Micronized Progesterone - Does it do anything?

[Abra_ka_dabra]

I started taking HRT a while ago and I felt was all over the place, sometimes on top of the world. sometimes awful - it took me a lot longer than it ought to have done to figure out that in the 2 weeks that I take Oestrogen only I'm amazing, and when I take Utrogestan with Oestrogen I can barely function - during this time I don't exercise, I eat junk and loads of carbs, I shout at my family and my anxiety is through the roof.

In the UK we had a while where you couldn't get Utrogestan, and I spent 2 months feeling amazing, I lost weight, I was happy, social, I ate well and I exercised.

I decided to have a look online at the current research into HRT and see whether me having a BMI of under 25 and taking unopposed Oestrogen was likely to have a greater relative risk than taking sequential combined HRT and spending half my life feeling awful and gaining weight.

So here's the kicker - on Google Scholar I found HRT and Endometrial Cancer reviews and papers. There's not much available for Micronized Progesterone specifically, but it categorically didn't reduce the risk of Endometrial Cancer compared to Unopposed Oestrogen (these are longitudinal studies - looking at whether women got Endometrial cancer, rather than clinical trials - but they were published in 2010 Allen et al. and 2014 Fournier et al.).

I've talked to my doctor and told them I won't take Utrogestan anymore, and they recommended i have a coil put in, as this is pretty much the only alternative. Based on the NICE guidelines I MUST take progesterone.

I had a look at the NICE guidelines, and Micronized Progesterone's ability to protect against Endometrial Cancer is just assumed - there is no reference to actual studies showing it works at all.

So I went and had a look at the total relative risk of taking HRT... if you start below the age of 60 regardless of whether you take progesterone or not your relative all mortality risk is around 0.7 - which is a 30% reduction in your chances of dying year on year.

I'd love feedback from other people - do you know of any real studies (Not the ones in 90's that looks at cell histology and uses combined equine estrogen, or when you dig in you realise they only had 50 cell samples for the micronized progesterone cohort) that show that Micronized Progesterone actually does what it's prescribed for?

Also, does anyone have enough clout anywhere that this might put this in a more public forum, I don't really use social media, and that seems to be the only way to contact anyone who might actually get some attention.

I believe that women should have agency to make an informed decision about taking the form of HRT that works for them. Smoking almost doubles your All Mortality Risk, drinking Alcohol every day increases it by about 50%. Being Obese increases it by roughly 25%. If you climb Mount Everest you have a 1 in 100 chance of dying. We are allowed to do all of these things, but taking Oestrogen only HRT which reduces your risk all mortality risk by around 30% is prevented by the NHS because of an increased risk in Endometrial cancer which accounts for around 90 of the 285,000 women who die in the UK each year(0.03%).

[Abra_ka_dabra]

Apologies, the statistic for endometrial cancer I quoted was per 100,000, I think it's actually about 2000 / year which is around 0.7%

[Sunnysidoop]

Fascinating. Thanks for sharing. Afraid I don't have any suggestions. One of the things I always wonder, and haven't looked into yet, is are there any reviews and studies that aren't pharma funded? So that we can have a truly unbiased risk benefit analysis

[Abra_ka_dabra in reply to Sunnysidoop]

I think in general that longitudinal studies are done by universities, but also, they look at the statistics after the fact, so they're quite difficult to subvert. For example Fournier et al 2014 is a French group looking at a cohort of over 65000 women from 1992-2008. They are taking the number of women who did and didn't take different types of hrt and comparing the endometrial cancer incidence. In this case there's no declaration of conflict, which means the funding cannot have come from anyone with a vested interest in the hrt drugs; it will be government or charitable grants.

[Sunnysidoop]

Good to know thank you

[Slinky23]

I use Utrogestan for 13 days of the month and I insert it vaginally so that it doesn't metabolise through the liver. This is one recommended way of using it by Dr Louise Newson.

Utrogestan is a micronized progesterone that is commonly used in hormone replacement therapy (HRT) to protect the lining of the womb. The usual dose of Utrogestan is 2 capsules (200mg) taken once a day, on days 15 to 26 of your 28-day HRT cycle2. It can be taken orally or vaginally. If you have not had a period for 6 to 12 months or more, your doctor may recommend that you take 1 capsule (100mg) once a day, on days 1 to 25 of your 28-day HRT cycle. Sometimes, your doctor might advise you to take it every day, if they think it’s OK for you not to have a period. You may have less bleeding, or none at all, if you take Utrogestan on days 1 to 25 of your cycle. If you take it every day you will not usually have any bleeding once your body gets used to the medicine.

Learn more:

1. thebms.org.uk

2. nhs.uk

3. menopausematters.co.uk

4. theindependentpharmacy.co.uk

5. balance-menopause.com

[Abra_ka_dabra in reply to Slinky23]

Thanks.

Eventually I got a referral to a consultant and talked her through the research I'd found that shows the NICE guidelines don't include any references for micronized progesterone's ability to protect against EC, and the studies which show it's not effective unless it's taken all the time.

She's sent a recommendation back to my doctor to allow me to just take Oestrogen.

Since stopping taking Progesterone I've lost over a stone (moving my BMI below 25) I wake up every day at 5.30am feeling really good, I go running or swimming each morning, my brain work, and I feel amazing...

It's been months since I felt the kind of hideous all encompassing tiredness and misery that Progesterone makes me feel (Even when I take it vaginally), I'm never going back to taking it.

[Slinky23 in reply to Abra_ka_dabra]

I have the contraceptive implant which is progesterone and didn't understand why that couldn't be used as the progesterone part of HRT. Your research is very interesting. Do you still have a bleed?

[Abra_ka_dabra in reply to Slinky23]

I think if you're fine with taking the progesterone then probably this issue isn't something you need to worry about. I was never able to use progesterone based contraceptives because they made me feel so awful.

I know that you can use a coil as the progesterone portion of HRT, so I imagine you ought to be able to use the implant, but I haven't read much around that because it's not something I'd ever do