Fed up with feeling so out of sorts!

[NippyCrab]

Hello, I've been on HRT from 2021, I am now on Evorel 100 and was taking 300mg of Utrogestan orally. This has been for 6 months now and I feel awful whenever i start the Utrogestan, my insides feel like they are being twisted and I'm bloated and mood is bad when I take Utrogestan. I have Endometriosis which has been dormant, but now it has flared up again. My Dr switched me to 200mg Utrogestan vaginally and I felt a tiny bit better but my period is so painful. She said I must be sensitive to progesterone and vaginally would be better, I've to take it continuously now with no break. If I'm still having periods is this okay? I don't want a coil, I don't want anything inside me.
I know this isn't the answer but I feel like coming off HRT all together! I've been in Peri since my mid 40's, I'm now 52 and fed up.
Any advice or similar stories.

I feel your pain!
I too am very wary of taking progesterone as it gives me low mood and rage, so am now on 100 for 21 days vaginal.

however I moved from gel to patches (50) and they fall off and the glue gives me dermatitis. So back on the 2X pumps gel, but it doesn’t seem to be working anymore- I have a return of flashes and disturbed sleep.
on top of that, I’m still having periods and they’re excruciatingly bad and heavy.
I’m so tired also. All bloods normal.
I thought this would be all over by my mid 50s but still going strong. Why why 😭

sorry to join you by moaning on myself! You’re not alone 👋🏽

Can you manage your symptoms through diet? Much more fruit, nuts and veg, more soy, reduce wheat & sugar. Cut out alcohol. Drink more water..

@LaJoconde please moan away, I'm sitting here feeling pants and I just want to be me again xx
@Meadowfinch I have an okay diet, low carbs, I don't drink alcohol at all now for the last 3 years and always drink plenty of water. I don't think that would do anything for dwindling hormones.

There are many other types of progestogens for HRT other than Utrogestan or the Mirena.

Sadly, since GPs are so poorly trained/ aware of HRT they can't seem to think of anything at all now except Utrogestan.

There are these types of progestins-

-Norethisterone (in most patches or as a tablet with gel/ estrogen only patch.)

-Dydrogesterone - only in the tablet Femoston (which many women like and is almost as body-identical /safe as Utrogestan.)

-The Mirena (which you don't want.)

-Mini pill in larger doses for HRT ( 3 tablets a day.)

MPA- another type of progestin in Kliovance

You're on a high dose of estrogen so I wonder if you can reduce that and then it gives you more options?

Your GP has put you on continuous to try to stop your endo flaring.

Can you afford to see a private meno specialist? You tend to get more experience and they can tweak doses etc.

Or if not, maybe consider the types above that I've listed.

@JinglingSpringbells thank you so much for this reply. I have considered a private specialist, there's one not far from me. I've also thought about dropping back down to evorel 75. One of the pharmacists at my local chemist is an HRT expert but she's off on Mat leave at the moment. I wasn't aware of all these options, my GP said this was the best one for me. She did say if I didn't get on with it after 3 months she would refer me to the menopause clinic. I tried to ask her about testosterone but she said only the clinic would deal with that and she wouldn't prescribe it.
I want to feel better but I'm wary of my hormones going haywire if I start anything new.
With the 300mg of Utrogestan I was walking the dogs in tears for no reason, I couldn't stop crying 😂 awful.

I cannot imagine using 300mgs Utrogestan daily. I use 200mgs (mostly vaginally) for 12 days on a cycle longer than 4 weeks (specialist monitored and suggested) and even then it's a bit of a slog.

You may know that the 300mgs dose was recently suggested by the BMS for women on high estrogen doses. This is/was because of the supposedly increase in women on higher doses of estrogen, some were getting odd bleeding and there was a risk of hyperplasia. It's also because Utrogestan is perhaps not as effective as Norehtisterone.

However (and I know this isn't an option for everyone) monitoring of the lining can be done privately to make sure all's okay, if women can't tolerate high doses of progesterone.

