Changing from monthly to 3 monthly progesterone

[Orangesandlemons77]

Has anyone does this please or know of it? It says in the NICE guidance it is possible to do cyclical HRT as follows. Planning to ask the GP about this.

• Three-monthly cyclical regimen — oestrogen is taken daily and progestogen is given for 14 days every 13 weeks.

I’ve not heard of this but very interested, as I use utrogestan pessaries, and they are messy. Would it make periods even heavier though, I wonder?

I will try linking to the guidance. I guess one heavy one every 3 months might be preferable to heavy ones each month..

https://cks.nice.org.uk/topics/menopause/prescribing-information/hormone-replacement-therapy-hrt/#regimen

Thanks, hopefully somebody will be along soon who has tried this. I will speak to my GP next time I havw a review.
I agree, one heavy period every three months definitely better than one a month!

I was allowed to do this by my consultant as I don't tolerate progesterone very well.

Now seen the specialist nurse and she's switched me to body identical progesterone and if I tolerate that better I will be going back to more frequent cycles due to the risks of thickened womb lining and cancer due to lack of progesterone.

Also going for a scan as it's been 4 years since they last had a poke around.

If you have heavy periods have you tried tranexamic acid?

It's been an option for a long time. I did this for several years through a consultant.

It's an option for women who are intolerant to progesterone. And usually you'd be expected to have a scan (which the NHS may provide.) Obviously this 'costs' and your GP would have to be convinced you needed to use a longer cycle and fund the scans (unless you did that privately.)

There is a tablet form of HRT called Tridestra which is a 3-month cycle.

If you were to go onto a 3-month cycle, it's sometimes better to consider the older types of synthetic progesterone (Norethisterone) as they're more powerful to counteract any build up of the lining.

And you'd usually be advised to have a scan, at least once a year.

Everyone absorbs estrogen differently and it's hard to know how heavy your bleed would be if you did the 3 month cycle.

This 3 month cyclical regime worked very well for me.

And then I had to see a gynocologist and she treated me like I was an absolute idiot for doing this (i.e. acting on advice from my GP) and she insisted I come off.

I cannot tolerate progesterone - I was taken off HRT and given something else for "hot flashes" that did not work. I have not slept well in months. I'm exhausted.

Just off the phone with doctors - I asked to go back on the 3 month cyclical HRT (taking Utrogestan for 2 weeks out of every 13 weeks) and doctor has agreed I can go back. It worked really well for me.

I have lifelong issues with progesterone that took a depressingly long time to learn about - pill, mirena, Utrogestan - all throw me into a dreadful depression.

I can tolerate Utrogestan for about 2 weeks I think - or at least its the lessor evil.

Hey @RandomMess , what is the "Body identical progesterone" please? sounds interesting.

I thought Utrogestan was "bio identical" - is this different to "body identical"?

My doctor says Utrogestan is bio identical and pretty much the only thing available to me.

Hi it doesn't seem to have a name??

thank you 🙏🏼 - I will keep that in mind to ask about next time, though as I am no longer ovulating it might not be suitable.

this is the AI summary on the differences:

Utrogestan and Zentiva progesterone are both hormone treatments that contain progesterone. Utrogestan is a brand name for a type of hormone replacement therapy (HRT) that contains micronised progesterone. Zentiva progesterone is a brand of progesterone that can be used to prevent ovulation.

How they work

Utrogestan
A body-identical version of progesterone that's made from plants. It's used in HRT to help with menopause symptoms.
Zentiva progesterone
Prevents ovulation by sending feedback to the brain to decrease hormone levels.

Side effects
Utrogestan
May cause changes in periods, headaches, breast tenderness, tiredness, mood changes, nausea, rash, or acne.

Zentiva progesterone
May cause bloating, stomach pain, nausea, breast tenderness, headache, drowsiness, mood swings, irritability, or vaginal discomfort.

Other information

Utrogestan is taken orally or vaginally.
Zentiva progesterone is available in micronised capsules.
A doctor or pharmacist can advise on the best dose and how to take i

@RobinEllacotStrike In the UK (if that's where you are) consultants are trying to replace the use of 'bio' with 'body'.

'Bio' was a marketing term originally and 'body' is more accurate.
Meaning it's the same as our own progesterone.

Your other question about Zentiva.

Zentiva is the name of the company.
It's not the name of the drug.

The drug is 'micronised progesterone' and it's made by Zentiva.

Utrogestan is the brand name of micronised progesterone and it's made by Besins.

The info you produced by AI is not exactly accurate. Micronised progesterone does not prevent ovulation. I think there is some confusion here as Zentiva also possibly make a progesterone only pill (POP) as contraception.

thaks @JinglingSpringbells

that is interesting - I wonder if I have the same reaction to my own progesterone then? Bit late for me I guess. I wonder if our own progesterone can trigger depression/low mood etc? I've certainly noticed the side effects when I have added progesterone to me.

Yes absolutely. That's the whole PMS scenario that kicks in after ovulation when we have 2 weeks (approx) of high progesterone.

Just to say I was looking at NICE guidelines and telling the doctor, but she said her doctor version of the NICE guidelines are different, and that the 3 month cyclical HRT model was "greyed out" on her version of the NICE guidelines.

We didn't find out why this is. She agreed to prescribing the 3 month cycle regardless, though to be fair I was insistent.

Considering so many women react to progesterone, there seems to be few alternative options for us.

of course!!

I had almost completely scrubbed PMT from my mind/memory.

I do it

But expect to be told off immensely. I was under a private consultant who sort of okayed it with an annual scan. Now just under GP and don't quite say how long I go. I cannot tolerate progesterone and if I don't do this I can't take HRT.

My understanding is it's more common in Europe to do this. And also that it's only really ok if you're late peri or already menopausal.

I had a scan after about 18 months and all fine. Must admit I do need another now after over a year.

I take two pumps of gel a day so normal dose. I then... and it's complicated and after lots of fiddling about. Insert (vaginally) half a capsule for about two weeks and then a full one for about 2 weeks. I do this as if I go straight to one capsule I am very ill. I seem to tolerate it more if I build up gradually, so no massive hormonal fluctuations.

I am menopausal now and did try a couple of times to stay on one capsule a day to move to continuous... but after a few weeks my mental health was shocking. Every three months I take it as above until the day I start to have dark thoughts. That day I stop again for three months.

As my lining seems to be thin (was 2mm) despite this, I might try half a capsule a day and see if I can tolerate that continuously. Might try that this time as just started again yesterday. Wondering if this would act almost like a mirena, very low dose continuous.

At the moment I am fine with what I do and think I accept the risks, will check in annually and stay on HRT. I know guidance now is take much more progesterone than was previously recommended, but I simply cannot due to its impact on my mental health. It's profound and scary.

I haven't had a period btw for a year. I did at first but now don't bleed at all. This did worry me but scan was fine so assume the dose of the gel and then the progesterone is enough somehow to keep it under control. I guess as I take it for up to 4 weeks (albeit at a low dose) and then take 2-3 months off, it must counteract the fairly low dose of gel. Could be I also do t absorb the gel that well, have heard this too for some people.

I'd be surprised if your GP said to do this, they seem very cautious and by the book (understandably)

But isn't the Nice guidance 'the book' ? I will try the GP and see how that goes.

Interesting- I moved to norithisterone after years of having an awful time with utrogestan ; cystic acne, low mood and terrible pain in my uterus . I am 57 and can only tolerate it it for about 11 days every month. I hardly bleed on it. Would love to go on a longer cycle. I tried conti but had an awful time. I had an awful time with the mirena too.