Ok, so it's been about 3 weeks (give or take a few days) of taking Vivelle Dot. I know I'm feeling more alert and less anxious. I am definitely feeling better with the Estrogen. I know I need to take the Prometrium to shed my lining but I just got done reading peoples responses (on another board) to prometrium and most were quite negative. I am scared to death to start taking this med. I know I can't go on forever just taking the Estrogen so I'm not sure what to do. I'm really against the prometrium. Not just because of the weight gain issues (not willing AT ALL to deal with ANY weight gain) but because I read most women feel truly crappy with this med. suggestions? I have 200 mg pills that I was going to take for 7 days each month. Not sure what to do. Doctor is of no help.

Patty

If you've got a uterus and are taking estrogen you HAVE to take the prometrium. I think you know what happens if you don't--you risk all kinds of awful things.

If it's any comfort, I take 100 mg. of prometrium EVERY DAY because I am post. I take it at bedtime because I feel it relaxes me and helps me fall asleep easier. Notice I said it relaxes me--not sedates me. It doesn't make me feel groggy. Menopause made me feel groggy and foggy brained. Prometrium does not. BTW, my sleep has gone back to normal since I went on hormones. I don't feel that prometrium has done anything but help me feel better. I've been taking prometrium every day since March 2007.

When people go on BC pills, it's the same thing you're doing except in higher doses and it's synthetic hormones. The first 21 pills are synthetic estrogen and the last 7 days have progestin (synthetic progesterone).

Keep in mind that not everyone has a bad response to prometrium. After all, your own body had been making progesterone--and estrogen--all of your reproductive life. You are just adding to what you are making to make up the difference--so you won't have the low hormone symptoms of peri.

Also, remember that you have to be on hormones for 3 to 6 months before you feel all of the benefits--so be patient. I found that out the hard way. It's not a quick fix--but it is a fix, IMO--and the only one that has worked for me. Also remember that the progesterone you are making is falling as well as the estrogen. Many of the symptoms of peri and meno are due to lack of progesterone. You may feel even better for having taken it.

Good luck. Take the prometrium or quit the estrogen--those are your only 2 choices here unless you want to risk having big trouble on down the line.

Miss Tibbs

Forgot to add that I have NOT gained any weight since I started taking prometrium. As a matter of fact, I have lost a bit--but that may be due to the fact that I have been able to resume exercising since I started on the hormones.

Miss Tibbs

I used Prometrium 100 mg for the last 14 days of my cycle for 2 months, along with my Vivelle Dot at 0.025 and then 0.375. The Vivelle improved my life tremendously, but the days I took Prometrium I was *very* irritable, bloated, constipated, zero sex drive ... kind of like really bad PMS. I'm 50, still having regular periods every month so my doc says I can stay on Vivelle without taking any progesterone for now. Eventually we'll do an ultrasound to check on the thickness of the endometrium, and obviously when I stop having periods we have to reassess. But perhaps by then I'll actually NEED more progesterone so I'll feel better on it?

Back in the day, birth control pills made me feel similarly, even the ones lowest in progestin.

Dr. Susan Rako (one of the experts who holds chats here on PowerSurge) recognizes how crappy *some* women feel on progesterone and advises having women cycle Prometrium 10 days every 2 months:

"I recommend that women take natural progesterone
for ten days every two months. 200 mg at night for only TEN days out
of sixty. And that's for women who HAVE a uterus. Women who have had an
hysterectomy don't need it at all."

Sounds better to me ... when the time comes I'm going to ask my doc about that option.

Pattyswind, everyone's different ... you could give it a try and see how it works for you. When I stopped taking it, I felt back to baseline within just a few days. Its effects don't seem to last too long. Good luck and let us know how things go for you!

In late 2001, I took Prometrium 100 for a few months to get my periods back in order since I was having 2 long, heavy periods per month. It worked great, it even made me feel better. I was not prescribed anything else. I did gain a few pounds. I later began to have problems with break through periods - all of this due to endometrosis and decided against a hysterectomy and opted for the depo-provera shot which worked longer than the 3-months. I would go for 6 months without a period and in total, only had 3 shots of depo which stopped the growth of the endometrosis. My last shot was 2 years ago. Last year I had one period, and as of September 2007, I've passed my one-year mark of having no periods at all.

