Struggling with progesterone-what are my options?

[footballmum]

I’m 53 and haven’t had a period for 6 months. I’m on 2 pumps of estrogel and 200mg of utrogestan for the 12 days a month. I’ve gradually realised that whilst I’m taking the utrogestan and for a week after I’ve stopped I feel generally lousy. Mainly headaches, fatigue, brain fog and general low mood.

Im going to make a GP appointment but want to be armed with all of the information before I go. From reading around the subject I think I have the following options:

Staying on utrogestan but take it vaginally. If I do this do I still take the 200mg or is it just 100?

Swap to a different type of progesterone, again with the option of administering vaginally.

Change to patches.

Come off HRT altogether. This would be the absolute last option for me as I think I’ll just swap one set of symptoms for another!!

Has anyone had success with any of the above and are there any options I’ve missed?

The mirena coil is a very low dose

I take 100mg daily now as I was feeling so terrible with the two week regime. No side effects whatsoever now.

Be careful and monitor mood carefully. My dd tried the coil for endometriosis and she was set back in her MH by six months.
She is very sensitive to progesterone we now realise.
Never again.

It's out now and it wrecked her MH and she is now back in therapy thanks to this so called low dose product. Loads of anecdotal evidence on here and Reddit etc

Interesting. i have the same terrible migraines and anxiety when taking it GP swapped me to taking it vaginally. Its the same tablet but you use it a different way (was expecting something different but there you go!)
Would love a solution but not the coil as can only be fitted under GA (they tried without) and that seems too extreme!

Are you better on the new regime?

I’m reluctant to have a coil fitted. I’ve had one before and still had loads of headaches plus it’s a nightmare to get an appointment and if it doesn’t suit me an even bigger nightmare to have removed! Will try it again if it’s my only option short of stopping HRT

If you're truly intolerant to progestogens there is no alternative. Even the menopause clinic couldn't offer any solutions, and I've tried them all, patches, pessaries, coils. The side effects are worse than any menopause symptoms for me, plus the oestrogen part caused a huge uterine fibroid as oestrogen feeds them. HRT is not for everyone.

Not at all. First month thought YES! now back exactly the same but also having the pain of putting a pill up my hoof for two weeks at bedtime then telling husband no sexy time now

Yes that is my fear. Last time I was HRT I was peri and was recovering from a major operation to remove a brain tumour. I think I’m now menopausal (blood tests also showing the same) so it might be that my symptoms aren’t as bad.

Oh no! Sorry to hear that 🙁

I was on HRT from February 2024 until August 2024. I found that I am sensitive to the progesterone, and ended up with more symptoms than I started with. In the end I decided to come off HRT completely, it simply wasn't helping me being on it.

I switched to vaginal suppositories (it was a different medication to the oral tablets - softer capsules and comes with an applicator)

Solved all my side effects so it’s worth trying for 1 cycle at least.

You're just going to have to experiment OP.

I've used Utrogestan for around 10 years (a different one before that.)
I was okay-ish with it orally but it does trigger migraines and a bit of low mood. So I swapped to vaginally (it's the same dose by the way.)
Still some side effects (mainly raised temp at night.)

You can use the same tablets vaginally. There is a 200mgs tablet but it's off licence (only for fertility) so it depends if your GP is willing. It's exactly the same just bigger.
I've had it before but it's very expensive (get mine privately.)

You're really asking about 2 different things- what to use and if you can do combined continuous.

Can you use it daily ?(possibly as you're 53 and probably close to post meno.)
The risk is it won't control your own cycles and you may bleed / spot.

You don't sound 'truly' intolerant - just the symptoms many women have on it to a greater or lesser degree.

There are many ways round this , more if you go beyond a GP and see a consultant. They can offer longer cycles (so you use it less often, like alternate months) or for fewer days each month, but with the precaution of a scan now and then.

@FusionChefGeoff You must be using something like Provera? It's not body identical. Assume you mean a pessary as a suppository goes up your bum :)

@footballmum Being realistic, I think many women have some side effects but have to balance not using HRT, and using it with a few niggles.

It's different it it floors you, of course.

Very few meds are totally side effect free. I felt pretty grim using it daily- constant headaches. I don't enjoy using it sequentially but it's the least worst option.
Everyone is different and some women are happy on using Utrogestan daily.

I am on my first cycle of 100mg a day after struggling with 200mg for 12 days. I am 52 and was getting regular periods but of course could just be withdrawal bleeds at this point. So far so good I think, I feel more stable after 20 days of this now, no breakthrough bleeding yet but early days. For me it was the rollercoaster of too much prog half the month and prob too little the other half. Fingers crossed this works, but like everything to do with hormones I know it is a guessing game!

Can you tell me the brand name please? as this was what i was expecting and pharmacy just sent me the same oral tablet but with ‘insert vaginally’ on it 🤦‍♀️

I've tried oral tablets, pessaries, gel, coil and patches. Progestogen doesn't agree with me at all and neither did progesterone when I had periods no matter what age. The trouble is, even though the coil is a low dose, there isn't a period to release all the adverse side effects progesterone/progestogen gives me. I came off hrt for about 3 years (am 57) but had really chronic sleep disturbance and (I still have hot flushes). For that I tried sleeping tablets of various kinds, over the counter and prescribed. Short of antidepressants there wasn't anything else left apart from patches again. I've settled on a 3rd of a patch every 4-5 days or so and am giving that a try for a few months to see how I go. I started with a full patch once every 8 or 9 days and the sleep got better, but everything else started - bloat, water retention, anxiety, slow digestion, trouble breathing.

I got a mirena fitted as the progesterone was no longer suiting me (I've been on various combos on HRT for 10 years since early 40s). That was great for a while, the slow continuous dose was fine. I can't take HRT now for various reasons but the coil is still in and I'm fairly sure I'm actually menopausal not per now and it's all fine - the occasional hot flush but that's it really - the other symptoms have all calmed down.

Thanks for everyone’s responses and sharing their experiences. I’ve seen the doctor today and we’ve agreed that I’ll try switching to 100mg every day and see whether that settles the symptoms down. As everyone has said, it will be trial and error. If this doesn’t work I might even try coming off HRT altogether and seeing how I go.

Good luck with your new regime OP. I’ve so far not found a continuous regime that works for me.

I’m intolerant to progesterone OP and I’ve tried most options available except for Mirena. I’m on a longer cycle regime which I can manage and tolerate.

I take 400mg of cyclogest pessaries/suppositories for 12 days every 8 weeks. It sounds like a whopping dose but I’ve actually found that this higher dose doesn’t come with more intolerance symptoms. So I do still have a bleed but it’s not that bad and doesn’t affect my day to day life. I have one day that’s heavyish so I just make sure that that heavier day happens on a Saturday.

Just wanted to jump on with a little update. The continuous progesterone is going really well. Feeling much better, my headaches have gone and the greasy hair seems to have cleared up. Still knackered but the brain fog has gone. Fingers crossed it’ll continue!