100mcg oestrogen patch how to cover the progesterone?

[Phunkychicken]

I've been on the 100mcg patches for 2 years, asking with 200mg progesterone pessaries for 12 days a month.

During this time I've had 2 urgent Cancer referrals for bleeding/polyps and am waiting for an aviation and possible hysterectomy. I also have endometriosis, adenomyosis and cysts.

My last HRT has flagged the progesterone isn't enough, I has a Mirena which Gynae removed due to bleeding, so I'm currently under dosed (75mcg patch) whilst waiting for the hospital to get back to GP. They may also put me through the cancer pathway for a third time due to supposed risks.

What progesterone would they normally recommend for this much oestrogen and how? I'm awkward as the patches and oral cause me migraines, but the vaginal is only available as 200mg.

And given I've seen at least 7 gynaes in the past 2 years for bleeding etc should at least one of them have picked this up?

Thanks, am more terrified they'll drop my oestrogen than risks of using too much tbh

I have moved up to 10mg provera and I use 100 patch. Utrogestan I used for years and only when I moved I realised how much it was making me wee at night, and also I thought I farted a lot but it turns out I actually don't 😂

feel much better on provera and it is controlling my bleeding - post menopause for me

I had the mirena, vaginal utrogestan and 125mcg evorel patches. This was all prescribed by a well known private HRT clinic. Eventually due to spotting and bleeding for over 2 years I got an urgent cancer referral to NHS gynaecology where I had an ultrasound scan showing the lining of my womb to be 8mm and then after that I had a hysteroscopy. The consultant told me I was ‘overloaded’ with hormones and should reduce and give the mirena a chance to ‘do its job’. I stopped the vaginal utrogestan and reduced the patch gradually to 25mcg. I have not had any bleeding or spotting now for 10 months and feel a lot better in myself, my mood etc. And I will not be going back to the private HRT clinic, I have lost all faith in them. So what I’m trying to say is that perhaps you are taking too much of everything?

I’m on 100mg patches + 100mg progesterone daily (was 200mg for 12 days/mo when I used sequential HRT). The amount of progesterone you are taking should be protective for the oestrogen you’re taking, ie it’s not a non-standard prescribing combo. But your other gyne issues are likely making the situation more complicated.

Hi OP, can't you have another Mirena put in?

I am on 100mcg patches with a mirena. My endometrial lining was up to 6/7mm but gynae did a hysteroscopy D&C and said the mirena was fine at that level.

If you want one putting in quickly, private GPs can usually do it (that's who did mine as the NHS list was so long).

I was told by GP and private gynae that mirena is sufficient for 100mcg.

I didn't get on with the mirena much anyway as I just bled a lot, and the threads caused me issues as I've got ectropion and polyps. So happy not to go back there. Oral progesterone had always triggered me migraines though so hence being so happy with the pessaries.

Finally I have worked up to the 100 dose, I was using terrible mood swings, dryness, insomnia and massive pain on the lower dose. And am still getting loads of hot flushes which are getting worse.

Happy to try the lower dose but not holding out much hope. I've always had a nightmare with my hormones though

@Phunkychicken The British Menopause Society has a long and detailed report on the use of progesterone with HRT (available online.)

The guidance is that for doses of 75mcg and 100mcg patches it's 200mg (2 capsules Utrogestan) daily (on continuous) and 300mgs sequentially.

This is a guide because how the endometrium responds is individual. The higher doses are for women who have spotting or irregular bleeding on lower doses.

There is no difference in the 100 and 200 capsules except size. The 200mgs are primarily for fertility and not licensed for HRT but are prescribed off-licence.

To get 300mgs you just use a combo of 200 + 100.

aah thanks @JinglingSpringbells I did ask about but the pharmacist was so spooked by me that she wouldn't agree to anything off licence. She's put an urgent message to the gynaes at the hospital as she's happy to prescribe on their recommendations but the GPs will only offer me the 75/200mg without their input.

Glad there are options though, let's hope they come through quickly as I'm not fancying my chances in the reduced dose

Your GP needs to get up to speed!
The BMS doc has been around for some time and it's there for GPs to read so they can prescribe. It doesn't need consultant verification.
I can link to it or if you search here you may find it anyway as I've linked to it before.
BMS/ HRT/ progesterone use of / guide

Hope you get sorted.

Pharmacist rang new today. She'd been worried about new as gynae can't see me until Jan so spoke to two GPs who have agreed that if the 75mg isn't enough they will put me back onto 100 and then just 200 vaginal and 100 oral progesterone. Soooo woohoo, thanks so much for your replies which really did give me hope

You can use all the doses vaginally. I've used 2 x 100mgs for years with my consultant's okay ( he's one of the most experienced in the UK.)
so you can do 200 + 100 vaginally. They are identical just one is bigger.

Even better,thank you