Utrogestan crash?

[Whentostarthrt]

I’ve been on hrt for around 3-4 months, and definitely notice a difference with the lenzetto spray - less brain fog, thinking more clearly etc. However, I’m on 200mg utrogestan (2 week on/off) and am starting to notice my mood dip significantly over the two weeks I take it and then it crashes once I stop taking it. I’m taking it vaginally as orally it sent me to sleep (to the point where I nearly fell asleep driving). I have been under a huge amount of stress lately so it may just be that combined with a hectic Christmas, but I wondered if anyone else had experienced the same and if there might be alternatives…

I’d have a Mirena coil as it’s low dose and continuous

unless there is a specific reason you can’t, it’s possible to take it continuously. You avoid the crashes that way. It’s mimicking your cycle at the moment, so it’s kind of PMT.
My cycle is very irregular, so my GP suggested continuous progesterone and it works well for me.

Oh that’s interesting- I didn’t realise you could take the progesterone continuously. Do you still get a bleed? I do still have periods although they were very irregular before I started the hrt.

I have thought about this but am worried about how I’ll feel - I’ve never tolerated the pill and at least with the utrogestan I can stop it straight away if it gets too much. I’d be worried about not being able to have the mirena removed if I didn’t get on with it.

I experienced this too and my gp suggested that i take it vaginally, as do you, and also continually. This has made a positive difference to my emotional stability. Although recently I have started bleeding again!
Hope you get a balance OP, I think the process can be quite trial and error.

The use of continuous HRT is for women aged 54 and over or with no periods for 12 months at a younger age.
There can be variations on this if sequential gives side effects.
However there can also be side effects of using continuous too soon- spotting and erratic bleeding.

I have the same 'crash' as you describe but it's not so bad I can't get by.

You could drop from 14 days to 12 days.

12 days is the actual dose and is on the leaflet.

14 days was only suggested in a training manual for GPs to say to women, as being easier to remember 2 weeks on/ off.

I do still get bleeds, yes. They vary in length and frequency, and are slowing.
A PP has said you have to be over 54. I was 51 when I switched to continuous, so that’s not necessarily the case. I found 2 weeks on and 2 weeks off completely confusing and GP said it was only suggested that way so women know where they are in cycle. It made no difference to when I bled, so it was easy to switch for me, and my migraines reduced a lot.

The 2 weeks (or 12 days) per cycle is the licensed amount to keep the endometrium thin and it mimics a normal 28-30 day cycle (without being on HRT) . For most women it creates a regular HRT cycle with a bleed every 4th week. The idea being you use it on the same DATE each month and ignore your own cycle .

The reason it's not advised sooner (for younger women or any women with more or less regular cycles) is that the guidance for continuous is any bleeding after 6 months needs investigation, starting with a scan.

So for anyone still having their own periods it's impossible to tell if they are having abnormal bleeding that needs investigating, or it's their own period.

I don't think this is quite right re continuous. I'm late 40s and was told to move to continous soon as I'd been taking sequential for nearly 5 years. They like you to move to continuous after 5 years to ensure better protection of the womb lining.

But yes it can also be possible to move too early to continuous if you have still have some natural bleeds. A gynae actually tried me on 25 days a month to allow for a bleed in between. Wasn't quite right for me but worth the OP going through all the options with a GP or specialist.

What you have been told is not always the case. It applies mainly to women over the age of 50 when they start HRT, who may be almost post menopausal. It's an option. If someone starts it at 43 they will probably not be period-free in 5 years.

I've used sequential for many years with a consultant gynaecologist and have a friend who's used it that way for 20 years and her GP is fine over it.

This is written by an NHS consultant .

https://www.menopausematters.co.uk/postmeno.php

POST MENOPAUSAL -
Continuous combined therapies.
"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age. The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved. When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin. Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy. Start with low dose preparations and increase as necessary for symptom control. The products marked * are licensed for osteoporosis treatment/prevention.

WHY & WHEN TO CONSIDER CONTINUOUS COMBINED THERAPY
Why?

• No physiological reason for menstrual bleeds if can be avoided.
• Most women prefer a no-period option.
• Cheaper for patient - one prescription charge instead of the two for sequential combined therapy.
• Possibly less risk of endometrial hyperplasia (thickening of the womb lining) in long term with continuous combined compared to sequential therapy.

When?

• Patient known to be post-menopausal at whatever age, ideally by having at least one year of amenorrhoea (no periods).
• If sequential therapy started while still having periods, wait till age 54 years. At 54 years 80% of women will have cessation of ovarian function and are likely to settle on continuous combined (period-free) therapy.
• Change from sequential to continuous combined by finishing the current sequential pack and start new therapy at the end of the expected bleed.

Definitely depends on the individual circumstances. This is what the NICE guidelines state:

Guidance from the British Menopause Society (in partnership with the British Society of Gynaecological Endoscopy, British Gynaecological Cancer Society, Faculty of Sexual & Reproductive Healthcare, Getting It Right First Time (GIRFT), Royal College of General Practitioners and the Royal College of Obstetricians & Gynaecologists) recommends that:

Women taking sequential HRT over the age of 45 should be offered, after five years of use or by age 54 (whichever comes first), a change to continuous combined HRT.

@Wonderbug81 should be offered

Yes, I agree. 'Offered' - it's an option.

The other link says 'Consider' - it's not mandatory.
It's a combination of personal choice and circumstances.

The other thing is, there is a difference sometimes between the guides for GPs which are meant to be simple and straightforward for GPs who aren't 'experts', and the dose offered by consultants who can give more individualised options and closer monitoring if needed.