Anyone do Progesterone Therapy for PMS/peri-m

[Insomania]

Now I’m feeling good on NDT Armour, my attention is turning to balancing other hormones: cortisol, oestrogen and progesterone.

Armour helps me get longer time asleep which has been huge but I still have the ‘getting to sleep’ issues. I don’t want to be on sleeping tablets (Amitryp) forever.

My cortisol by saliva test has been low for two years (I’m due another test) and I know this is impacting.

I’ve been reading about progesterone therapy as an alternative approach for PMS/peri-menopause. That progesterone can help cortisol. I still have a lot of symptoms that regular HRT haven’t touched (ov pain, breast pain for 2 weeks, heavy periods). HRT did help anger and mood though.

I’m keen to try progesterone therapy and have made a GP appt to discuss but I do feel a bit nervous about dropping the oestrogen patch.

Any other hypothyroid women considering or doing progesterone therapy? Please share your experiences…

[FallingInReverse]

I just shared this with someone yesterday, so good timing on your question!

I’m about 4 days into 200 mg bioidentical micronized progesterone at bedtime. Perimenopausal.

I’m in the early days of HRT learning. My doctor was zero help but at least I was able to ask for what I wanted.

I chose bioidentical micronized progesterone because of its calming effects, and because I read that the bioidentical is ANTI-inflammatory and the synthetic is actually slightly PRO-inflammatory! I also suspected I was estrogen dominant post ovulation (Im perimenopausal.) I observed symptoms and tested my sex hormones for a few months and it seemed to be supported. We’ll see if I’m right, not entirely sure I am : )

[Insomania in reply to FallingInReverse]

Yes, that’s how I take it too, 200mg micronised progesterone tablets days 14-28 at bedtime. Does nothing at this dose to my sleep. I do 75mg oestrogen patch throughout cycle.

I’m going to test my oestrogen and progesterone this cycle and I expect oestrogen to be high. Plus testing cortisol by saliva to see if thyroid treatment has helped low cortisol.

[FallingInReverse in reply to Insomania]

I did a 6 point cortisol last spring, nothing out of whack as far as I could see.

I think (symptoms and tests) I was estrogen dominant. So asked my doctor just for the progesterone- even though she tried to originally give me a combo.

Interestingly enough, the first couple progesterone pills hit me like a sleeping pill… eyes crossing and bumping into things… was still tired through the morning … but a few days later and it’s mellowing out. But for comparison- yeah if it does nothing for you then if I were you I’d mix it up too.

Are you peri or already menopausal?

[Insomania in reply to FallingInReverse]

Peri. Periods are in the heavy and stretching out for 7 days phase.

Cor I wish I felt like that from 200mg progesterone! Good for you. Hope it keeps working.

It’s good your GP listened. I hope mine does. I get so upset when they push anti depressants for everything.

[FallingInReverse in reply to Insomania]

I’m in a mood about doctors right now.

Yes, good to be listened to. 💯

But not after she outright lied (“bioidentical is just marketing, no difference.”) and then pushed some combo HRT, and then when I suggested … hey, based on my googling and research I think I need bioidentical micronized progesterone, and she said - well that’s really hard to manage… and I was like - I can handle it… counting 14 days on and 14 off…

I am grateful she listened to reason.

But wouldn’t it be nice if they did their job so I didn’t have to be my own doctor.

[GussyG in reply to Insomania]

By testing if you mean a blood test then I’m not sure it’s that useful. It won’t show you how much oestrogen or progesterone is being used by the body and if it’s accumulating or how well it’s being eliminated. It’s a only snapshot at a specific moment which might not accurately reflect overall hormonal fluctuations. A Dutch test is a better option if you can afford it. It also captures cortisol at the same time.

[GussyG]

Hi there, what HRT were you/are you already on? ‘Regular’ HRT will have progesterone in it already. Do you mean switching to progesterone-only HRT?

[Insomania in reply to GussyG]

My regular HRT is 75mg oestrogen patch and 200mg micronised progesterone tablets days 14-28.

I’m looking to increase progesterone & take it throughout the month and drop oestrogen patch. See if that helps my PMS/peri-m symptoms.

[sparkly in reply to Insomania]

Have you thought about going on to continuous regimen?Also do you take your utrogestan early in the evening to give them chance to kick in with sedative effect?