Now, my sister was prescribed the same thing in early 2002 and she had total opposite affects - it did not help her. She had fibroids and had to have a hysterectomy in 2004.

My only problem now is trying to figure out why I am having such severe hot flashes.

Thanks,

-Tina

I was offered Mirena IUD by one gyno when I mentioned HRT. I could not tolerate any form of natural progesterone too, including Prometrium , so I had to quit it all together. So she suggested Mirena IUD that releases tiny amount of progesterone, just to protect uterine lining. This delivery method has minimal side effects of oral progesterone, that creates nasty metabolites and not well tolerable for many women.
Personally, I would give Prometrium a try first, you never know, you may be feeling well and have no side effects, not everyone has. I had issues may be due to not enough estrogen (I took Biest, lowest dose) so it could be the ratio was not optimal. try it and if this makes you feel bad, there are other options on the market, like progesterone vaginal gel.
HTH,
I.

I tried the Prometrium back in May and I gained 5 pounds in 9 days. Thats what I'm afraid of. I haven't gained anything taking the estogen alone.

patty

I also have difficulty taking Prometrium orally. I gained 4 lbs. a month for 4 months taking 100mg daily as I do not cycle my hormones. If you are careful to not increase your caloric intake...and that IS hard because progesterone tends to make you crave carbs...the weight gained while you use the Prometrium will mainly be fluid retention and should come off within a few days of stopping. It is similar to how many of us tended to retain fluids, feel bloated, and gain water weight in the week leading up to our periods when our own natural progesterone would rise. The fluid weight gain should come off again within a few days, just like it did when the progesterone dropped and we started our periods in the past.

I have read that bio-identical progesterone acts as a diuretic and the synthetic progestins cause women to retain fluid.

Also, my carb cravings have stopped since I started hormones--don't know which one did it--and don't care. It stopped the madness. I ate things I NEVER eat! I gave what is left to the birds in their feeder.

Miss Tibbs

If you try the Prometrium and find that you have severe side effects with it you could try vaginal progesterone instead. Vag. progesterone does not have the issue with the first pass through the liver which produces the metabolites that cause some women’s issues with oral progesterone. I cannot tolerate oral progesterone and I have found that vaginal works well without all the side effects. The dose is different though (lower—20-50 mg/day) and some doctors will not have a clue about it. You can get vaginal progesterone with a RX (Prochieve); I think the dose is 40mg every other day. It is long acting and I have read that some women experience progesterone excess side effects with it. In addition, I think it is expensive. Instead of buying Prochieve you could have your compounding pharmacy make up vag. progesterone for you. The trick is finding the dose that works and does not give you too many excess side effects. Prometrium can also be used vaginally but the dose is too high (unless you divide it—may be a little difficult because Prometrium is oil inside a capsule). You may be one of the lucky ones who like Prometrium but you will not know until you try it.

Good luck,
Kathy

My family doctor gave me a flyer last spring from a compounding pharmacy that he trusts and stated they had excellent prices - about 30% less than our local compounding pharmacy. He says many of his patients use this pharmacy.

I have tried to stick with FDA approved estradiol and progesterone so I could benefit from my prescription insurance. My insurance will not cover any nonFDA compounded hormones and the only bioidentical progesterone on their list is Prometrium. Prochieve and Crinone are not listed at all, not even in the nonformulary group of meds with the highest copay! I looked up the price of a month supply of Prochieve (I don't cycle so would need 15 doses for a month supply) and I gulped..really hard! I simply cannot tolerate using oral Prometrium 100mg daily and using it by the vaginal route gives me breast tenderness because the dose is so high....it does greatly reduce all the other negative side effects though that I had with the oral route.

Anyhow, I finally got around to emailing this pharmacy to compare pricing on a vaginal route of bioidentical progesterone. As it turns out, the price quoted for 20mg vaginal progesterone daily is less than the $20 copay on my Prometrium! They also are half the price on my testosterone cream than I have been paying from a local compounding pharmacy and they are only a bit higher on their estradiol than I am currently paying for my generic estradiol - a $10 copay.

