Oral progesterone alongside Mirena - declined by GP

[starsonabackground]

Hi all! During a short period of no coil (while waiting for a new insertion, later followed by a new coil), I was directed to take micronised progesterone 100mg by the HRT nurse at the surgery. Then when the new coil was put in, was advised to stop taking the oral progesterone as well. The nurse told me it would have "no benefit" on my meno symptoms, although when I stopped, my moods went a bit crazy, so I tried taking the leftover supplements again which seemed to reset me and help.

An appointment with an interim Consultant she agreed I could keep taking the progesterone alongside my estrogen, but could not do me a long term prescription. I'm now at the end and went back to the GP to ask for an extension, who referred back to the HRT nurse, who said said "no" to the ongoing progesterone due to "increase breast cancer risk". This is the same nurse who declined that oral progesterone has any benefits, although from my research I have found her assertions to be false in both cases. Many women do report additional benefits from oral progesterone (even taking it alongside mirena) and from what I can also tell, the breast cancer risk is not shown to be a thing in a big study.

Also the specialist consultant woman I saw earlier seemed fine with it and something about no increased risks associated. She seemed to think that other women do this as well.

So, can anyone back this up for me - have you successfully argued for and been prescribed ongoing oral progesterone for any benefits you got? Do you think the advice of the nurse (who seems to be the HRT controller at my surgery) is incorrect, both on the breast cancer risk as well as saying that "oral progesterone makes zero difference to symptoms" - my experience and research says the opposite - that many women do find it helpful for mood, anxiety and sleep.

I'm worried about going cold turkey having had my body used to it for several months now, and I feel the advice the nurse is giving me (not GP, who referred me back to the nurse, which I feel a bit wary of given their incorrect info before) is wrong.

Thanks! Also if you experienced similar effects when taking or giving up oral progesterone could you tell me your experiences? Thank you

I take this. What I did was have an informed risk discussion with my doctor. Yes, there may be a slight risk increase, but I experience symptom relief so it does also bring a benefit. My HRT regime has allowed me to make lifestyle changes that support my health - exercise, giving up alcohol, eating better, so I'm willing to accept the risk in the overall context. I also have no personalised risk of breast cancer. I have the coil to address adenoymosis and oral to address sleep and mood, so each brings a different benefit.

Okay let me tell you the facts as I know them!

Micronised progesterone has only been studied in a few trials. To date, there are 2 trials (not in the UK) which were observational. These showed that there was no increase in breast cancer when used for several years ( years were around 8 to 12.) However, one of these studies has been queried since.

Which 'big study' did you read? Micronised progesterone hasn't been included in all the major studies, even recent ones.

The 'take' on it is that it's probably safer than synthetic progestogen (of which the Mirena coil is one.)

The BMS says that there are no extra cases of BC when using it for up to 5 years. However, no doctor is going to say it's safe forever, long term, simply as there is not enough research. My own consultant says it's 'safer' but can't say categorically it is risk-free.

The risk of BC with HRT is the progestogen element. Women using only estrogen do not have added risk and have less BC. So it makes sense to keep it low.

TBH you're at a greater risk of BC by using the Mirena coil. It releases a small amount of synthetic hormone and it does get into your system, not just the womb.

The real question though is why use both? Micronised progesterone can act as a sedative but at the same time, your body can get used to NOT using it, if you stop it.

I use it on a cycle- vaginally to reduce side effects. It doesn't help with sleep that way. Wnen I did use it orally (for years) it did help sleep but I did feel groggy the next day.

I also have adenomyosis, but I wouldn't have a Mirena now for reasons to do with it being a synthetic progestogen.

Personally, my advice is use one or the other.

It has to be a personalised decision, some of the things you have said don't hold true for everyone. Oral/vaginal progesterone doesn't always have enough of a womb lining action for some issues to do with womb lining and bleeding. It didn't solve the adenoymosis and extended bleeding for me, so I needed to switch to the coil. Oral progesterone had a huge positive systemic impact for me, more important than oestrogen I'd say, between sleep and mood. So it's not a case for me to take one or the other, they do two very different things and address two separate issues.