I took them as I got in bed for 2 years, would still be wide awake at 2/3 am.

Then by one day took them about 8pm and by 10, I couldn't keep my eyes open and had to go bed and fell asleep instantly.

I know not everyone gets the sedative and calming effect off utrogestan. Worth changing to continuous so first so no breaks and taking earlier in evening

I love utrogestan and cannot sleep without it. I also noticed a more calming effect when I increased from 100mg to 200mg.

I know a lot a women try progesterone only when suffering with pmdd or endo. I think they have to go it alone or go private as nhs won't entertain it. Why though, I don't know as it does work for some women.

[Insomania in reply to sparkly]

I take 200mg progesterone tabs at 9pm along with sleeping tab, magnesium and amino acids. I fall asleep at midnight to 8am (briefly wake for Armour dose at 6am but usually go back to sleep quickly).

[Smartypants1 in reply to Insomania]

Totally agree with everything GussyG has said in her post above. I first went to the doctor when I was 45 with peri symptoms. They gave me HRT and my symptoms got worse. I don’t think oestrogen is all it’s cracked up to be and I firmly believe that it kicked off my Hashimoto’s. I now see a functional doctor (she was previously an NHS GP) and she has me on 100mcg continuous Utrogestan and some bioidentical progesterone cream, which I apply in the morning and it has a tiny bit of oestrogen in to help with the night sweats. I didn’t get anywhere with the GP in terms of switching things up. GPs won’t prescribe continuous if you’re still having periods but if I don’t take it this way, I have 10 days of heavy bleeding. I feel slightly more energetic on continuous and I definitely feel calmer. I do agree about managing your expectations also though. I know HRT is life changing for some, but it hasn’t been for me.

[GussyG]

Ok so the first thing I’ll say (from my own experience) is that ultimately I’m not sure you can achieve ‘full balance’ of hormones while in perimenopause. And I think that’s the mindset that’s least likely to lead to feeling let down, as slightly depressing as it sounds. I think you have to ride the storm as best you can keeping an eye on symptoms and adjusting doses as you go. It’s a difficult time! I’ve yet to find balance and I’ve been on HRT for 3 years, my needs changing almost monthly sometimes. I am saving for a Dutch test to get a better view of my hormone status. Maybe others will come in here and say they found the right dose of oestrogen, progesterone and testosterone for them that keeps everything steady behind the background surges and drops of oestrogen/progesterone and that’s fantastic.

I’m currently taking continuous Utrogestan x1 a night and I also add more in luteal (x2 on alt nights where I feel I need it). Overall I do find it helpful. I’m trying to wean down my oestrogen gel very slowly as I up my thyroid medication. (I believe part of the reason my thyroid started to fail was due to too much oestrogen even though it was only transdermal and within the licences dose, but if you’re oestrogen dominant with low thyroid then it’s throwing petrol onto the fire).

The best place to get specific tailored and experienced advice is from a menopause specialist, but you obviously have to pay. I’ve yet to find a GP knowledgable enough and I don’t trust them to get it right.

As for thyroid and cortisol then it gets more complicated as they all interact. As I’m still early in my journey with those I’d just say start anything new slowly, keep a diary of symptoms and check bloods. I hope that helps!

[Obsdian in reply to GussyG]

I agree with it changing a lot. I'm having a fluctuation now. The fluctuations are getting farther apart though which I celebrate.

[FallingInReverse in reply to Obsdian]

I’m also a huge fan of Basel temperature. Have you ever tracked it? I started when my cycle was still regular and the temperature pattern (plus cervical mucous changes) were plain as day.

Attached is the clearest chart I’ve found to help me with interpreting blood tests while still in peri - if you don’t know when (or if) you ovulate, as Gussy notes, I’m not sure you could really interpret anything.

Chart

[Obsdian in reply to FallingInReverse]

I haven't ever done temperature and don't know how.

In December tge (not my) GP decided to change a medication and totally messed up my hormones since. I think it triggered ovulation as I've had a monthly bleed since after not having one in aaaaaaaaaages thanks to continuous hrt.

[FallingInReverse in reply to Obsdian]

What a mess.

Basel temperature basically - get a 2 decimal place thermometer (usually marketed as a Basel temp thermometer).

