Things have not been going well for me lately as far as my HRT is concerned. I’ve been experiencing problems with both my progesterone and testosterone treatment.
Low Testosterone Levels
Despite the fact that I’ve been applying Testim gel very day for over two years now, a recent blood test showed that my testosterone levels are still very low (0.7) and consistent with that of a woman who is perimenopausal and not taking testosterone.
I have no idea why the testosterone is not being absorbed properly and unfortunately, my consultant was unable to offer any suggestions but said it was nothing to worry about. Although it’s obviously not life threatening, I do worry because I’ve been feeling tired and depressed and withdrawn and more like the person I was prior to starting on HRT – which is not a good state to be in. I still have to spend more time with Dr Google to try and get to the bottom of this.
It’s also become apparent that I am progesterone intolerant. For 12 days of every month I take 200mg of Utrogestan, a micronised form of progesterone that is bioidentical. Even though bioidentical progesterone is meant to produce fewer side-effects in women, on the days I take it I am bloated and feel depressed and antisocial. I get migraines, my libido disappears and when my period starts the real fun begins.
For the past few months I’ve been experiencing heavy and painful periods where the walls of my womb feel as if they’re being scraped with a comb of nails. By the end of my ten day bleed I felt positively anaemic.
In total I have about one week a month where I feel able to do all the things a normal, energised woman likes to do; work, exercise, be creative, sexual and social and have a bit of fun.
Symptoms of Progesterone Intolerance
|Fluid retention||Abdominal cramps|
|Heavy, prolonged periods||Restlessness|
|Weight gain||Panic attacks|
|Migraine and headaches||Depressed mood|
|Increased insulin resistance||Poor concentration|
|Acne, greasy skin and darkening of facial hair||Dizziness|
The symptoms of progesterone intolerance are very similar to those of premenstrual syndrome or PMS. In fact, women who’ve suffered from PMS are more likely to be progesterone intolerant if they take HRT during their menopausal years.
Studies have shown that progesterone intolerance is one of the main reasons why many women discontinue HRT and the way I’m feeling at the moment, I may soon be joining the ranks of the non-compliant.
Unfortunately, if you have a womb and are taking oestrogen HRT it is necessary to include progesterone as well as it prevents endometrial hyperplasia, thickening of the lining of the uterus, which can cause endometrial cancer. Progesterone is responsible for shedding the lining of the uterus in the form of a monthly bleed.
Treatment Options for Progesterone Intolerance
At my appointment with the Consultant last week I was given a few options to try and reduce my heavy, painful periods and other side-effects of progesterone intolerance.
One was to increase the Utrogestan from 12 to 14 days a month and see what impact that has on the bleeding. The problem I have with that is it means two extra days every month of feeling bloated and depressed.
However, reducing the duration of the progesterone to 7 or 10 days a month can reduce the symptoms of intolerance, but may cause heavy and prolonged bleeding to be more of a problem. It will also increase the risk of endometrial hyperplasia.
In other words, I’m caught between a rock and a hard place.
Have the Mirena Coil Fitted
Another option was to have a Mirena coil inserted and this was the option the Consultant favoured most. The Mirena coil is a long-acting, reversible form of birth control called a hormonal intrauterine device (IUD) and is effective for up to 5 years. It’s also been approved to treat heavy menstrual bleeding in women. It works by releasing progesterone directly into the uterus making the endometrial lining very thin. Less progesterone floating around your system means fewer side-effects and in some women, the end of periods altogether.
This all sounds marvellous, but a bit of research on the internet revealed another story. Forums are full of horror stories from women who’ve experienced side-effects like migraines, ovarian cysts, depression, mood swings, aches and pains and constant bleeding for the first few months. It can take up to six months for your body to get used to it and for the bleeding to settled own.
The Mirena coil is also prone to spontaneous migration and perforation of the uterus. Other side-effects include pelvic inflammatory disease, acne, ectopic pregnancy and weight gain. Of course, I must be clear that there are many women who have had few side-effects and are full of praise for the Mirena coil. We are all different, but it is good to be aware of potential harm before having something implanted in your body.
So, I think I’ll pass on the Mirena coil. Another thing I don’t like about it is the fact that you have less control. Once the device is fitted, you have to wait for an appointment with a health professional to have it removed if you start experiencing side-effects. Some women have had difficulty convincing their doctors to remove it. Also, it contains synthetic progesterone rather than bioidentical and I really prefer to go the bioidentical route after my awful experience of taking Prempak-C, a synthetic HRT.
Different Approaches to Progesterone Treatment
So, where does that leave me? Mostly with a long list of questions for the next time I see the Consultant.
For a start, I am confused by the different approaches various menopause specialists in London take when it comes to progesterone treatment. Professor John Studd, a prominent London gynaecologist and pioneer in the use of bioidentical HRT in the UK, advocates Utrogestan 100 mgs daily for the first 7 days of each calendar month. However, my Consultant at King’s College Hospital Gynae-Endocrine clinic prescribed double that dose for me.
I have since discovered that there are vaginal forms of bioidentical progesterone available in the form of Crinone vaginal progesterone gel and Cyclogest vaginal pessaries. I think these are usually prescribed to women undergoing fertility treatment but they can also be used as part of hormone therapy.
Vaginal progesterone has the advantage of bypassing the liver and having direct access to the uterus. It is associated with fewer side-effects. I don’t know why my consultant didn’t mention them and offer them as an alternative, so I’ll have to question him about that at my next appointment.
I am due to have a scan of my uterus next week to check the endometrial lining for any abnormalities which may be causing painful, heavy bleeding and then I’m due to see the Consultant again at the end of May.
In the meantime, I’ll follow the Consultant’s recommendations and up the Utrogestan 200mg to 14 days a month. But I’m not happy about it and unless we can find a solution so that I can cope with the progesterone intolerance, it may be the end of HRT for me.
What about You?
Have you had a similar experience? If you’ve experienced progesterone intolerance, or have been prescribed the Mirena coil or vaginal progesterone I’d love to hear from you. Please share your experience by leaving a comment in the box below.
UPDATE: Read about what happened when I took Cyclogest vaginal pessaries in my post HRT and Me: Utrogestan vs Cyclogest Natural Progesterone