New to HRT and think progesterone sensitive. What to do?

[Reginaphalangeeeee]

Hi all.
New to HRT aged 46. I still have regular periods and began Oestrogel (2 pumps a day) with local vaginal cream too and cyclical vaginal 200mg progrsteronefron day 12. Well I am 3 days into the prograterone and after feeling euphoric with the estrogen (cured my brain fog and joint pain and generally lifted my low mood), the progesterone hit hard. Pelvic cramp initially& bloat/constipation. Now feeling quiet low mood/sad/can't be bothered and also have sore boobswith return of joint pain. I have put on 2 kg and sure retaining water.

Do I just see it through and hope For the best?
I really don't want the Merina coil but understand that is the solution for some.
I think another option is to take it continuous, but would Injust stay miserable and forget happiness as the norm?

If I hadnt have felt so bloddy great with the estrogen gel for the first 2 weeks, I would be saying right now that the progesterone symptoms are as bad as PMT and maybe it's not worth it?

Will it settle and get better?

I have got patches and the progesterone part of the cycle is not great - low mood, flat, tired etc. But i sm going to give it a couple more months in the hope it settles.
Sadly like many of us at this stage of life I have plenty of other stressors, and I am busy. I want HRT to work. I think time is needed to see if if settles before asking for a change of dose . 🙏🙏🙏🦋

Meant to say I don't want a Mirena either, had one before and it didn't suit me at all

Thanks, good to on it a not alone. Silly thinking maybe but would guess vaginal gives less side effect than both oral and patches?

I guess I am not many days into the progesterone so should see how settles but honestlywas like night/day. Felt really good on Estrogen, bit like my old self.

Yes vaginally does usually mean less side effects. Not sure about patches. I struggled with the progesterone tablet (as you described) and found the coil to have far less side effects after the initial cramping died down. No more periods was also bliss and I just had to remember the oestrogel. But I understand your reservation re the coil as it doesn't suit everyone.

I’n not feeling any HRT difference 1 month in. But progesterone is exacerbating my acne I think. Considering stopping.

I found I had really bad anxiety after the progesterone so switched to taking it vaginally. After about 3 months I felt fine so switched back to orally (better for sleep) and it’s all good. About 4 months in I think is when your body starts accepting it. Keep going!

I too am SO sensitive to progesterone, it causes PMT type symptoms, crying, suicidal thoughts and generally depressed. The PILL never suited me and now I know why, the dreaded progesterone. In the end I paid to see a specialist who prescribed Tridestra, this regime is 70 days of estrogen 2mg tablets, then 14 days on medroxyprogesterone and estrogen tablet followed by 7 days placebo where I have a bleed.

Unfortunately it is no longer manufactured but my Dr prescribed all the components separately, I tried patches instead of tablets but got lots of bleeding, back on the tablets now and loving life. I can tolerate the progesterone for 2 weeks so I don’t mind so much and 70 days of estrogen is wonderful. I also take testosterone as my libido was absolutely shocking, even after 6 months of HRT there was no change, it’s been miraculous.

If you struggle with your G.P I can let you have the information of the menopause specialist I saw. She can do video consultations and is very reasonable, she used to run our NHS menopause clinic which was closed due to lack of funding, disgraceful. So instead of her knowledge going to waste she offers private appointments.

Thanks @Snippit that would be great. Your response to prograterone sounds extreme! My symptoms probably in the annoying category.
@Fluffyowl00 interesting you returned to oral. I have begun on vaginal progesterone and it is making me sleepy still.
On WLI so understand taking orally could also cause some issues so I will stay on vaginal I guess.
Think I am on count down to have a break from them and feel good again. I may just be jekel and Hyde each month 🤷‍♀️

Hi I tried it for two years and have threads about it. I decided to stop taking hrt altogether in the end and am so glad. It made me feel truly awful, at first just whilst I was on the progesterone but after a while the whole time. It wasn't worth it and I feel so relieved to feel normal again now. It's poison to some.

Hi OP. I managed three cycles on utrogestan then changed to a mirena. It changed my life for the better.

The pill and utro both made me suicidal.

The mirena is absolutely bloody marvellous. I now get the full joy of 100mcg of oestrogen without utrogestan cancelling any of it out!

Following

@Reginaphalangeeeee You need to give it time if you can bear to. 3 months/ cycles to see if it settles down.
Swapping/ switching after a few weeks is not recommended as side effects can settle.
Fingers crossed for you!