All I have to do is have my scripts faxed and they can fill & mail my hormones automatically every month using my debit card. I am already paying shipping on my testosterone because that compounding pharmacy is 1.5 hours round trip so the shipping is not an increase in what I am used to paying. To heck with my insurance company - I think I may be going total compound!

May I ask what happens when you report you "can't tolerate progesterone". I am on it orally and noticed a am nice and relaxed before bed (I take it at night). I think it has taken the edge of my pms type of attitude too. I had very low progesterone but perhaps some taking it had much higher levels that is why they had trouble with it?

It did not help me sleep at night, but had a terrible "hangover" effect the next morning which lasted most of the following day....extreme fatigue, groggy-foggy brain, mild depression that didn't wear off until about 4 or 5pm. Of course by then the day was almost over and I'd finally feel the fog lift, but then it was just a few hours away from needing to take the next dose. I also had fluid retention - bloating, swollen fingers and just kept gaining weight. I had the same effects when I tried using topical progesterone cream a year before. When I switched to using the Prometrium vaginally the symptoms improved significantly and the weight came off with little effort.
I think my biggest problem with tolerating progesterone is that my estrogen level is far too low. I found in the past the more I increased the estrogen dose the better I was able to tolerate the progesterone. I think progesterone works best for those in early peri, when you are still making a sufficient amount of estrogen. It may even carry women through that are farther into meno, if a sufficient supply of estrogen has been stored away in body cells. But after taking 2mg of oral estradiol daily for the last 6 months my blood level is still in the same range as a postmenopausal woman who is taking no estrogen at all. My doctor has switched me to topical estradiol gel and vaginal progesterone gel. We'll check the hormone levels in 2 months and hopefully improve the balance.

I think you've summed it up very well, NiteOwl!

Hey Everyone -
Just my "two cents worth" on the Prometrium. I too experienced the weight gain. But wow! It was because I was ravenous - hunger pangs like I hadn't eaten in days, which of course, caused me to overeate. It was only a few pounds but on my 5'3 frame a few is too many. I'm down to doing 100mg for 10 days every other month. But it's 10 tough days. Not sure what to do......
Adair

Yes, progesterone definitely caused carb craving with me when I took it orally! I know there are authors out there that are very "pro-progesterone" for peri-meno symptoms but I have not found their info to hold true for me. I think Dr. Elizabeth Vliet has it right when she says that progesterone is not the treatment for PMS, it is the cause of PMS and additional use will only compound the problems. For those that had difficulty with bloating, weight gain, carb craving, moodiness, etc that week before your period that is because your body's progesterone is at it's highest point. She states if you feel your best following ovulation, especially the 3rd week of the cycle when progesterone is peaking, you may benefit from additional progesterone use throughout the month.
But for those that felt their best during the first half of the cycle, when estrogen rises to dominate and progesterone is almost nonexistent, and then feel worse as you get near your period - when progesterone is at it's peak, adding progesterone is only going to compound your symptoms. You need enough estrogen to combat the negative effects of the progesterone. Whichever it is that helps your symptoms, the key is having the correct balance of estrogen to progesterone to feel well again!

I disagree with the Vliet comment about progesterone causing pms, not true for everyone...it isn't proving true in my case but I do believe everyone is different and how I react can be totally different from another woman. It is too simplistic to paint everyone with a broad brush. Just a slight difference in someone's hormone levels can completely change the way they react to a particular hormone - IMO. I have never felt this good in years since I started the progesterone....I noticed the change almost immediately. My pms is basically gone! I think I will be constantly monitoring the levels of estradiol and progesterone over the years to find the right balance, but there was a very positive effect for me when it came to ending the pms symptoms...I am speaking of the crabby, short tempered part of pms that I felt was getting worse the closer I got to meno. I only noticed a mild crabbiness with a period so far, nothing major at all. A huge improvement for me...one I was not expecting at all. I do wish women had more choices of dose...100mg or 200mg seems so limited and depending on what our progesterone level is, who's to say that these two amounts are the best?

I don't think there is enough data on progesterone out there yet.

