Do I kill myself or give in to the uge to kill others? That’s what it ultimately came down to when I weighed up the difference between taking Utrogestan or Cyclogest natural progesterone.
A year ago I wrote a post HRT and Me: Progesterone Intolerance in which I described the problems I had been experiencing with progesterone. Thanks to the responses to that post I realised I am not alone and that there are many women out there who are suffering from progesterone intolerance and battling to find a solution.
Since then I have changed the type of progesterone I was taking and in this post I share my experience of the differences between Utrogestan and Cyclogest natural progesterone.
Utrogestan Natural Progesterone
The first type of natural progesterone I took was Utrogestan which comes in the form of oral capsules and is available on the NHS. Utrogestan is a micronised form of progesterone that is bioidentical, which means it is structurally identical to the progesterone produced by a woman’s body.
Because it is bioidentical it is meant to produce fewer side-effects and, unlike synthetic progesterone like Provera and Climanor, does not increase cell proliferation in breast tissue in postmenopausal women. Unfortunately if you are progesterone intolerant, as I am, then any amount of progesterone, natural or synthetic, is going to upset the apple cart.
I took Utrogestan 200mg for 12 days a month, on days 15 to 26 of my cycle. On those days I became extremely bloated, my libido disappeared, I suffered from migraines, my breasts were often tender, and I became very antisocial. I was too tired to want to do anything much and felt so fat and ugly I just wanted to hide away from the world and wait for my period to be over with. I was an absolute ‘joy’ to live with and my poor partner never knew when I was going to over-react to something and snap at her. Work became more difficult as I often struggled to think straight and focus. On the plus side, because I took the Utrogestan before bed and it has a calming effect, I did sleep a lot better.
My periods usually started on day 6 of the progesterone cycle and continued for up to 10 days. They were excruciatingly painful and so heavy that I ended up with iron deficiency anaemia yet again. The period pains felt as if my womb was being slowly scraped clean with a medieval torture implement made of spikes and nails. My days and nights revolved around mega doses of Ibuprofen which had little effect, hot water bottles, towels in the bed to mop up leakage at night and increased spending on sanitary products. It was nothing if not exhausting.
Utrogestan and Depression
But the worst symptom in the lead up to my period was the depression. With each successive day of Utrogestan treatment I sank further down the black hole of despair. Some days I had suicidal thoughts which really frightened me as I knew I didn’t really want to kill myself but I couldn’t stop the thoughts.
That’s when I knew I had to change my progesterone treatment.
My consultant enthusiastically recommended having the Mirena coil inserted as it can actually stop periods altogether but I was not keen on the idea of having something inside me permanently releasing progestogen.
The other option was to increase the Utrogestan from 12 days to 14 days a month. Yay! Two extra days of bloating and depression. What was there not to be happy about? But I opted to give that a go. Better the devil you know, right?
However, I was confused. I knew that Professor John Studd, a well-known London gynaecologist and menopause expert, often prescribes Utrogestan 100 mgs daily for the first 7 days of each calendar month for women who have difficulty with progesterone and yet I was being prescribed double that dose. When I asked my consultant about it he said that reducing the dose can reduce the symptoms of intolerance but you may have more of a problem with heavy and prolonged bleeding. It also increases the risk of endometrial hyperplasia (thickening of the lining of the womb) which can develop into womb cancer in some women.
After two months on 14 days of Utrogestan I felt ready to give in to the suicidal thoughts. Although my periods had been lighter and less painful, my depression had gotten worse. The discovery that I had fibroids, an endometrial polyp, adenomyosis and a thickened endometrium did nothing to lighten my mood. And after a hysteroscopy and polypectomy I was ready to throw in the towel on HRT, menopause, the whole damn lot.
Out of desperation, I made an early appointment to see my consultant to discuss changing my progesterone. As expected, he enthused about the Mirena coil again. Every time I hear about the Mirena I get a bad feeling and wince at the thought of having it inside me. Instinctively I know that it will not be good for me and all the persuasion in the world is not going to change my mind.
When I asked my consultant about the possibility of taking Utrogestan vaginally instead of orally he said that it was the same product and would have the same side-effects. But he did prescribe progesterone in the form of Cyclogest vaginal pessaries 400mg to be taken for 14 days each month.
