progesterone sensitive?

[meemeemammy]

Hi, I recently started lowest dose of HRT ( oestrogen patch 25mcg) and 2 body identical progesterone capsules)
The first 2 months were great - more sleep, more energy, 28 day cycle, 5 days period.
However the 3rd month has been difficult - mainly emotionally. I'm very sensitive, crying 1 week after starting progesterone, and thought it would stop when I had the progesterone break. I'm now on day 13 of no progesterone and only now beginning to feel better.
I've had some advice to increase the oestrogen and to administer the progesterone vaginally. I'm unsure if I'm sensitive to progesterone, or getting some kind of withdrawal as I felt worse into my period. I'm also suffering vertigo/ palpitations while on my progesterone break. Does anyone have any experience of this / any advice much appreciated. Thank you

Following with interest as my symptoms are similar.

Patches working great after a bad experience with gel. But now on the first round of progesterone and I feel rotten. Really sluggish, emotionally and physically drained. Be interested to hear of others experiences.

@meemeemammy I'd agree with the advice you have had (here or from a doctor?)
That the estrogen dose is very low.
Unless there is a real reason for that, it's normal for women to start on 1mgs (tablet), 2 pumps of gel or a 37.5 or 50mcgs patch.

The 25mcg patch is more for very much older women (60+) starting HRT for the first time.

You're very likely in an imbalance with too much progesterone and not enough estrogen.

You won't have any progesterone in your system by Day 13 of the new cycle, so the obvious thing to do it ask for a higher dose patch- your symptoms sound like low estrogen.

Get a higher dose patch asap, use Utrogestan vaginally (12 days a month is enough- the 14 days was suggested to GPs in a training manual, as it was considered 'easier' for women to do 2 weeks on / 2 weeks off.

But the patient leaflet in the pack does say 12 days.
14 days is for women who find they have heavy bleeding.

Thank you so much for your reply. They started me on a low dose as I was very sensitive to the contraceptive pill and injection ( stopped at 20 yrs) but what you're saying totally makes sense as the progesterone dose does not change so likely an imbalance. I've got the gel now and put on 1 pump last night on top of my 25 mcg patch, and this morning have removed the patch and have done 2 pumps. I didn't want to wait for divided doses as I felt so bloody awful yesterday. It's a waiting game now. Again, thank you so much for your reply and advice

Just to add. I'm getting medical advice through GP practice ( pharmacist) she thought progesterone sensitivity, but also agreed I could try increase oestrogen via the gel in 2 divided doses, but I've gone straight for the 50mcg. I hoping I can try titrate it a bit easier with the gel, and once it's all stable hopefully go back on the patches.

@Itcantjustbemecanit what dose patch are you on? What was your bad experience with the gel?
How long have you been taking HRT?
What symptoms are you getting?

They started me on a low dose as I was very sensitive to the contraceptive pill and injection ( stopped at 20 yrs)

Just to add- the estrogen in HRT is completely different to the Pill and progestin injections.

All of those are what's called 'synthetic' forms of estrogen.

HRT now - all the estrogen side- is body-identical. That means it's exactly the same as our own. (the on' one that isn't in in tablets called Premarin and Prempak which aren't prescribed much/ at all in the UK.)

TBH whoever prescribed should know this and not conflate the Pill with HRT.

@JinglingSpringbells Thank you. I didn't realise the oestrogen was body identical also. That's good to know.
I think you were completely correct about the lack of oestrogen as I feel a bit better today. Nausea, dizziness, palpitations still continue, but my mood is a bit improved, and I'm glad I didn't hand my notice in to my work on Friday, and can rationalise things a bit more.
You have been really helpful- thank you.
I've had to take the progesterone orally though this evening as I've also developed thrush 😞.
I had read on the menopause page that you only need to take the progesterone for 12 days. Can I ask your opinion on whether you take that 14 days into your cycle still , or whether you would start on day 16?
Thank you

I'm really pleased you're feeling better.

It's best to time the progesterone to the same day each month (which is what many specialists suggest.) You can't stick to your own cycles as they will be all over the place in peri.

So if Day 14 of your cycle was (for example)and the actual date was (for example) 27 June, you'd start again with it on 27 July, and so on.

This does mean there would be a 30 day cycle not 28 days, but it doesn't seem to make much difference. You can take it for 14 days if you want to, as a couple of extra days may reduce the bleeding, but just stick to the same DATE each month.