Hi,

oncourse~ I felt fine on progesterone also, for the first year that I was on it (prometrium), it wasn't until that point that I began to notice that it "turned" on me. I hope that it continues to work for you.

Currently for me, I am using the estrogel, and doing great with it. My own periods are coming at a more stable rate (after skipping for 4 months in the early part of the year). I think my own progesterone, produced by my body has been sufficient, so I am not using the P right now, but will use it only "if" I skip a period (for now).

I have been taking my morning Temp, and keeping a log of the rise in temp, which show's me that during mid cycle I am ovulating (good news), and getting my period. If I was not getting my period, then I would feel the need to suffer those days on progesterone, at least every other month or so.

I'm pleased to see how many of you are having great results with estrogen, I think it's truely a life saver for us.

Juliann

I think that at a certain point I will have replenished my P and things make go south....I think it's really dependent on the labs and we all know hormone levels change. It's one of those things that needs to be checked though the lab numbers periodically and what works today will most likely change in the future.

Yes, I don't mean to speak so negatively about progesterone use. I know there are many on this board who have had wonderful results with it. It just hasn't been wonderful for me and I think a big part of that reason is not having proper balance. I have switched to Estrogel since my doctor appointment and I feel much better than I did on the oral estradiol. I've also switched to the vaginal progesterone from the compounding pharmacy. It has only been a few days so I'll just have to see how it goes. I think for those of us who have problems tolerating progesterone side effects we just have to keeping trying different alternatives until we find a solution we can live with.

Oncourse,

Vliet talks about two different types of women in her Screaming book; those who love progesterone and do well on it and those who do not. I think she may get it more than say Reiss who seems to say that most women should feel good on progesterone unless they are having a paradoxical side effect.

I am like Julie, my progesterone turned on me. I used to love it and it helped me feel better but not anymore. I think the estrogen progesterone ratio probably has a lot to do with my changing effects but I am not sure. The funny/odd thing with me is that sometimes I do not notice my progesterone irritability or think it is not too bad until I go off for a couple of days. One thing that I really hate about it is that I never fight/get into conflicts with my husband unless I am on progesterone. I started tracking this trend so that I can remember to tell my husband that I started progesterone and please give me some slack. This helps but not every month.

As far as the oral progesterone doses of 100mg and 200mg… I have read that there are studies that show that 100 mg every day or 200 mg for 12-14 days protects the uterus. Pub Med is a good place for finding studies. If you take a lower dose you risk not protecting your uterus. If you want to go outside the recommendations, you could have intermittent vaginal ultrasounds to check the status of your endometrium to know for sure what works for you.

Kathy

NiteOwl,

Be careful about just using 20 mg of compounded vaginal progesterone/day as it may not be strong enough. The studies are on prochieve/Crinone. The studies show that Prochieve/Crinone 40 mg every other day works; compounded vaginal progesterone may not be as strong as prochieve—you may require a higher dose. I was only able to find one study on PubMed regarding compounded vaginal progesterone and their conclusions were to use it cautiously because of inconsistent findings. When I was using compounded v. progesterone my dose was 50 mg. When I switched to cyclogest v. progesterone 50 mg was too much for me. Cyclogest may be as strong as prochieve but there are no studies to confirm this. I have never tried prochieve so I cannot compare them.

I am still ovuating, so I am making some of my own progesterone. If you are no longer ovulating I would be even more careful.

Good luck.

Kathy

I think you are right about the ratio. It must keep changing as we age so I suppose the only way to get the best result is to monitor it through labs. I just got Vliet's book and am looking forward to reading it. Even though I'm not taking P for pms symtoms, I did see a big difference, honestly I was shocked that I felt calmer and just better in general, but I know there are others who can't tolerate it at all. My own take on HRT is that it is something that needs to be tweaked periodically to insure the best result.

I do wonder what happens if you are on 100mg P and reach a point where you have enough or it begins to overtake the estrodial. Does anyone know what the norm is for E and P levels in a peri woman and meno woman?

Does anyone know if P (pill form) is basically out of your system within 24 hours? I went off it but didn't feel like I was "off" of it for at least 48 hours.