Every morning when you wake up, before lifting or head or getting up (sometimes I don’t even open my eyes), before taking your pill or sipping any water - take your temperature.

Write it down. And That’s it!

I’ve done it for a year or so now, and my results when charted do look like the pic attached.

It’s remarkable how consistent it is (for me anyway) - it’s 97.4 F in the follicular phase, then jumps to around 98 at ovulation. Then drops on day 1 of my period.

I’m still perimenopausal- up until a few months ago was regular around 25 days. Now it’s a bit volatile - but the temperature jump used to be exactly on day 14… now it’s between 9 and longer. I still feel it’s telling me something about my hormones and in that way - it’s a free, easy, at-home way to be in touch with our bodies.

edit- not sure how HRT will impact… but I’ll see!

Temp

[Insomania in reply to FallingInReverse]

I get awful ovulation pain so I can’t miss it! Though it can go on for 2-4 days so maybe it’s attempts to ovulate. Then I get breast pain until period starts.

[Insomania in reply to GussyG]

When I said balancing other hormones, I’m talking about symptoms improving particularly chronic insomnia and those I get in the three weeks from ovulation to end of period. I really don’t want to be on sleeping tablets for life.

I’ve been on HRT for three years too. My current regime doesn’t allow me to increase or decrease based on how I feel, I’d love that! I would like to try progesterone throughout the cycle, more in luteal, and like you eventually drop oestrogen.

I’ve saliva tested cortisol in Feb 2023 (low, pre-Armour) and Feb 2024 (8 months slowly titrating Armour, still low, DHEA had improved) and have ordered this year’s test. My plan was to focus on thyroid first, in the hope getting to ‘optimal’ would take some of the body’s stress away, then see if it had had any effect on cortisol. It maybe too early to tell.

[GussyG in reply to Insomania]

Extra progesterone will make you feel more sleepy and I hear in some people it definitely helps with sleep. For me at first it made me wee at night! And then that settled and now I’m back to waking up most nights anywhere from 1 to 4am. I’ve not got the answer there. It’s probably my sky high cortisol.

[Insomania in reply to GussyG]

I’m excited to feel sleepy! Haha.

Waking in the night is horrible. Hope that passes soon for you.

[sparkly in reply to Insomania]

I would definitely suggest continuous regimen. I was started on continuous from day one. I was 48 years old and still having periods. They stopped straightaway and was the best thing ever for me as I suffered pmt. There is no solid reason why women have to start or be on cyclical regimen but it is the preferred method. More knowledgeable specialist seem to work differently as in my case.

Not everyone will stop having bleeds but it's worth a shot as you only go through the same issues when later change to continuous.

Better to have progesterone constantly for mood and sleep than just to have a bleed for sake of it.

Also I would try taking your utrogestan about 7pm with food as it increases absorption.

This will all be down to gp who likely knows nothing though. The peri/menopause world is just like the thyroid world, you end up having to be your own health advocate

[GussyG in reply to sparkly]

Last sentence here is so true sadly.

What would be absolutely brilliant (one day) if there was a doctor that knew about both, imagine?! The perimenopause doctor I spoke with was helpful with HRT but clueless about thyroid. She told me my labs were normal with a TSH of nearly 4, such a shame. I never went back…I’m yet to find the golden egg of both (plus knowledge of cortisol/DHEA would be the icing on the cake)! Oh and ideally not charge £250 for a 15min online consult 😩

[sparkly in reply to GussyG]

I struck gold. I went to a private endocrinologist because my T3 medication wasn't working anymore. Unbeknown to me she was a prominent menopause specialist too. I was under her for 18 months due to complexity but she saved me. Sadly she isn't taking on new patients as my friend tried last year.

I would have a watch of this video that was shared to the group if you haven't already seen it.

This private thyroid specialist is bob on regarding peri/menopause. I wouldn't hesitate to have a zoom appointment if needed in the future.

healthunlocked.com/thyroidu...

[Obsdian]

I do continuous hrt. My estrogen changes sometimes but 2 utrogestan tablets daily is the only way it works for me. When I took it only two weeks per month nothing adjusted ever... By the time I was starting to adjust to the progesterone it was time to stop it again. Only continuous works for me.

I wanted to add, I also use high strength evening primrose oil which helps take the edge off for me. Doesn't work for everyone.