Any hormone experts willing to share knowledge with me?

[menohnopausal]

In essence, I'm wondering if I need to add progesterone to my existing HRT set-up, in order to mitigate ongoing anger / irritability.

I've currently got the Mirena coil (had them for yonks, suit me well).

I've been using Lenzetto for the last 18 months (most of the time on two sprays, but have recently increase to three sprays, thinking it might improve irritability), and testosterone to help with libido (not a huge improvement with sexual desire, but it has give me more "lust for life").

However, I've just had three weeks of simmering rage. I'm 99% sure it's a hormonal dip - it's been accompanied by more vaginal dryness, and generally crabby, lethargic "PMT" vibe.

Part of me just wants to say fuck it. I'm a miserable bint, and everyone else can just deal with it. On the other hand, I love my family and don't really want them to suffer unnecessarily 👺. I had a thought that maybe the Mirena's progesterone is so localised, that it's not able to affect me positively in a systemic way.

Can anyone enlighten me?

And if progesterone is likely to help me, what would be the best (safest) delivery method.

BTW my GP is lovely, but not very informed about HRT. She's very amenable to me making an informed request.

Are you pre or post menopausal? If pre, you should be on progesterone anyway. You should only be on oestrogen only if you are post menopause.

Disclaimer: I am NOT a hormone expert.

That’s not correct - if you take HRT and you have a womb, you need progesterone whether you are pre- or post-menopause.

She has a Mirena coil, so she clearly has a womb, but otherwise you are right @CortadoPlease

OP the Mirena gives you progesterone already so are you asking if you think you need more than the Mirena is giving you? Personally, for angry feelings I find more oestrogen helps, not more progesterone. Maybe try oestrogen in a different form? I'm on Oestrogel, which is good. I'm on three pumps per day of that.

If you haven't had your uterus removed, you should take both estrogen and progesterone.
Estrogen can thicken the lining of the uterus
Progesterone will help balance the effects of estrogen in the uterus .

I think for some women systemic, body identical progesterone (eg utrogestan) can have a calming, slightly sedative effect. You won't get that from the type of progesterone you're currently using (Mirena). Utrogestan can help with sleep, which would perhaps make you less irritable.
But for some women it's awful. You won't know unless you try. You might even be able to take it in addition to your coil.

It can need a bit of trial and error OP (and frustrating when you feel your GP is relying on you to be the expert in the room). If the Mirena is replaced every 4? years (not sure of the specifics if it’s being used for HRT), you shouldn’t need another form of progesterone. Maybe you could suggest to your GP that you try 4 sprays of lenzetto. If that has no effect, then perhaps try another type of estrogen delivery (gel or patches) as you might absorb it better. You can also get topical estrogen for vaginal dryness so don’t suffer if it’s troubling. When I started on HRT I started with 50mg patches and after a few months felt my symptoms were coming back so moved to 75 and then 100mg which has been great. I think that’s the equivalent of 4 sprays of lenzetto.

Yes, just to clarify, my question is whther it might be worth adding more progesterone to my existing set-up. Mirena is sufficient to prevent over-thickening of womb lining.

I actually sleep pretty well, so it's not sleep-deprived irritability.

The max Lenzetto dose is supposedly 3 sprays, so I'm not sure about going up to four. Also, I'm a bit wary about going too hard on the oestrogen as I have a family history of breast cancer (have considered all the risks, and feel it's still worth it for me to take oestrogen).

And the lack of clarity about dosing differences between spray, gel and patch is just.... infuriating 👹So pissed off that there's not more concrete research and/or punclically available information.

Taking each point in turn @menohnopausal :)

Most side effects come from progesterone and many women would love to use only estrogen. In theory, progesterone is the 'anger' hormone as the older types in patches are androgenic (meaning linked to male hormones) and often linked to PMS.

The benefit with micronised progesterone is it's a sedative which some women find helpful at night but others hate it (headaches, low mood, etc.)

The combo of estrogen +progesterone is linked to breast cancer (estrogen only isn't linked to an increased risk) so keeping it to a minimum level is best for all women. At the moment there is no evidence that higher doses of estrogen = more risk (this is in the BMS papers, by the way.)

The equivalent doses of gel, spray etc are established but there can't be an exact equivalent because they delivery is different.https://thebms.org.uk/wp-content/uploads/2024/02/15-BMS-TfC-HRT-preparations-and-equivalent-alternatives-JAN2024-B.pdf See page 4

Or Lenzetto three sprays (40 mcgm) equivalent to two measures of Oestrogel or 50 microgram patch.

Lenzetto is supposedly the same as 2 pumps of gel.
But you can use up to 4 pumps of gel. That would be 3mgs and the equivalent of a 100mcg patch.

I agree with a PP that your next step is to think about swapping Lenzetto for gel and increasing the dose.

Thank you so much @JinglingSpringbells ! (I had been hoping you might spot my bat-signal!)

Just to add @JinglingSpringbells you've been the source (or at least the springboard) for my "informed opinion" at the GP. Your work is much appreciated 🙌

Happy to try to help.

The benefit with micronised progesterone is it's a sedative which some women find helpful

Yes, that's why I take progesterone tablets orally - in order to benefit systemically.

I used to have the Mirena coil but much prefer the calming effect of taking micronised progesterone orally.