HRT review: Dr recommends changing progesterone brands

[boyohboys]

I've been on combined Oestrogel & utrogestan for about a year, it's never been great but everything seemed more manageable until recently when my non-physical symptoms (anxiety, dreadful low mood, brain fog, zero libido) have come back with a vengeance. I asked for an HRT review and doctor just wants to change my progesterone pills to another different brand & come back in 3 months. Has anyone gone from Utrogestan to another pill and noticed an improvement? It seems unlikely a change of brand would really have much impact but who knows!

She has said if nothing changes by then she'll refer me to a menopause specialist - I asked about possibly trying testosterone which they won't prescribe but acknowledge it could be the answer🙄. It's such a bloody minefield just getting basic help - you can guarantee if men went through this there'd be a significantly better service available!

(Changed to Medroxyprogesterone 5mg & Estradiol)

My impression is that you're not being fully involved in the decision process.
Is that right?

The first step is often to increase estrogen depending on your age and if you've moved from peri, into deeper post menopause. This is what should be tried first. so maybe 3 or 4 pumps rather than 2.

What dose are you on?

There is no doubt that many women don't get on with Utrogestan. It's only very recently that it's become the popular sort of progesterone. 10-15 years ago, hardly anyone was using it in the UK.

So it's true there are other types that may suit you better.

MPA is an older synthetic type. There are pros and cons.
It terms of breast health it's considered (research shows this) a higher risk compared to more body identical types like Utrogestan, or dydrogesterone which is in the tablet Femoston.

There are other things to consider which include if you're using it daily or on a cycle. Many women don't get on with combined continuous and choose to stay on 12 days a month, as an option which can help.

Swapping to a synthetic form of progesterone should be further down the line and of course trying to stay with transdermal if possible.
Are you being asked to swap to a tablet form or gel + (MPA as a tablet?)

It needs a more detailed discussion IMO.

Thanks @JinglingSpringbells for taking the time to reply. No I don't feel like I'm involved in the process but my old confident and assertive self is lost right now so kind of being washed along doing what I'm told but now doubting it's the right advice!

So yes I increased from 2 pumps to 3 about 6 months ago and it did feel like there was some improvement but now I'm almost considering giving up altogether as I'm worse than ever. Dr said not to go to 4 pumps but change progesterone which surprised me. I'm not happy about being on a synthetic progesterone generally but certainly not after an awful experience on evorel sequi which is what they first put me on (& appreciate it may not have been the synethetic progesterone but still, put me off wanting to try it again!). Just checked my new prescription and it's 2 x MPA 5mg tablets days 15-28 then Estrodial gel 2 pumps so this is a reduction as it's the same strength as the Oestrogel I was doing 3 pumps.

Agree it needs a more detailed discussion but with who? The doctor couldn't get off the phone quick enough and was very set in her 'this is how we prescribe at this practise regardless what you might need or want!" I can't really afford to, but wondering if I should just book a private appointment with a menopause specialist. I want to speak to an expert who will tell me what to do and it be correct and up to date advice and if that doesn't work, help me find the right combination without an uphill battle. I just haven't got the mental capacity for this right now 😞

I was on utrogestan and felt extremely low. Swapped to a different progesterone and have got my life back.

PP is right, utrogestan is a body identical progesterone which not everyone can tolerate. I would try the synthetic progesterone you've been given as it might improve things for you.

You're right, it's not acceptable to boss you about without giving you more info and a proper consultation where your options can be discussed.

If you can afford it, pay for a private consultation - choose carefully- and get some advice.

My opinion is that you should go up to 4 pumps and see how that feels first. No point throwing the baby out with the bath water if all it needs is that.

Can I please ask which progesterone are you on now. I also have a very low mood on Utrogestan and the 12 days I take it I feel awful. This ranges from low mood to extreme hunger and I struggle to control my eating, after the 12 days all returns to normal when on the Evorel only phase.
I have booked appointment with my doctor next week to discuss. He's pretty useless so wanting to go in with a plan as to what to ask for.
I'm on 50 Evorel daily and have been advised on here that may need to be increased.

@LongtimeLurker2 oh wow the insatiable hunger is insane isn't it (& I say hunger, but not even sure I'm hungry I just can't stop eating!), I literally seem to spend 2 weeks of each month eating then the next 2 weeks dieting and then can't work out why it's taking me so long to lose half a stone!

I'd also be interested to know what you now take @SurelyNot22

Has anyone suggested using Utrogestan vaginally? Many of us do and it reduces all these symptoms hugely.

I have read about using vaginally but it has never been suggested to me by the doctor or menopause expert.
Is it the same dose, 2 per night for the 12 nights?
Reassuring to know other people are suffering with the hunger like I am as I haven't really read about this on the internet when I've been researching.

I am now on Evorel 75 sequi patches. The patches which I take in weeks 3&4 contain a progesterone called Norethisterone, which is synthetic as opposed to utrogestan which is body identical.
I had been through all the options including increasing pumps of gel, vaginal use of utrogestan. Absolutely nothing made any difference at all.
The noticeable improvement came from changing the progesterone from body identical to synthetic. Yes this meant I had to come off the gel and move to patches but I didn't care at all as I needed to get my life back on track. I totally get that body identical is better for the majority but for me the utrogestan was absolutely hellish.

Who is your menopause expert? I don't mean name them, but just asking if they are a GP with extra training or a consultant?

Your GP won't usually suggest it as it's off-licence in the UK but common practice in Europe, especially France where they've used it that way for ages.

My consultant says they prefer women to use it that way.

It bypasses the liver so can reduce all the neurological/ mood side effects as well as gastro type side effects.

Yes it's the same dose.

There is a 200 mg capsule but in the UK it's off-licence now as it's only licensed as a fertility drug, but can still be prescribed off-licence.

Just for info, you can still use gel with Norethisterone. The Norethisterone is prescribed as a separate item as a tablet. So you would lose the transdermal bonus but the upside is it means women can adjust the dose of estrogen more easily with gel.

I used it that way for 6 years but through a consultant.

My menopause expert is a GP with extra training. I can see her through my GP practise however she covers many practises, works part time so her appointments are few and far between. As lovely as she is I do get the feeling when I've spoken to her she's more a sympathetic listener rather than offering solutions or other options to problems.

@JinglingSpringbells yes thanks I know. I've done a lot a of research. This combination is the one which works best for me. Obviously can't comment for anyone else.

If I was to use it vaginally would I still use the vagirux alongside twice weekly? Also would it be worth buying an applicator to insert them with?
I've had a quick look online, does anybody know which would be the best ones to purchase?
Sorry if these are daft questions, I feel I get more information from Mumsnet than I do my own doctors.

There is no applicator for Utrogestan ( well, there is for the 200mgs but it's a waste of plastic and doesn't really do the job.)

You just lie down and insert with your finger, as far as you can reach. Job done :)

Yes, you can use vaginal estrogen with it, just do it at a different of day.

Great thank you for your advice, I will give this a try next time and see how I go on.

@LongtimeLurker2 I repurpose a Canesten pessary applicator to insert 2 utrogestan.

That's great thank you. May I ask do you start using it this way due to side effects taking it orally? If so, do you find this way better?

Just coming back to this as I've got a couple of month's supply of Utrogestan left & I'd quite like to try using it vaginally before moving to a different synthetic progesterone. Can I just check - is it literally the same capsules you take orally you just insert vaginally? Same dose & timings just different way of absorbing the hormone (in my case 2 capsules for 12 days a month)