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.

You seem to be ignoring all the mirena suggestions? That’s what I use too - really like the idea of only using the progesterone locally

She’s not? She’s just said she may try it. Also it’s not for everyone.

How bad were your menopause symptoms? Worse than what you're going through now?

HRT is not the magic cure-all that's touted on here (by many) and in the media (looking at you Davina). It doesn't work for everyone. I tried it and felt absolutely dreadful. Came off it, went into menopause naturally soon after and have felt a million times better since then. I know I'm lucky (probably?) to have minimal menopause symptoms (for now) and I'm not ruling out trying HRT again in the future. But for me, it made me feel so much worse than without.

Another vote for Mirena coil - o couldn’t tolerate utrogestron 12 days - felt dreadful
coil delivers the progesterone locally and is much better. Good luck

I could not tolerate utrogestan at all but am now on cyclogest pessaries instead and have no side effects whatsoever.

Me too. Utrogestan was a car crash for me and I tried all variations - continuous, sequential, different doses etc.

Im on a sequential regime but long cycle, so the cyclogest once every 8 weeks. I do get a few symptoms but not bad and I know it’s only for a short duration and that it will end soon iyswim.

I was also told I could increase my oestrogen during the progesterone phase. I’m on patches but have gel to top up.

Just catching up now having a bit of a monster work week - not aided by feeling like crap, thank you for replies.

@HippyKayYay - this is the question, whne I started four years ago the main problem was aching joints and periods where I had every single PMS/period syptom each month. At the point PMDD was under control with Citilopram.

Now despite a whole raft of doses and combinations, I have overheating, night sweats, joint aches have come back, acid reflux, weight gain sore boobs, periodic incontence, depression, brain fog and grinding presistant exhaustion - so it looks like HRT hasn't helped much or I need to up oesttrogen or I am just getting older.

Somebody ( @reversegear ?) mentioned histamine response - I pretty sure that this has been an issue, but it's very hard to unpick from Covid, much much worse hayfever, hives and other odd reactions and perimenopause (I am also hypermobile).

Seeing GP on Monday. I doubt they will go for the Slind as off list for HRT. I will ask for the coil, but people have suggested several other options that I have never heard of and I am not sure where to start or what will be viable.

I would really like to manage with diet and excercise, but I am really struggling with due to the fatigue and aches. Any exertion beyond normal day to day wipes me out.

Mainly I am confused and tired.

Umn, no. Mirena is likely next step

OP lots of those symptoms are low oestrogen linked, have you tried a higher dose?

@reversegear , that was just occuring to me! Problem is a certain private clinic put me up to 100 very quickly and my GP was not happy. I didn't feel great on it wither, but now I think it might be the progesterone not the oestrogen that was the problem. Argh argh argh

So if we are similar as I suspect..then I had to do 25 patches for 2 months then 50 for a few months and then 75 etc.. I’m now fully able to feel when I’m high or low on oestrogen. And I keep the progesterone steady and stop cycles.

if it drops lower which it did recently I upped to 100 and felt great, my first symptom to reappear is aching gums, then heart palpitations, then sweats.. and if I stop totally or miss a change of patch I can notice within a day.

if your super sensitive take the antihistamines daily you can buy from Amazon cheaply.

I am pretty certain I know when it drops - it's just hard to see through whats happening when you are in it. I think I will get the coil sorted then approach about upping the estrogen. We are only allowed to talk about one thing at a GP appointment and I think they will want to refer me back to the consultant.

I was suicidal on Utrogestan, even vaginally. Mirena was similar, although I felt continuously awful instead of just for 2 weeks a month. They didn't want to remove it (this was at a well-known pharmacy, who my GP outsourced this to), so I refused to leave the clinic unless they took it out. Lord knows what would happen if you weren't assertive. I still think it's worth a try, as a progesterone-sensitive friend really got on with the Mirena. We're all different.

I'm now on Cyclogest, which is off licence for the menopause. It's through Newson Health. I found it makes me angry rather than suicidal, but because of worries about the lining of my uterus, they've recently doubled my dose and, weirdly, the anger is now quite minimal.

If you're still having symptoms, it could be that you need to up your oestrogen, or maybe you're not absorbing it through the patch. I'm on 4 pumps of gel, which I think might be more like Everol 75, but don't quote me on that.

Also, surely your oestrogen and progesterone levels count as the same thing. You should be able to discuss both at the same appointment - that's ridiculous if you can't!

Hi @Asabat I am under a consultant for PMDD or severe PMS as he calls it…. I’m on 150mcg estrogen and I take progesterone (tablet) but only every third month and it’s helped massively with my symptoms. The consultant wanted to do mirena but I declined as the thought of it and putting it in makes me feel sick which I know is ridiculous but I’d need to be sedated. His next step if this didn’t work is hysterectomy but I’m doing well so far although follow ups are scarce and no scan offered so I’ll be asking for one when I eventually get a follow up.

@Asabat my GP prescribed me Slynd last week. The BMS guidance states off licence use for people experiencing progestenic side effects. It’s been great so far

I think it's unlikely they will prescribe me that combination as I have already lining thickening and frequent breaksthrough bleeds (currently I have been bleeding more on than off since 1st of June). Right now I want the mirena more than anything!

Is it the actual vaginal Utrogestan? Or you just use the oral tablets as pessaries? Sorry if that’s a stupid question

@FusionChefGeoff it's the oral tablets as pessaries - they are sort of gel capsules and both GPs and consultants have said this is ok

Whats Slynd?

The coil has been life changing!

Had to have mirena removed as it was no longer effective. I couldn’t tolerate utrogestan and they made me stop oestrogel if I wasn’t taking progestogen.
4 days after removal, and I’m bleeding, so I’m not done with periods.
I really don’t want another mirena as each time I had a new one I bled lightly every day for 6 months

So we will see how cold turkey goes and if I can’t cope then it’s another mirena. I feel quite foggy again but I’ve been recommended something called Happy Mammoth which I’m going to look into

Slynd is a progesterone only birth control pill (mini pill I think?) which they seem to be recommending for progesterone intolerance in HRT now.

I have now started on it (only since Monday) and I have to say I feel a lot better (despite a rubbish week) - but who knows what's going on - I am not sure things can change that quick, and I know from the ugesterone there is a build up in how it affects me.

The depression and dull feeling has lifted and the bleeding has stopped, but I am furious all the time, though that might be the heat, all the irritating people and being the mother of teens.

I am taking it until I can get a coil fitted.

Just to say new GP was amazing, listened, got it, had read my notes and sympathised. She also apologised for the lack of joined up thinking between consultant and GP. We discussed options and she was sensible and knew her stuff. It may just be being listened to for 10 minutes that has made me feel better!

How is the Slynd going OP? Have been in it a couple of weeks and bleeding like crazy

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