@JinglingSpringbells that's great advice, and totally makes sense. Thank you

Hi,
@JinglingSpringbells hope you don't mind me tagging you.
I'm 3 days into the progesterone and feel awful. Taking travel sickness tablets to control the vertigo.
I'm much more tearful, depressed. Palpitations seem better. I'm thinking I may be sensitive to the progesterone after all. It's making me sleep well though! But I am exhausted all day.
Mornings are the worst just before I have my 2 pumps of gel. I'm yet to try the progesterone vaginally as I'm sore ( I thought it was thrush, but I'm red and sore, so maybe not)
I am paying for a private consultation tomorrow to try get some advice before I ditch it all completely, as HRT seems to have made everything worse and increased the number of symptoms I have. Have you had any feedback from anyone switching from oral to vaginal progesterone and does it make a big difference?
Thanks ☺️

@meemeemammy I am sensitive to progesterone and switched from oral to vaginal for a while although I am now able to take it orally, it definitely helped me but I would also say that time also helps. Your body needs to get used to the HRT so if you can persevere then keep going and give it a few months. I am someone that always struggled with progesterone, I couldn't take any hormonal contraceptives and I really suffered when I did IVF and had to take huge doses of progesterone after embryo transfer. I have now been on utrogestan and oestrogel for a couple of years and I am managing fine. What I would say is that I take it continuously at 100mg a day rather than two weeks on at 200mg and two weeks off. I think that helps for me.

I don't mind at all @meemeemammy

You really should give vaginal use a go.
Nothing to lose.

What I'd suggest is that you treat your soreness which will likely be vaginal atrophy and also use Utrogestan vaginally to get rid of that hung over feeling in the morning. (Assume you've been taking them orally last thing at night? Otherwise you will feel dizzy.)

I've discussed this with my private consultant and what you can do is to use Utrogestan vaginally at any time of day (not only at night.)

I've used it both ways. Using it vaginally I get very few side effects apart from sometimes feeling a bit hotter at night and more vivid dreams. Nothing too awful. I also get on with it reasonably okay orally.

So you could use your vaginal treatment (Ovestin or Vagifem) at night (giving it time to work) and insert Utrogestan in the day (as long as it doesn't fall out.

If you can - and it may not be possible if you're dashing off to work - you can lie down for 30 mins after inserting it to help.

OR if you choose Vagifem, (not Ovestin) the tiny tablets stick to the vaginal walls so you could insert those in the morning and do the Utrogestan at bedtime.

What I do, is mix the two ways of taking it. I can't go for 2 weeks without using vaginal estrogen, so I use Utrogestan orally for at least 2 days of a cycle.

I hope this doesn't sound too confusing but I'm sure you will find a way if you experiment for what suits you.

@JinglingSpringbells thank you for your continuing sound advice!
I've just done the PV Progesterone ( the brand I use is Gepretix) but you described the way I feel in the mornings down to a T. I have been taking them last thing at night and feel rough in the mornings. I always feel better in the evening.
I also think you're right about the vagina atrophy . I was thinking that it was maybe this. I didn't have this prior to HRT, and I got it initially after starting and thought it was thrush as the treatment worked, but it's not worked this time and as I've got lots of itchy dry patches of skin over my body, it's likely to be the same on my vulva. Thank you for the advice on the vaginal oestrogen - I will discuss this at my appointment tomorrow. Thank you for explaining your routine as it's helped me understand timings of when treatments can be trialed.
You have been so very helpful with all your knowledge that you have passed on to me. Thank you. I'll let you know how I get on tomorrow.

@StopTheGreyness thank you for sharing your experiences of your progesterone sensivities and I'm really pleased for you that things have settled.
I think I've always been sensitive too as I got bad PMS week 3 of my period ( tired++, no energy, low) so maybe I'm sensitive to body identical anyway. As I've said below, I've tried it vaginally tonight, so maybe I'll wake up feeling great!! 😃
It does feel very powerful orally. I almost feel ' high ' when I'm falling asleep and get rushes, so it's interesting to know you take it in smaller doses. I was going to talk to the doctor about the amount that's in mirena coil and if it's tiny I may consider this as an option also.
Thank you for your advice

I had my HRT consultation this afternoon and felt better prepared due to your advice @JinglingSpringbells.
She said I should've been on an up titrating dose of oestrogen every 2 to 3 weeks- 25mcg to 50 to 75 to 100mcg, which has obviously not been happening, so it's no wonder I feel like I'm having a breakdown. She also said patches are better for women with a history of PMT ( like myself) as it's a continuous release of oestrogen, and the gel can be used if I feel I need a top up. I'm going straight onto the 50mcg patches then will increase to 75 in a week. I would've felt so much worse had I not increased the oestrogen already, so I appreciate you for advising that my symptoms sounded like low oestrogen.
She agrees that I'm completely out of balance with oestrogen and progesterone and hopefully this will stabilise with the increased dose.

