Is there HRT without progesterone or an alternative?

[Asabat]

Is it possible to have some kind of HRT without taking progesterone? After various permutations over four years, I am currently on a pretty average Everol 50 and 200mg of utrogestan for 12 days of the month.

I really cannot tolerate it, while not quite suicidal, for days on end I just want to sleep or disappear I am so unhappy and weary. I have PMDD which has associations with progesterone intolerance and also have never been able to take the pill without slipping into depression - in my 20s they gave me beta blockers to help, but things improved when I stopped taking the pill, so I never took them.

The only suggestions I have been given from consultant is to try Slind for 6 months or taking 100mg of Utrogestan constantly. I don't really understand why that would be better - but I am guessing from my reading that the constant dose might help with the peaks and troughs of progesterone that seem to cause the PMDD and depressive mood symptoms? Oh and the other suggestion is the mirena coil, but again constant progesterone doens't seem like a good bet for me.

I can't really go on like this and am thinking that I probablly need to just give it all up and just try and live with the symptoms I have till I actually get to menopause - I will still feel awful, just a slightly different awful.

Im intolerant to progesterone.
I take Tibolone instead of normal hrt and vaginal oestrogen.

The guidance on intolerance (written by a UK consultant) suggests a reduced dose of progesterone, such as 100mgs for 7 -10 days a cycle in cases of extreme intolerance. The guidance is also regular scans to check the womb lining. That could be every 6 months or maybe longer.

You are not likely to get a GP to offer this as it's off-licence but you probably would privately.

À mirena iud gives enough progesterone to protect the womb from estrogen, but is a very low dose in terms of how much gets into your system.
i would ask your gp for one.

Thanks I will look that up.

I was on 100mg before for 12 days. I was taken off it because of my scan results, which indicated thickening, and told that it was no longer recommended, by my consultant. Three months later on 200mg the 2nd scan result is better, but I want to go an lie down in the road.

Back and forth we go.

Slind is off licence for HRT and GP unlikely to prescribe according to consultant. But I don't want it anyway.

I think I would like to try the coil if the dose is that low, but I am concerned that if it is still as bad getting it removed will be problematic.

oh and I am now bleeding every two weeks.

What’s Tibolone @Branleuse?

I can’t tolerate progesterone either and felt like you do on utrogestan- I also have a history of PMDD.
I get along so much better with the Mirena coil.

I can’t stand it either OP. I came off it all. Am currently doing weights, low carb, and taking various supplements. It’s helping.

I found the mirena was great, having been worried about the continuous progesterone. Should have had one much earlier.

Mirena is great for me, had to temporarily take progesterone orally as my mirena was out of date, felt dreadful until my mirena was replaced and stopped taking it.

Have you considered tried taking the progesterone vaginally instead of orally?

Watching with interest. Also considering giving up on HRT as progesterone hates me.

Yes you can get a Mirena which is a different type of progesterone and it’s local so might be less of an issue, I’d try that first. Especially as it can suppress bleeding.

I’ve heard a suggestion to use the utrogestan as pessaries. But that’s off label.

I do use the utrogestan as pessarries, I can't tell if it makes any difference. Messier though.

A different view here I couldn’t tolerate the bio identity progesterone but settled well on continues synthetic brand called norethisterone, prior to trying the coil you could take 5mg of this and see if you can tolerate?

@reversegear that's interesting. It seems the opposite direction that everyone goes in - how did you work it out?

I kept trying and eventually paid for a menopause lady who looked through my entire NHS pill history and worked out when I felt the best, she then looked at the levels and selected that pill, it’s been from day one fab, no periods, moods are balanced and just works for me.

I never wanted a coil, I couldn’t tolerate the new progesterone brands and this old school one suits me.

Some other link, I have high histamine and take antihistamines daily which also helps me with my absorbing HRT.

it’s the opposite, yep!! I alway feel like the odd one out, I’m allergy to the gel, react to some patches, it’s been a journey.

as I also don’t ever break, but again with a history of endometriosis the advice is that women with endo don’t do cyclical progesterone.

I was really struggling with progesterone, a Mirena worked for me. Low continuous dose rather than peaks. I’m not on the oestrogen any more but still got the Mirena in, it’s fine. I’m mod 50s.

I recommend St Erme Medical. I'm now on Slind but they were great at discussing all the options for PMDD/2 week bleeds. I didn't want a Mirena.

Thanks for these replies. It's good to know that it's not just me, depressing to know it's so many of us. I have a GP appointment next week and I think I will try the coil. Nothing to lose really.

This is interesting, as I am very similar. Which HRT combination do you take then? Despite being 59 I am still on Novofem which is a sequential regime with Estrogen/ norethisterone.
Bioidentical progesterone gave me the most terrible migraines and I could barely move.

I believe I also have histamine problems, but have never really got to the bottom of this - how did you get tested?
I take anti-histamines for food/sulphite intolerances.

hysterectomy and then onto oestrogen patch, thats what I did😁

If you stay on HRT long term it's worth reassessing this as the synthetic progestins are linked to a higher risk of breast cancer.

I take the progesterone 5mg norethisterone and evoral 100 patches hopefully back to estrdot when it’s back in stock, I’m 50 and have been told due to historical endometriosis that no breaks is better and advised.

i have surgery at 45 to remove endometriosis after years of self diagnosis I pay privately and I’m still not NHS diagnosed but he removed it from every organ, so in answer to your high histamine I’ve been intolerant to so many things my whole life, in my 40s I read medical papers in my spare time and learnt even more during covid about mass cell activation, autoimmune conditions and the link to high histamine in women with endometriosis.

So I followed a low histamine diet, take them daily and it’s also linked to progesterone. Simply put when women are pregnant we produce tons of our own anti histamine to protect the baby, and I always wondered why I felt amazing when pregnant…but that’s also linked to high progesterone levels.

The histamine reaction all links to women who can’t tolerate HRT I had a histamine reaction to the Gel, I have a rash from patches. We are just sensitive and it takes longer to find the right combination.

Weirdly we all also tend to by hypermobile but I never read a paper that figured that but out.. maybe one day when women are studied we will unlock the cure to cancer that lives in our uterus, the most fascinating understudied organ in the whole human body.