Prostap / chemical menopause - support please

[80smomma]

Morning all,

So I paid to see a private gynaecologist about my cyclical pain, emotional outbursts (possible PMDD), pelvic discomfort (fibroids and potential adenomyosis). I've been on HRT for a year already and it's not really been helping with any of it.
She has prescribed Prostap to stop my ovaries producing estrogen and put me into a chemical menopause.
I know it is temporary and it's a diagnostic tool to see if all my symptoms are pre-menstrual. She has suggested 3-6 months.

All I've read online is negative stuff and now I am spiralling. Keep crying and worrying about it all.
I'm having it on Thursday.

She has said if I struggle with menopause symptoms I can use add-back hrt of which I've already got gel, tablets or patches.

Has anyone been through this - I just need some support. I am worrying myself to death, even talking myself out of it all.

I don't have any work on in may (which is why she suggested starting asap) but I am working in June and July, with a holiday planned in August and I'm so worried I will be feeling bad.

Please help me x

The first question is have you had your HRT adjusted over the last year?

If it's not helped at all that suggests it's the wrong dose, maybe the wrong type and it could be changed to another sort.

Also, have you had a scan for confirmation of your fibroids and adeno?

The bigger question is, if you are having PMDD what is the plan going forwards? Total hysterectomy? ie surgical menopause - removing ovaries?

Has anyone suggested the combined contraceptive pill (if you're under 50) to help your symptoms by reducing the hormonal ups and downs? It's sometimes suggested for younger women.

I was struggling with PMDD, severely heavy periods with clots and hormonal contraceptives weren’t really helping.
I was put on prostap for a year with the end goal being hysterectomy.
Prostap was absolutely amazing for me! My mental health had never been better and the only side effect that bothered me was occasional hot flushes but they were manageable.
My body did metabolise it quicker than normal though so instead of having the monthly injections, I had to have it every 3 weeks.
I had a low dose of Tibolone (HRT) along side it which was great.

I’ve now had my hysterectomy with ovary removal (2 weeks ago) and I feel exactly the same as I did on the prostap.

I genuinely mean it when I say menopause has been the best thing for my physical and mental health.
Give it a go and if you don’t like it, you can always just stop taking it and it will leave your system quickly.
For me it’s been life changing and I’d recommend it to anyone xxx

I have been medically menopaused using Prostap following breast cancer. I keep asking myself why it’s not been offered to some friends of mine who are really struggling with persistent anaemia, horrendous bleeding, fibroids etc. I was in perimenopause and on HRT, and my symptoms were changing wildly all the time. The HRT definitely helped. Following my diagnosis, I can’t take any oestrogen and need to minimise it in my body by any means possible, hence the Prostap. Fluctuating in peri was horrible. I would get huge mood swings very very frequent rage and felt rubbish a lot of the time. The initial dose is a big shift in your hormones and it takes a little while to settle, but because I couldn’t have HRT, I had to go cold turkey. It’s doable, I promise. What’s really important is good nutrition and moving your body. Get yourself some exercise that you enjoy doing and if you feel rubbish go for a five minute walk 10 minute walk. Have a read up on breathing techniques and see if any of them work for you where you take a moment focus on your breath and get back on with your day. I have to take prostap until I menopause naturally, so I could be on this for eight years. Now I’m out the other side of peri I feel a whole lot better. There’s a new normal element to it, but it’s one I trust, it’s one which is stable and it’s one which I can easily manage. I recognise myself again. If you are suffering, I think trying this makes a lot of sense to me and I can see why it’s been suggested. Good luck!

The downside is there is a much higher risk of osteoporosis when estrogen is lost before menopausal age. And development of heart disease is also a consideration. This should be discussed and part of the treatment options/ monitoring long term.

Removing all your estrogen (especially before 51-52) is a risk for bone density and heart disease. (This is why HRT is the medical treatment for premature or early menopause or younger women who have a hysterectomy.)

Any women having an early menopause for any reason need bone density monitoring for life, if not on HRT.

My understanding is that younger women who use any estrogen blocking drugs are also monitored and potentially treated with drugs for osteoporosis when necessary.

