Utrogestan experiences please - desperate to feel better!

[Sleepy21]

I recently saw a private hormone doctor who was great and really listened to me - I did try HRT with my NHS GP but didn’t get on with it - she said I don’t need the oestrogen but that my progesterone and testosterone is low and prescribed utrogestan 1 a night - my sleep and anxiety is quite bad - some me, some hormonal - anyone had this approach and it has helped? I am nervous to start as I am really sensitive to hormones. Thanks for reading and would really appreciate your views x

Not sure how old you are and if you are still having periods @Sleepy21 ?
I never thought I could have HRT after being diagnosed with endometriosis at some point.
I got put on a very low dose of oestrogen (I was 51) and Utrogestan 3 weeks out of every four.
Now my periods have stopped my oestrogen gel has gone up a bit and I take Utrogestan every night.
I am really really sensitive to hormones. When my periods were horrendous I was given I was given progesterone - not the HRT type - and I did not do well on it at all.
Even now the docs pushing the Mirena coil and I don’t want it although I know some swear by it.
My experience of Utrogestan has been actually positive in that has helped my sleep.
I am aware when people have side effects they use it like a pessary instead - the NHS tend not to recommend that but private gynaes say it’s fine.
I was really, really wary of taking it but I’m glad I did.
I did put weight on with it though but I have accepted it’s just part of what happens.

Thanks for your reply - I am 43, and she said as I am having regular periods she doesn’t think the oestrogen is necessary - also supported by blood tests which showed low progesterone, though she did say blood tests are just a glimpse - I told her my reaction to the HRT and she said lost likely my body didn’t need the extra oestrogen - I was only taking one pump as well and had side effects

It's not standard prescribing.

Do you mind if I ask what are her qualifications? Is she registered with the BMS as a specialist? Is she a consultant gynaecologist?
Only asking as there are so many doctors now jumping on the meno bandwagon and some have little training.

The role of progesterone is not usually relevant. One blood test showing it was low is not really relevant. Maybe that was a month when you didn't ovulate.
Post menopause women have no progesterone at all- it's only produced as a result of ovulation. But they still have symptoms from loss of estrogen, sometimes for decades.

Progesterone is only added to HRT to protect the womb lining and stop it getting too thick/ becoming cancerous while using estrogen. It's not relevant in terms of improving symptoms like hot flushes, mood, night sweats etc.

One form of progesterone- micronised progesterone - can cause sedation at night which is why some women like it, but others hate it and have low mood as a result.

In your shoes I'd be wary - and query her experience.

She is qualified - a GP that specialises in hormones and not getting far with my own GP - I saw her as I also have my thyroid to consider - I saw her last year and progesterone was low then too so took a wait and watch approach

You did ask about her prescribing and I'm not convinced she's right. sorry.

I'm comparing what she's doing with almost 20 years on HRT with one of the UK's best menopause specialists.

I am 43, and she said as I am having regular periods she doesn’t think the oestrogen is necessary

This is completely wrong. There are loads of women on this forum who still have regular periods and are on HRT.

Your symptoms are loss of estrogen. Blood tests at 43 are not accurate.

Look at it this way- if low progesterone was the issue, why are all women with symptoms not prescribed only it? They have no progesterone at all once their periods stop. They only use it to protect the womb.

But what are her actual qualifications for that specialty?

Is she a GP with Extended Role? If so she's done women's health training (if that's her chosen topic) on top of her GP qualification, but this consists of supervised practice and evidence of CPD in the relevant area alongside her GP role, not years of specialist education and exams. She'll know more than the average GP but it's nothing like training as a specialist gynecologist or endocrinologist.

I take continuous Utrogestan only, gynaecologist prescribed, for pelvic pain. I'm 45, my only peri symptoms were insomnia, anxiety and tinnitus and all have gone since I started progesterone. It's commonly prescribed alone in the US, in early peri. It makes sense to me if this is the first hormone to drop that it would be replenished alone.

I took it (for adenomyosis) for two years prior to adding estrogen. Continuous dose and completely solved the adenomyosis.

I am very sensitive to it p/o so I take it p/v without any issues at all.

Thank you everyone for your responses - yes - those are the main symptoms I have - insomnia and anxiety - hence why she started me with progesterone, which she acknowledged went against the NICE guidelines

@Livingmagicallyagain @SophieV80 are you both UK based?

Is that in the UK @SophieV80 ?

Progesterone is produced after ovulation.
If there is no ovulation, started by estrogen, there is no progesterone.
Women with periods can still have anovular cycles (no egg released bu they still bleed.)

The US has different views on HRT and there are also a lot of doctors there who believe in progesterone only but they tend to have different qualifications to the UK- many are practising forms of alternative medicine not accepted in the UK.

It's not prescribed alone. The reason for that is micronised progesterone often works as a sedative. so it might help with sleep or it might not. (It doesn't help me and makes my sleep worse but I've stuck with it as it's safer than other types.)

You said you had tried HRT before- what did you try and the dose and for how long?

Did you have regular reviews and ask to try a different sort or dose?

Do you know what her training is? At the very least she ought to have done the basic HRT prescribing course through the British Menopause Society and ideally the Advanced Prescribing course.

Anxiety and insomnia are the two main symptoms of peri and respond to estrogen.

Hello, sorry to jump aboard with a side track...

Women with periods can still have anovular cycles (no egg released bu they still bleed.