There are many slight variations on HRT which specialists can provide and, although it can become expensive, if you can afford it, you might find a solution faster than working through all the options with a GP who isn't very clued up.

I'm going to make an enquiry on Monday regarding the specialist. With the 300 orally I wasn't getting a period, started the 200 vaginally and my last 2 periods have been hell. Normally I would start it on the 20th and my last dose would be the 12th, I don't want to keep taking 200mg vaginally and I do feel I should drop the Evorel dose. Even my sex drive has dipped a lot using the higher Utrogestan and even the lower dose vaginally and I normally have no issues with that.
It's a minefield for women at the mercy of a GP who isn't clued up.

I feel so bad and in pain in my side tonight I've taken my patch off now. I'll leave it off now I think

I had the worst periods when I was taking utrogestan vaginally. I think more of it is absorbed that way so it is equivalent to a higher dose. I switched to oral but was lucky becuase I don't experience the other side effects of taking it that way.

If possible I would try to see someone privately and look at monitoring your womb lining through scans so you can go on a lower dose. The Newson clinic advices on halfing the dose for vaginal use but it will need close monitoring.

If possible I would try to see someone privately and look at monitoring your womb lining through scans so you can go on a lower dose. The Newson clinic advices on halfing the dose for vaginal use but it will need close monitoring.

A couple of points -
The higher dose of 200/300mgs for high doses of estrogen is a guide. It was introduced by the BMS as a response to some women being given high doses of estrogen (sometimes VERY high, far in excess of licensed doses, and usually always by private clinics. The BMS didn't name clinics or doctors.)

The half-dose vaginally is not correct and the BMS made that point in their report/guide on the use of progesterone.

The reason the Newson clinic does it (as far as I know) is that several years ago, one research paper (with a small number of women) showed that half the dose vaginally was ok. It's not mainstream advice . As you say it might be ok privately, and with an annual scan. (BMS actually suggests 3-monthly scans for off-licence regimes like the 3-monthly cycle.)

I've used Utrogestan for around 10 years. My consultant (more experienced than the Newson drs) has never suggested halving the dose. I wouldn't want to, because I get a fairly heavy bleed even using 200mgs on a low-medium dose of gel. The compromise for me is slightly longer cycles (more than 4 weeks) and I have private scans.

If you had heavier periods on it, that suggests it wasn't being absorbed as the bleeding would be less (it reduces the thickening of the lining.)

I have the rage today, rage at everything. I took my patch off yesterday morning (they don't stick well anyway) and I did take 200mg Utrogestan vaginally to see if it eased this pain in my side. It has. The reason I was put on 100mg of Evorel was because I wasn't absorbing the oestrogen, blood tests confirmed it. Would i be better with a lower dose oestrogen gel rather than the patch? And taking the progesterone vaginally or in a gel?
I will call both the GP and the menopause clinic, the menopause specialist near me is the lady who assisted Davina McCall with her documentary on menopause. I'm praying she's not majorly expensive for a consultation. X

I don't know if this helps but I've been advised by my consultant (who's a hormone expert) that blood tests for estrogen when on HRT are not accurate. The only way to be accurate is to test over a 24 hour timescale. One-off tests show the level at that particular moment.

You could try gel. You can't get micronised progesterone as gel- only as a tablet.

I don't know who Davina's dr is but they ought to have a website and their fees should be there for you to see. Most private consultants show their fees on their websites or clinic sites.

Thank you @JinglingSpringbells you are a wealth of information and should be an advisor for GP's xx
The Dr is Dr Helen Smith and is part of the British menopause society, I'll give the clinic a call tomorrow.

Hello, I have a hormone update. My GP was lovely today and I have been put on oestrogel and I've to have my levels checked for absorption in 6 weeks. She is part of a menopause teams group and she is asking for suggestions for my progesterone. She did say they will say the mirena coil. I explained my reasons for not getting it but I can also see huge benefits for me with my endometriosis. It's having a wee party in my body with my hormones being out of sorts. The pain in my side is the pits. I didn't contact the private clinic yet. X