Utrogestan depression

[JJkate]

Hi, I've been on hrt for two years; estrogen gel and utrogestan tablets. I find I'm badly affected by the utrogestan (very low mood, irritable etc) so have been able to convince the Dr to let me take 3 pumps of gel with two utrogestan tablets. This has taken the edge off the utrogestan low mood but only a bit.

I tried taking utrogestan vaginally but the side effects were bad. I dare not try the coil as the thought of having something that has to be removed feels like such a loss of control if it doesn't work out. My question is, do I just put up with this? Low mood for 12 days a month forever?

If I stop all hrt I can't sleep and have very inconsistent mood changes with peri symptoms so opted for this as the least worst option as at least I sleep however I'm feeling so ground down by this depression and irritabity each month and also worry that I'm taking too high estrogen dose. If anyone has found a way out of this please could you share your stories. Thanks.

Have you tried patches?
Evorel Sequi or Femseven Sequi, both have 2 weeks of oestrogen and then 2 weeks of progesterone and oestrogen.
I was awful on utrogestan, very moody and depressed.

I was given utrogestan when I continued to spot with the mirena. I took it a few days and I was monstrous and very, very bloated. I had to stop. I think I'm fairly progesterone intolerant but with a thickening womb lining have had to have something. I have to say it's all calmed down for me now and I love the coil. I resisted it for a long time though. I have however gained alot of weight which feels like water retention for the most part. Although, it probably isn't the coil, just a coincidence timing wise.

The way I understand it the Mirena provides localised hormone at a lower dose, so it’s a small amount in the area where it’s needed.
I was tearful and low on daily oral progesterone (no improvement taking it vaginally). I don’t feel amazing now but I put that down to menopause itself. My moods aren’t worse than before I started HRT and I have the benefit of HRT to my sleep, bones and heart, relief from hot flushes and aching joints etc.

Have been in your shoes! It sounds like you're very progesterone intolerant so think very carefully about having the Mirena coil. The progesterone in it does not only stay localised. Some of it enters your system and it's synthetic progesterone which is even worse. Be careful.

NHS doctors tend to know fuck all about HRT or progesterone intolerance and they can't be bothered to learn either. Even the doctors in my Menopause Clinic hadn't received any specialist training in HRT or the Menopause.

I ended up seeing a private consultant who was (he's now died, sadly) Chairman of the Menopause Society and a world authority on HRT. He diagnosed me as being so severely intolerant of progesterone that he would only prescribe me 100mg every day, for only 7 days per month. And even that super low dose had to be off set by 4 pumps per day of Estrogen.

He was very, very relaxed about the supposed risk of uterine cancer though he did suggest having a yearly uterine scan to check that my lining was within normal limits.

It worked very well for me and took me from constant suicidal ideation to being well on the road to recovery within 3 months.

Are you talking about the late John Studd?
There are still consultants following his ideas, although not always as low as you had BUT there are also examples of women who did use only 7 days who did end up with endometrial cancer- I'm pretty sure that one woman like that posted on another forum.
You're right that privately, there can be more variation.

Yes, I was a patient of his for a few years. He passed away a few years back but I think his clinic is still running, staffed by doctors who trained under him?

He did suggest monitoring my uterine lining every year, but was quite laid back about it. He also advocated going long-trial of 3 months on estrogen only, followed by 2 weeks of Utrogestan (so only taking Utrogestan 4 times a year). This worked brilliantly for some women.

If you go privately you do get far more expertise and the confidence to go off licence with HRT for a more personalised treatment.

Yes, there are still consultants working who trained with him.
And even those who didn't train with him, know the same stuff.

I had 3 months of estrogen only with my consultant, to get the dose right.
Then long cycles (3 monthly) but I found the bleed too excessive after 3 months. I still do cycles longer than 4 weeks.

The reason that these options are available is that they are through consultants who take responsibility for them and are more knowledgeable.

You can't take it everyday if you have any period/ bleeding at all. Has to be cyclical utrogestan.

You can if it's prescribed and you understand the risks associated with that prescription.