With regards to the progesterone I'm likely sensitive, but she's hopeful the oestrogen will help balance. She did say to just make 1 change at a time, so to continue to take the progesterone orally for now for 12 days. I did take them vaginally last night, and it wasn't a very nice experience for me- couldn't sleep, crawling skin, constant waking and night sweats which I haven't had since I started HRT - but this could also tie in with the low oestrogen so will increase the oestrogen first before trying PV again.
I discussed vaginal atrophy - increased oestrogen may sort it out, but if not then can trial the oestrogen cream ( she suggested swabs to rule out other causes first)
I'm feeling a lot more optimistic and am happy that I'm not having a breakdown, feeling like every area of my life is doomed and that I may have needed antidepressants. I feel happier knowing that this may be able to be fixed with more oestrogen. I dread to think the state id be in today, had I not increased my oestrogen from 25 to 50 a week ago, so thank you so much for that advice 😊

Thanks for updating @meemeemammy . I'm really pleased it looks as if you are getting somewhere. I think you've got to see how you go on the higher doses. Most specialists would advise you give each new (higher) dose a few weeks ( or even a couple of months) before you go up higher.

The vaginal estrogen- evidently, 1 in 4 women need both (vaginal estrogen and HRT.) I do! I started vaginal estrogen before HRT. See how you go, but it's a mistake to allow it to take hold as it then takes longer to reverse.

Hope it all goes well for you.

@JinglingSpringbells yes that's right about seeing how you go on the higher doses. I think it's important to point that out- so thank you. She said if one is feeling good on say 75mcg, then you won't need to increase, but yes, I agree you need a bit of time to stabilise. For me, as I'm feeling so awful if I've got no relief after 2 to 3 weeks I can try increasing again in the hope it'll help. I hadn't realised a lot of younger women need maximum doses and thought this took a lot longer to get to the maximum dose.

That's interesting about the vaginal oestrogen. I think she was a bit reluctant to prescribe it in case it was something else like infection, so suggested GP to assess first, but if everything ruled out then she said to get my GP to prescribe. I don't want it to get worse and be irreversible, so will book in for swabs - although I'm pretty sure it is atrophy as it comes and goes and I've never had anything like this before and only started after HRT.

Hi @JinglingSpringbells . I hope you don't mind me tagging you again for some advice. Your advice so far has been amazing, thank you.
I keep on thinking about what you said about one must stabilise before they increase the oestrogen. I was prescribed increasing doses of oestrogen every 2 to 3 weeks. I was still getting symptoms on 50mcg oestrogen so increased to 75mcg. Since then I've been really dizzy especially in the mornings. It still continues with my progesterone course. I'm also not sleeping. I stayed at 50mcg for 2 weeks. Do you think think I shouldve stayed there for longer? My mood is so much better on the 75. All is better apart from dizzy and lack of sleep.
By the way I also got the oestrogen cream prescribed as suggested by you and it's being effective, so thank you very much for suggesting this

Anyone experience really itchy skin, and very sore down below I've tried everything and can get no comfort have an appointment 30th takes weeks to even see a doctor I'm at my wits end any suggestions

Hi I have itchy skin and a few hives over my body ( back, hip, shin) I've had these for any a year and I think they are hormone related. Have you got a rash? If so, have you tried any topical treatment first? I find moisturising twice a day helps.
Re being sore down below,- if infection and thrush has been ruled out, it's very likely going to be vaginal atrophy. Your skin sounds like a hormone issue also. I now use oestrogen cream vaginally and this has helped.
With my hives, I'm trying to get my HRT balance right but some days are better then others. Do you take HRT?

Hi thanks for your message, can the oestrogen cream be purchased over counter or does it have to be prescribed I've treated myself for thrush but nothing improved, yes I'm on HRT for last year things are still very up and down. The tiredness is very hard as I'm sleeping well, lot of aches pains as well, other friends say this is common with menapause

My tiredness has improved with increasing oestrogen. The soreness and itchiness improved with oestrogen increase so if you have multiple symptoms maybe you need to look at increasing oestrogen?
Re cream- I was also treating myself for thrush before getting the Estriol 1mg/g cream. I got mine on prescription via GP. I've just googled and you can buy it online but it's £30. If you've no discharge and being treated for menopause you should be able to get it on prescription easily enough. I also found canestan intimate soothing cream really helpful. I couldn't wear jeans before using this!