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.

This is an incredibly useful thread, thank you - I was about to post something v similar.

Is there any way of telling how you are going to react to the Mirena? Dr is quite keen on it, because Gepetrix daily (I am post meno) made me want to die, and taking it vaginally is better, except it irritates my bladder which makes the whole thing pointless as I am trying HRT to improve my irritable bladder. But if I end up feeling grim for months I would rather just give the whole thing up.

Also, is there a difference between Gepetrix and Urogestan, so is it worth me trying that instead?

Apart from the bladder issues I was feeling quite good at the start of this year, and now I am fat, bloated and sad; and have the choice of being either profoundly depressed or gently leaking urine constantly due to the irritation.

I also have an irritable bladder and I don't think the coil (or caffeine) help it tbh. But. The oestrogen gel has definitely offset it. You can also use vaginal pessaries containing oestrogen which also helps the bladder.

I am bloated on the coil. I think the water gain is partly due to the coil but I feel it's less than other progesterone types I've used.

Gepritix is the same as Utrogestan- different name, same product except one has a slightly different oil (ingredients are available online if you search) to bind the micronised progesterone.

@BusinessScrub I was told by my private gynaecologist that if I had the coil removed I would have to stop the gel but could still use the vaginal pessaries for vaginal health and to help irritable bladder. Maybe this could be an option...

For what it's worth the British Menopause Society (guidance on progesterone in HRT- all online - you can read it) says women who are on vastly reduced doses of progesterone or anything deviating a lot from the 4-week norm, should be scanned every 3 months. This isn't realistic but if you did have heavy bleeds then maybe you need to discuss this.

The only positive in it is you're only 46 and if you still have normal periods you will be producing your own progesterone each month anyway.

Is the consultant one who trained under J Studd? Are they London based?

?
Why could you not use another form of progesterone with gel?
Is there some reason for that?

@JinglingSpringbells oh I could theoretically but I really didn't get on with utrogestan. It is now thought im postmenopausal and I queried if the coil could therefore be removed (was put in 4 years ago for thickening womb lining) and if it was removed, what type of oestrogen I could continue with. Unfortunately, due to my history, I'd have to stop the gel and just stick with the pessaries but I'm only late 40s and my gynaecologist would prefer me to keep the oestrogen up till I'm 50.

There are other options not just Utrogestan or the coil.

There is Norethisterone (tablet to go with gel)
Dydrogesterone (in Femoston tablets)
And a different form yet again in a patch.

You could also be advised to use long-cycle HRT which is for women intolerant to progestins. That means using it once every 2 to 3 months, not monthly.

Has any of this been suggested?

@JinglingSpringbells no. I got the impression that the coil issued the lowest dose or most localised dose of progesterone and so if that was an issue the tablet forms would be a no go. I've only heard about the cyclical hrt from mumsnet!!

I would like to say thankyou to you for your generous sharing of your wisdom on this topic.

The time I doubled up with utrogestan was when the coil failed to stop breakthrough bleeding and it was horrendous. So I have taken the tablets for a short time. Eventually (after a good couple of years) the breakthrough bleeding stopped and it is settled for now. But. It will need replacing in 12 months.

Hi @JinglingSpringbells thanks I might see where I stand with a scan especially as I’m likely to be on this for a while… he is based in Hampshire but did his postgrad in London in the late 1980’s so likely under Studd?

Possibly but the late 80s was almost 40 years ago.

It's not really about it being localised but more about what suits you.
I got on fine with Norethisterone for 6 years but swapped to Utrogestan after that re. its supposedly lower risk as I've been on HRT for ages.
I feel worse on Utrogestan even vaginally but my consultant allows me to do longer cycles so I grin and bear it.

Oh that must be frustrating having benefitted for 6 years with something that did work. I've only been on HRT (the gel and androfemme) since autumn and it was easy to start as the coil was already in! I'll remember everything you have said when it comes to replacing the coil in 12 months. I'm not sure I do want to just replace it there and then especially as it took years for the mild cramping and random spotting to stop.

This is all so helpful, thank you. Thing is my brain is scrambled when it comes to all the info esp when it relates to me. Have PMDD right at day 10-12 of cycle so prob linked to ovulation. Nearing 49 so must be peri. Flooding periods that are 28 days clockwork though.