• how would you know if they were anovulatory cycles ?

To the OP - I'm 42, I've been on estrogen and utrogestan for 2 years. My experience with utrogestan has been good, it helped my sleep and I found when I switched from using it part time to every day it helped me feel calmer and more stable - it was definitely that which made the difference.

However, I was having trouble staying asleep past 3am and waking up abruptly with anxiety, it until I increased estrogen that this improved. I also had terrible hot flushes which estrogen has partially improved.

I haven't found estrogen replacement the be all and end all though. I think it's complicated when you're young and still have a strong cycle but also have symptoms. In my case its been trying to buffer the huge hormonal fluctuations rather than raise an absolutely low level.

I also have regular periods, my GP never said that was a reason not to have HRT, she said you use HRT to treat symptoms - which I had.

I admit I probably didn’t give it enough time - I stopped after 3 weeks because I had such bad side effects - worse anxiety, waking at 3am in a panic, bad stomach, sore boobs. I worked in private health care for over 15 years and this doctor was a personal recommendation from a trusted old colleague so I trust her view, but I just feel nervous as I react strongly to hormones it seems - I do agree though a second opinion might help

100% - it’s the fluctuations that are the killer at the moment it seems and that’s the bit that is a challenge to manage - did you have side effects from the estrogen to start?

Excellent advice from @JinglingSpringbells

The recommendations from this private GP are worrying, I cannot see the logic in them.

Are you being treated for your thyroid issues? Hypothyroidism symptoms include insomnia and anxiety.

To answer your question about Utrogestan I was completely unable to tolerate it, it felt like 10 days of the worst peri symptoms. But many others find it great. (I switched to another form of progesterone, Duphaston, not prescribed for this purpose in the UK - I’m in Ireland - and have a good experience with it.

it is a known side effect that patients can experience increased/new anxiety in the initial weeks of taking HRT. I was similar to you OP, waking at night feeling panicky, anxious at work, my confidence took a knock but it did improve.

I would question the oestrogen. It isn’t only needed for menopause symptoms, it protects bone and heart health.

At this stage, a single blood test result doesn’t give the full picture as your hormones will fluctuate.

OP, this is mad. You tried HRT for 3 weeks and just stopped? Why on earth didn’t you try other options?

I’m not sure about ‘strong reactions to hormones’ 🤔 you have had side effects which are not uncommon, it’s often a matter of trying different products. I responded very well to oestrogen as it happened but I did have tender breasts for quite a few weeks.

Respectfully OP, you seem a bit uninformed.

it’s not that it’s a special challenge for you to manage hormonal fluctuations - that’s the nature of peri menopause, indeed adult womanhood. Our hormones fluctuate.

The challenge in peri menopause is the varying & sporadic nature of those fluctuations which has such problematic impacts for most of us.

I’d really re-think this approach you are taking.

Utrostegan - I love it. Sends me to sleep at night, it’s mildly sedative. Don’t take it in the morning.

Thanks for your comments - yes, I am a bit uninformed - still learning and navigating all this - these symptoms feel like they all came on rather suddenly - and I didn’t mean that it’s only me experiencing challenges with changing hormones! And when I say I have strong reactions to hormones, I was also including my thyroid in that

Yes I did, it felt a bit like early pregnancy. I had really huge sore boobs and felt very nauseous. I think it lasted about 3 weeks, but I also felt some positive effects pretty early on too.

I have since learnt I need to increase more slowly to avoid these. Im on patches, when I needed to increase again I cut them into quarters and increased by 1/4 once I felt I'd settled or after 2 weeks.

I have to say it's far from perfect - I still get a lot of symptoms around my periods, flushes, irritability, insomnia, anxiety. But its 4 days out of a month now, not all day every day. My cycles have started to change now, so I do get some other phases of increased fluctuations, but for a long time HRT cut it down from crazy every day to crazy a reliable 4 days a month.

Thanks @EarringsandLipstick

Just to add- dydrogesterone ( the progesterone you use ) has now been licensed for use in the UK! I have a friend using it, swapping from long term Utrogestan.

It's only a year since it was licensed and is under the brand name Nalvee.
My understanding is that not all health trusts offer it (which I don't understand as it's not expensive) but the BMS says it's available.

You were possibly given too high a dose of estrogen to start with. This is where a more tailored approach can work but using standard drugs.

My consultant advised me to start on 1/4 of the average dose of gel- half a pump which is half a 25mcg patch.

I did this for a couple of weeks then gradually increased to 1 pump, and eventually 2 pumps. I was also put on long cycle HRT which was 10 weeks of estrogen only to get the dose of that right.

The mistake of many GPs is too much too soon, not adjusting the dose or offering different types of progesterone.

3 weeks is nothing. I had nausea at first on gel but by working up slowly, it went. (I was in my early 50s and late peri.)

Blood tests are inaccurate. NICE says not to do on women over 45. Under 45 they are done to rule out other conditions and, for young women under 40, to check for premature menopause by their FSH result.

You should have 2 tests on consecutive cycles . blood should be taken on days 2-5 of your cycle. This should be do-able as you say they are regular. And regardless of the result, they are not very accurate.

Yes I'm sure it was that. I've gone up several times since then and done it much more gradually, it's been much less bad.

It was bad but quick though, 3 weeks and I was over the hump. Cutting the patches up felt a bit like dragging it out.