Cyclogest Vaginal Pessaries
Like Utrogestan, you need to take Cyclogest just before bed to benefit from progesterone’s calming effect. Take it during the day and you’ll be drowsy. But unlike Utrogestan which is a capsule you swallow with water, Cyclogest needs to be inserted in your vagina the way you would insert a tampon with your finger. It looks like a wax bullet, but it is actually solid vegetable fat and once inserted the fat melts and the progesterone centre is then absorbed into your uterus. This means that you need to lie down as soon as you’ve inserted it, otherwise it could slip back out again, and it also means that you will be slightly messy in the morning once all the melted vegetable fat has dribbled out of you during the night. Just be prepared. If this doesn’t appeal, there is also the option to insert the pessary in your rectum.
Cyclogest is natural progesterone, just as Utrogestan is, and I hoped that by taking it vaginally instead of orally I may lessen some of the side-effects.
That did not happen. I still got bloated each month to the point where I could no longer fit into most of my jeans. And in place of depression I became extremely irritable, unreasonable and angry. Instead of having suicidal thoughts about wanting to kill myself I was having murderous fantasies about killing others. Let me be clear, I had no intention of acting on my fantasies but I felt irritable and angry enough to attempt serious damage if provoked. I still had swollen, painful breasts occasionally and felt even more tired than usual which added to my sense of overwhelm.
Periods from Hell
Two days after I completed my first 14 days of Cyclogest my period began. The period pains were the worst of my life. I have never given birth so I can only imagine what it’s like and this is how I imagined childbirth to be; mindblowingly painful. Enough to cancel out everything in the world except the pain. The cramps had me doubled over, unable to move, moaning like a cow in labour. I writhed and sweated and panted and cursed everything and everybody I could think of and nothing helped.
For several months in a row I actually PASSED OUT from the pain. Twice I happened to be at home, which was lucky, and on one occasion I was in the hairdresser’s. On all occasions, I lost sight and vision, the world went black and silent and I crumpled to the floor. When I came to, I was ghostly white and sweating, barely able to breathe from the pain and the cramping. It was terrifying.
It got to the point where I was too afraid to leave the house on the first two days of my period. What happened if I passed out on the train or in the supermarket or in a busy London street? It was too risky.
On the plus side, my periods only lasted for about 5 days, with two to three of those days being extremely heavy. And, like with the Utrogestan, I slept well.
That’s the long story of it. If you’d like a summary, here’s a table with the main comparison points between Utrogestan and Cyclogest.
|Utrogestan 200mg||Cyclogest 400mg|
|Oral capsule||Vaginal pessary|
|Take for 12 - 14 days||Take for 12 - 14 days|
|Side-effects include: breast tenderness, tiredness, bloating||Side-effects include: breast tenderness, tiredness, bloating|
|Main side-effect: Depression and wanting to kill myself||Main side-effect: Irritation and anger and wanting to kill others|
|Period starts on day 6 of 12 - 14 day progesterone treatment||Period starts 2 days after completion of 12 or 14 day progesterone treatment|
|Period lasts for 10 days||Period lasts for 5 days|
|Period pains, but don't pass out||Pass out from period pains/cramps|
|Period is heavy for approximately 3 days||Period is heavy for approximately 3 days|
|Makes me sleep better||Makes me sleep better|
It’s obvious that neither of these forms of progesterone is ideal. The alternative offered by my consultant was to try a synthetic form of progesterone such as Norethisterone or Provera, but after my experience with Prempak-C I was not keen. Also, synthetic progestins are more likely to cause breast cancer.
I’m Sticking with Cyclogest
I decided to stick with the Cyclogest mainly because I hate feeling depressed so much that I preferred passing out to feeling as if life was not worth living. Also, I decided it was better to want to kill others than to kill myself and I preferred having a 5 day period as opposed to a 10 day period.
In the past few months I have gradually reduced my dosage of oestrogen, I’m currently on an Evorel 25mg patch twice a week and I’ve noticed that the less oestrogen I have in my system, the less severe my period pains are. I guess that’s because there’s less build up of endometrial lining.
The situation is far from perfect and I feel stuck between a rock and hard place. Because of my progesterone intolerance I have decided to come off HRT altogether – more of that in a later post.
In the meantime, I am soldiering on and looking forward to a time in my life when I will be progesterone and period-free.
How about you? Have you had a similar experience? If so, I’d love to hear from you. Please leave a comment in the box below.
HRT and Me: Progesterone Intolerance