Ditto

@TheTwinklyLilacSquid You absolutely can. The reason cyclical progesterone is prescribed for women who still have periods is that it can cause continuous/heavy bleeding. It hasn’t for me and continuous progesterone is the preferred option for long term HRT as it offers slightly increased protection for the uterine lining.

Some women do take it daily for various reasons, before their periods have stopped.

The only 'risks' are that there is often breakthrough bleeding.
This is because in peri when women still have periods, 100mgs a day doesn' t always control their cycle. @TheTwinklyLilacSquid

@Pampampam

The idea of better endometrial protection has to be balanced against the slightly higher risk of breast cancer. Drs seem to ignore telling women this. The lowest risk of BC is with estrogen-only, (for women with no womb), the next is cyclical, and the highest is combined continuous as it's the progesterone that adds to the risk.

Women have a choice over which they want to stick with.

I had similar issues with oral utrogestan and switched to combined patches and haven’t had a problem

I got a Mirena fitted recently to combat heavy periods and the progesterone side effects have returned with a vengeance, to the point I’m going to request to have it removed

@JinglingSpringbells would continuous combined include the mirena coil and gel?

Yes. There is info on this online where it says the progesterone in the Mirena coil which gets into your system is roughly equal to the amount in a low dose combined patch.
You're getting progesterone daily from a Mirena, albeit a lowish dose.

For the posters who have experienced a better private service, where / how did you find a good one? I might end up going this route and am overwhelmed by all the info online.

In take it daily and haven’t had any side effects at all. Try daily and see how you get on

@OudAndRose I found the newson clinic disappointing with the exception of their willingness to prescribe androfemme which is testosterone. I had very low testosterone levels. I had the coil fitted by my private gynaecologist (who had done my previous surgeries for endo) and he prescribed me the gel. I deviated from him for the testosterone as he had been less willing in this area but after a slightly improved libido (which is what I needed help with) he is happy to take over. What I'm trying to say in a long round about way is that you might need to talk to a few people to find the right 'partner' going forward. It is overwhelming at first.

hello @JinglingSpringbells I take estradot (or whatever is available) 150 daily and only take progesterone for 2 weeks every third month.... from your research/knowledge would you say that's quite risky? I've been on this regime almost two years with no scans at all.... thanks

Hi, I'm also sensitive to progesterone and had three different types of HRT before settling now with Oestrogel and Provera 5mg continuously. Tried Utrogestan vaginally and although slightly better than oral, I was still down a black hole come the time to start it. Even after one dose at night I was lower than a snakes belly the next day, crying while walking the dogs, couldn't stop. Now I'm absolutely great, no mood drama at all, I'm 52 if that helps. X

I felt absolutely grim on Utrogestan, and taking it vaginally didn’t help. Had to wait for a few months to get a Mirena fitted but it’s been so much better. Honestly, I’d give it a try if I were you.

Presumably a consultant has suggested this?

What was their take on it?

It is very little progesterone partly because you're on a very high dose of estrogen- assume you mean a 150mcg patch (which must be 2 patches as they don't come as 150.)

Can you elaborate a bit about why you're doing this, why, and what your dr has said.

You've got to do your own research maybe starting with who there is locally, or if you're willing to travel. google menopause consultants, read their profiles online, see who grabs you?

I chose mine as they had a special interest in what I was worried about and they offered a very comprehensive service for women.

Hi @JinglingSpringbells I'm under a consultant and I take it like this as I have PMDD (or severe PMS as he called it). I don't seem to do well with progesterone hence this approach. I take either 2 x 75 patches or 3 x 50 or a 50 and a 100. It varies according to the supply... No risks were mentioned at all and no scans have been offered. I had one follow up with a different consultant who prescribed tranexamic acid as I had quite heavy bleeds but that has calmed down (or I'm managing it better). No end date was discussed to this HRT either (I'm 46) just getting a bit concerned about potential risks and how long I do this for. Consultant fairly keen to do a hysterectomy instead of HRT

hi @JJkate sorry didn't mean to hijack your thread but has some relevance.... My very very low moods are massively improved by taking HRT as described above....