Thank you for the responses so far - it is really reassuring that this option might actually help my symptoms.

For more context - I am 44, and have suffered all my adult life with heavy, clotty periods, painful breasts, pain - so had an ablation when I was 38. It stopped the periods completely but I have lots of other cyclical symptoms which have worsened since peri. My emotional outbursts last about 5 days (2 of them are the worst) and then I have periods pains, recurring costochondritis, anxiety, a fullness in my pelvis, frequent urinarion.

My last scan was in 2024 and it confirmed at least 2 fibroids, one measuring about 5cm. I haven't been diagnosed with adenomyosis but it seems suggested. Both my uterus and fibroids had increased in size since the scan I had (2020 I think).

The gynaecologist did say it is like test-driving a hysterectomy to see if it would help. I don't think I fancy a hysterectomy at this moment to be honest and she did say we could discuss other options (an oral medication) after the trial. I think it's mainly to get to the root cause of my cyclical issues.

I do have night sweats already along with intermittent anxiety, brain fog which suggests perimenopause.

I have tried birth control pills over the years, and didn't get on with the mini pill and have family history of breast cancer so it's a bit too risky.

Re, HRT - I've tried conti patches and then switched to estrogel (going from 2 to 3 pumps) alongside 100mg continuos progesterone. None of this is addressing the symptoms I find most troublesome and the gynaecologist said it suggests the issue may lie with my own fluctuating hormones, hence this trial.

I am able to continue with the HRT to balance out the menopause symptoms and counteract issues around bones and heart. She has suggested a 3-6 month trial, and I know if I feel bad in June then I can just stop.

I am scheduled for an injection every 4 weeks.

I am aware the first 2 weeks will surge hormones and my symptoms may get worse.

I am able to deal with physical issues but I don't like psychological issues - the crying and overwhelm in particular.

I am hoping that continuing with my HRT will take the edge off.

I am just so anxious and emotional about all the unknowns and what-ifs but I equally can't imagine having these monthly cycles until I actually reach menopause - which would be another 10 years!

Can I ask how old you are?

Great to hear such positive results and outcomes.
Was your hysterectomy done by keyhole surgery?

The bit I don't understand with this @80smomma is how will using HRT along with chemical menopause make any difference? HRT is putting back the hormones you are zapping with Prostap.

You haven't tried many HRT options yet. You could go to 4 pumps of gel and try the Mirena coil. Or something like Tibolone.

Have you done any research yourself on severe PMDD? I seem to remember that some specialists suggest large doses of estrogen to prevent ovulation, but check this out.

The thinking is that it's my own yo-yoing hormones that are causing the problem. HRT itself won't sort it out. So if they flatline mine, the hrt will be enough to counteract any menopause side effects but not enough to fluctuate.

I have tried the coil before - it didn't help, and it is now embedded in my womb wall.

I have read more recently about PMDD. I am not diagnosed with this - I would describe my symptoms as very emotional and grief like. It is also cyclical.

I am still not 100% sure what the outcome will be, but I've tried the pill, the coil and hrt. Fibroids grow with estrogen so I think the rationale is to stop the estrogen and then just substitute enough to steer off menopause symptoms.

It's the yo-yoing of my hormones in peri that they think is the issue.

For the urinary urgency, ask about vaginal oestrogen. An absolute winner that stuff!

I’m 35 years old (36 in August) and yes, it was done by keyhole 😊

It's the yo-yoing of my hormones in peri that they think is the issue.

I'd be asking for another opinion.

For younger women, the mini pill is often prescribed for hormonal fluctuations as it stops ovulation, or one of the newer types of Pill which have body-identical estrogen.

You mentioned a family history of breast cancer, but the mini pill at least doesn't have any added risk and even IF it had it's no 'worse' than HRT and probably less.

Following with interest as prostap and tibolone have been suggested to me while i wait for surgery for fibroids. I'm 51 and have tried minipill and 2 coils both of which evacuated themselves in torrential floods. Waiting list in my area for gynae surgery is currently 34 weeks so prostap was recommended until then. Like OP I was unsure as alot of stuff online was quite negative.