Newson clinic gave me oral cyclical progesterone and a pump of oestrogen gel. Didn’t feel good. They upped the oestrogen and I was suicidal. Quickly came off all.

NHS gyno wants me to have the Mirena and “enough oestrogen to stop you ovulating”. When I panicked at taking lots of oestrogen, she agreed I’d be the “one” who it wouldn’t work with and suggested dietary changes instead (for mood).

The worst of my mid cycle mood symptoms can be managed with low dose SSRIs but I came off them due to other side effects. Not a good idea I’ve found out now I’m mid cycle and ragey and very low.

Literally do not know where to turn next. Most days I do what I need to do, the basics, then barely leave bed. Everything is a mess

@AnotherNaCha I'm sorry it's so tough. In addition to HRT, I'm on sertraline (have been on it a few years now) and personally I'm not planning to come off it. I don't expect HRT (rightly or wrongly) to help with my mental health. I'm on it for managing low level anxiety and intrusive thoughts though as opposed to cycle related mood.

I have heard having too high levels of oestrogen can cause same issues as too low levels and I've also heard Newson can be blasé about increasing oestrogen doses.

Now the coil has calmed down I have to say I'm benefitting from it and the sertraline enormously. Could you approach it in bite size pieces? Try the mirena and see if it does work because when it does it's really good and I know plenty of women who got on with it much more quickly than I did.

Ons thing I will add is the flooding periods stopped immediately on the coil.

I don't expect HRT (rightly or wrongly) to help with my mental health. I'm on it for managing low level anxiety and intrusive thoughts though as opposed to cycle related mood.

This is 100% why HRT is prescribed. NICE guidance is HRT is first line treatment for low mood and anxiety that coincides with peri.
Many women are given ADs in peri and they don't work. Specialists have been banging on for years to try to get this changed.
Lots online about this from medical sources.

I have the same issues with progesterone that the OP and lots of you describe (tearful and borderline suicidal) so I’ve ruled out the Mirena and Utrogestan. I’m now on Cyclogest (off licence, privately) for 12 days a month (plus daily oestrogen gel). Cyclogest does make me a bit irritable, but I prefer that to feeling so low. My doctor now wants to move me onto a continuous regime, but I’m not keen to mess with things when my mood feels relatively stable for the first time in a long time.

@Hillsmakeyoustrong thank you, that’s helpful. Sounds like Mirena is worth a shot in small steps like you suggest. But yes think MH and hormones are all linked. As are various sensitivities to them too. It’s just such trial and error but that’s a good plan.

Does it take 5 seconds? I have a Mirena and realise too late that I didn't discuss the exit route. I'm really worried it'll be a nightmare. Actual 5 seconds would be very reassuring.

This thread is incredibly helpful.

I had a terrible experience with mirena, absolutely catastrophic mood wise, am better with progesterone 2x on day 14-28, but even with that my mood wasn't completely stable. I tried with both taking evening primrose oil, as advised by a nurse at the GP surgery. Well that was a disaster too. I've stopped it now but I was furious with everything and everyone for a good couple of years before I twigged.

This is all so very hard. The whole emotions/hormones interactions, I barely feel I can trust myself any more. I don't know what's me and what's my madly firing womb and ovaries.

It takes 5 seconds to remove a coil.

It can take fucking months to get a GP to agree to do it though, and after that it can take weeks for an appointment. I swear I was on the verge of ripping the bastard thing out with my bare hands in the end - I paid a private GP £150 to avoid killing myself/anyone randomly nearby.

I absolutely feel your pain and know exactly how it feels. Things have very much improved and settled down for me, I assume because my hormonal fluctuations are less (I'm 54 but still have regular periods).

But every few months the awful hormonal low mood descends and nothing helps. Nothing. I just have to endure until my hormones shift again. Back when I saw Prof. Studd he told me I was extremely progesterone intolerant, one of the worst cases he had diagnosed. Looking at my family history I can see that my cousin, my Grandmother and my Great Aunt were exactly the same. It's often inherited, apparently.

I really struggle with utrogestan too. I did find however that over a period of several months the side effects lessened a lot. I now take it daily and once my body got used to it (fatigue was bad to begin with) I actually find my mood is much more stable and I no longer feel low on it. Moving to daily has been much easier than I anticipated