Pmdd - progesterone?

[Ahumanjellyfish]

I’m 47 and have been using oestrogen patches and vaginal progesterone for several years. Initially for pmdd then I stopped. Started having night sweats and issues improved.

I still have regular periods, and I take the progesterone during the luteal phase — around two weeks before my period.

Lately, my mood during this phase has become extremely poor. It’s beyond just feeling low — I struggle to function, and it’s getting worse. I’m starting to wonder if the progesterone could be contributing to this.

I’ve been thinking about stopping everything just to see if I feel better off it, but I’m also not sure what’s wise.

I’m also considering speaking to my GP about trying an SSRI, but I hesitate because I don’t want to waste their time if this is “just hormones’.

I wonder if any of you may have advice or been through something similar?

I still have regular periods, and I take the progesterone during the luteal phase — around two weeks before my period.

Everyone on sequential HRT uses progesterone for 2 weeks and the withdrawal bleed comes at the end of it.

Are you doing it differently and trying to coincide it with ovulation?
Long term this doesn't work and you just take it on a cycle, but the same days each month.

There are several other types of progestogen you can try.
Utrogestan is not the only one although it has become the default, which is kind of annoying as it doesn't suit all women.

The first step is to perhaps increase your estrogen- what dose are you on?
You can go up to 100mcgs.

If that doesn't work, you can try other types of HRT.
Patch +Mirena
Patch + Norethisterone (a different progestogen)
Femoston (tablets and a progestogen in them)
Tablets like Kilofem
Another vaginal progesterone- Cyclogest.

There are all of these ^^.

Too soon to start thinking of ADs especially as Utrogestan is KNOWN to cause low mood.

What would you fancy trying?

Really helpful post, thank you!

I’m not sure where to start, and I’ve been assuming my GP would handle any adjustments. I thought I was on the best form of progesterone, but I now realise I may not be very well informed . Currently, I’m using a 50 mg patch, twice a week. I’m feeling a bit anxious about the idea of having a coil fitted.

I’ve been assuming I could line up the two tricky parts: the luteal phase and starting progesterone. That also seemed to match the dosage instructions, which say to begin on day 12. I’m so confused. I confess I have never understood hormones!

I'll try to iron out a few things you've asked @Ahumanjellyfish !
First, your GP won't necessarily know all the options (ones I mentioned above.) Most do not have any meno/HRT training beyond the very basics.

Your estrogen dose- it's considered 'medium'. At 47 you may need more. I had a phase in my late 50s when I increased my gel from 2 to 3 pumps - roughly a 75mcg patch. I'd been using 2 pumps (same as a 50mcg patch) since 53.

Micronised progesterone came into 'favour' about 10 years ago and has been offered as the default option. It appears to be safer re. breast cancer and is relevant for long-term use. However, it doesn't suit many women.
You might get on better with patches that contain Norethisterone, or the tablet Femoston that has a type of progesterone as safe almost as Utrogestan.

Timing of Utrogestan - the leaflet is not great. Ideally, women take Utrogestan mid cycle to line up with their own cycles. However, the main sign of peri is periods that are all over the place- not he average 28 days. So when women start missing cycles and have weeks or months between them they can't be waiting for 'mid cycle' each month.

The advice now is to take it on the same DATE each month, to create an HRT cycle. This is how HRT patches or tablets work- you don't try to juggle the patch/ tablets in the pack around your own cycle.

It sounds as if you're taking them at the same time every 4 weeks anyway- but you may not be having 'periods'- the bleed you get each month may be the HRT withdrawal bleed. Your natural periods may have stopped or be further apart.

First step is to ask for a higher dose of estrogen which can help reduce the side effects of Utrogestan. If you don't want to bother with patches, ask for gel and start on 3 pumps which is the same as a 75mcg patch. Give that a few weeks and see how it goes.

There are also other options around Utrogestan which you may need to discuss with a consultant, privately, as they are off-label.

1. Using it less often (eg alternate months only)
2. Reducing the dose to 10 days , not 12.

Hope this helps!

This is such a helpful post. Thank you!

I’m going to try progesterone for the ten days. I developed a polyp some time ago and that scared me into not increasing the oestrogen dose.

🙏