I understand that. But the OP was asking about the BC risks and they may be increased by using two types of progesterone, continuously.
The difficulty is the OP is coming up against drs who won't allow her to use both.

thank you to everyone who has responded! Appreciate your input and taking it all into account.

The GP/nurse is correct - this is unlicenced use and probably a placebo benefit, it is discussed quite often among doctors who are experienced in the menopause and most won't do it.

Mine is a menopause specialist and was happy to do it once we had discussed risks and benefits. Why would it be a placebo effect? The problem with oral progesterone and the widee systemic impacts is that it's a cheap generic drug and no one will pay to study the impacts on the wider body, e.g. sleep and mood. That doesn't mean they don't exist. We have to rely on the self-reported benefits by thousands and thousands of women or decide that because there's no formal study they can't have the benefit. That's not fair to women who are struggling. It's licensed for the protection of the lining of the womb in HRT, but that's relatively recent wider use and they are seeing more women (like me) where it doesn't have enough of a protective impact when taken orally, it's not localised enough. So there are two products, which provide two distinct benefits, and may make sense to both take together.

If taken in large enough doses @BloomingGardens it will control the womb lining. The BMS says 200mgs daily or 12/14 days x 300mgs for women who need more.

It's been around as a drug for over 40 years as it's used extensively in fertility in large doses, on a daily basis. So there is plenty of evidence on that.

It's not licensed for 'sleep' or as a sedative and in fact many women hate it for those side effects. The medical advice is to use more estrogen for insomnia as it connects with the receptors in the brain.

Obviously if your consultant is happy for you to use it that's between you and them, but in principle through a GP, or the NHS where they work to licensing, it's not the norm.

However, for the OP, her dr has got the risks the wrong way round. The Mirena is a synthetic progesterone and that has (supposedly) more risks than micronised progesterone. It evidently is on a par with the synthetic progestogen in a 25mgs combined patch. So it would be better, based on current research, to increase the micronised progesterone and drop the Mirena.

It doesn't sound like you had an issue before the micronised progesterone, so it is likely that you would go back to how you were before (all be it with some initial withdrawal symptoms).
If you genuinely feel better on it now compared to before your coil change, I would approach your doctor by saying that you are aware that there is some uncertainty about the extent that it can increase the risk of breast cancer, and that you are happy for them to document that this has been discussed, but for you the improvement in quality of life is worth the potential extra risk.

I literally just started HRT when I started the micronised progesterone, so don't have experience of "before" it if you get me? That's when I also started the oestrogen as well.

Hence I think the imbalance upset me more.

Thanks everyone I am going to try to taper off see how I feel then reassess without. If I am still struggling I will definitely go back to the GP.

It does concern the actual specialist consultant I saw was more than happy to prescribe it (short term, as apparently my GP needs to sign off ongoing HRT), but the GP defers to a nurse who says "no". Strange system.

The irony though is the breast cancer risk, if any, comes from the coil not Utrogestan.

The evidence produced by the BMS ( available online) says no increased risk of BC with Utrogestan for at least 5 years.

So the nurse/ GP is wrong in any case.

It won't add to the risk but it's not licensed as a sedative to be used alongside another form of progestogen.

OP why not ditch the coil and stick with Utrogestan?

@JinglingSpringbells thank you for the feedback that's a great idea but I love not having periods and the contraceptive protection of a coil... otherwise I would totally do that.

Having spent a couple of days off the oral progesterone I am feeling a bit dizzy and off. Hopefully it is a short term thing. I'm trying to slowly taper. 😰

If you're stopping it, it's best just to stop.
It takes about a day to leave your system, so if you're dosing up every other day it's just going to give you more withdrawal symptoms longer.

There's no point at all taking any more on an intermittent basis.