I had to switch to the Mirena for the same reason. I hope it settles down for you, might just be early days

My response to the progesterone got significantly worse as I got older. I eventually at 54 ish reluctantly got a mirena. It’s great. The low continuous dose was much better for me. Had it 3 years now and no longer for various reasons on HRT. But it’s fine.

I’m progesterone sensitive too and definitely didn’t want the mirena.

when I was taking progesterone cyclically I found I was all over the place initially. Very emotional, very low, sore breasts, bloated, exactly like PMS symptoms after around day 4. However after about 3/4 months things did settle a lot and the symptoms were much more manageable.

I eventually moved onto taking it continuously and actually found it much better. The side effects eased off after about 3 months and everything settled. The on/off of taking is cyclical just left me feeling physically and emotionally like I was on a roller coaster. As much as it settled after 4 months there were still some side effects for me, more emotional than physically.

Ive only ever taken it vaginally.

If you need to reach out to Dr Smith my menopause specialist her website is: peakmpst.co.uk, there’s also interesting information on there, 🤗

I thought I had done a lot of reading and been well informed going to the GP. It was me that went with idea of vaginal use and thought I may be a bit sensitive as get PMT. However, over recent years where my cycle occasionally lengthens I noticed I no longer get sore boobs so assumed I’d be ok.

Well hearing all your stories have enlightened me more.
I will stick with it for a few months unless mood get very low. I am looking forward to a boast when I come off it cyclically but think I may grow to dread 12 days each month.
Worry with more continuous use or Merina is that I’ll be not really low, but the shine taken off life and a bit flat/not myself but not know as there is no break in it for the sun to shine through.

Hi OP. For me the opposite happened with the mirena.

I had one awful month when it settled, boobs were enormous, swollen tummy, worst PMT ever. Nearly fell asleep standing up in marks and Spencer.

Then wham. Nothing. All receded. Testosterone kicked in. Felt amazing.

Trying it vaginally instead of orally may help.

If not there are multiple other oral progestins as well as the mirena.

There's also tibolone but you would probably have to say your periods had stopped to get this on NHS.

Most women can find an option that suits if they have a knowledgeable clinician willing to help them.

You got testosterone prescribed too?

Yep I have been taking vaginally. Because of WLI I didn't want to mess with oral from the start

After 6 months on oestrogen! GP very happy to give it to me when she saw my blood test result!

Hi @Reginaphalangeeeee
I am progesterone intolerant and sadly have had to come off HRT.

I loved the Ostregel, it made me feel "normal" but I couldnt take the Uterogestan - I tried taking as initally prescribed, then (with advice from GP) taking it vaginally, and then taking it for 2/12 weeks, then patches.

Taking it 2/12 weeks worked the best - I still felt the horrible effects but at least it was for only 2 weeks or so every 3 months. Then I had to come off that as another GP said they couldn't support it.

Looking back I relaised I have been suffering the ill effects of progesterone intolerance since first being prescribed the pill as a teen.

The Mirena (from age 43) was dreadful but it took me 5 years to notice. I started the Mirena just after birth of DD2 and I was breastfeeding. I think the oxytocin countered the progesterone so by the time I was really starting to feel bad/depressed was after stopping BF. this was at the same time as I left XP - lots going on. I didn't connect 5 years of low mood with the Mirena. Once I clicked and had my 2nd Mirena removed after a few months the cloud I had been living under for so long quickly lifted. So do go carefully with that as an option - the "its remote so will be OK" isn't true for everyone.

The patches were by far the worst though - sledgehammer. Last time I took progesterone (we agreed to give the patches a try "its a different form of progesterone - more tolerable) after 5 days I couldnt get out of bed - completely immobilised. It took me 3 days to start to come right. I've only ever had this kind of thing happen on progesterone.

So now I am on an anti-depressant off book to treat the hot flushes. Its OK - not perfect,but ok. I miss the oestrogel. If you can't tolerate progesterone and you have a uterus there are very few options for HRT its seems.

Good luck working through the different options - be cautious and keep a track of what is going on.

"she used to run our NHS menopause clinic which was closed due to lack of funding, disgraceful. "

@Snippit you've just reminded me - I have been referred to the NHS menopause clinic. I was referred last July 2025 & my appoinment is in October 2026.

It really is disgraceful. Its like they hope we will age out or die.

Thanks @RobinEllacotStrike that is really useful to hear your experiences.
I am day 6 since starting progesterone. I guess the cramping has gone so maybe other symptoms may too.
Mood booster today with exercise and sunlight so hoping that can counter act it a little or a lot!