderate or high dose estrogen, or micronised progesterone, is unknown. If a shortened duration of progestogen is considered in women with an intolerance to all progestogen types (including 52 mg LNG-IUD and off-license use of standard dose estrogen with 150 micrograms of daily desogestrel or x3 noriday tablets i.e. 1.05 mg NET), and in whom hysterectomy is not suitable or acceptable, informed counselling about endometrial risk, and the lack of evidence to support surveillance accuracy (six monthly ultrasound), should be discussed and documented.

The more I think about it, the more horrified I am that an NHS menopause clinic is doing this with no regular scanning. I would suggest that you show them this guidance and ask what they're going to do about it, and if you get no joy then I'd think about a formal complaint and consider reporting them to the CQC. They are putting you at risk and clearly haven't counselled you at all about the risks @RandomMess

Yes, the "soft capsules" you can either swallow them or insert vaginally.

I get about three days of light bleeding every 3 months.
Feel great!

Everything transdermal. 53.

Livial tibolone works pretty well for me, but i had to really fight to get it before my periods stopped.