I hope the vaginal P works for you. I'd rather be on a cream rather than the pill form of P and I'd be on Estrogel too if I could get it. There was a study in France that showed the risk of stroke from oral estrogen was higher. I'd much rather use a gel myself so I think it sounds like a safer choice.

I think you're right about balance and it's so difficult to find just the right one. I'm under no illusions, I think even if I do fine with the P and it solves all my problems, it will probably change at some point and I'll have to look for another solution.

Yes, I wish I could use Prochieve/Crinone. I do feel safer with an FDA approved drug because I know testing has been done and the dose is consistant & exact, but my insurance does not offer any coverage on it whatsoever...no idea why. Prometrium & progestins are the only choices. I could possibly have my doc write to the insurance company & explain I can not tolerate oral Prometrium and see if they would make an exception for coverage. I do think as more women demand alternate forms of bioidenticals the insurance companies will be pressured to allow more variety in forms. Dr. Vliet states that 20mg used vaginally for 10-12 days a month is sufficient for endometrium protection. I am using it every day of the month so surely I will received enough over the course of the month...but I know what you are saying, with compounds you cannot be absolutely positive on what you are getting. I may go off every few months to test & see if I get a withdrawal bleed...a drop leading to a bleed when I stop the progesterone should show that I am getting a decent dose.



The normals for estradiol & progesterone are listed in Dr Vliet's book. Estradiol is around 80-100ng/ml at it's low point on Day 1 when we are young, rising to 350-500ng/ml at it's monthly peak. During peri it can drop into 30's-40's on the lowest days and this can lead to our symptoms that crop up during the start of our period....I know that was when my insomnia, anxiety, internal tremors, migraine auras, etc all kicked into high gear. During meno we usually stay down in that 30-40 range of estradiol without supplementing our hormones. Dr. Vliet states ideal range to protect bone, heart, mind, and body (energy, sleep patterns, sexual function, etc) is around 90-100ng/ml. She doesn't go into much detail on progesterone levels, but I think she mentioned 0.3-to 0.9 during first half of cycle, rising up to 10 range during peak. I am heading out on a weekend getaway in a few minutes and have already packed my book to take with me so I can't look up the
exact numbers...going from memory here on all these figures so I may be wrong. If we are not ovulating, once in meno...our progesterone would stay very low..back to those 0.3+ ranges and that is fine as long as we are not taking supplemental estrogen. Doing so would cause our uterine lining to build up again so we would need the progesterone to protect from endometrial cancer. I don't remember seeing an optimal range for progesterone level during HTR therapy. When my serum hormones levels were drawn my progesterone was 1.6ng/ml (I was using the Prometrium 100mg PO daily over this time) and my doctor said that was was fine. I had taken my Prometrium dose about 12 hours before the blood level was drawn but don't have time to look up in my PDR (Physician Desk Reference for all medications) right now for peak and half life. I will check into that when I am back on Monday. Enjoy the book - Dr. Vliet has a totally different view on P than Dr. Lee and others...but her stories seem to fit what I have been experiencing in peri & now meno.

I think there is a whole list of side effects from excess progesterone. I got a line down my abdomen (pregnancy line). It has been there for over a year and is not budging! Some women have issues with too much progesterone or even a little progesterone causing mild to severe hair shedding. Women who have done the Wile protocol have reported lots of horrible side effects. One thing that progesterone does is suppress our immune system and decrease growth hormone production to support pregnancy. I just think that we need to be careful and not use too much (but use enough for it to do it's job). My compounding pharmacist told me the sky was the limit with progesterone and I could use as much as I wanted. That was back when I got my pregnancy line and was following info in Reiss’s book that said to maximize progesterone. I learned my lesson though and follow information from Vliet and Gillespie now and the line reminds me every day to pay attention, read, and be careful.

I had the same issues with oral progesterone feeling like it did not wear off for days.

Kathy

I know Dr. Lee isn't the most popular but I have had hair thinning and Lee thought LOW progesterone can cause that. Like a lot of things, I guess too much or too little can be a problem, i.e. iron. I wonder how much P is too much? I just wish we had more options that the 100 and 200mg doses available. I worry that it may get too high and I haven't heard of anyone taking it every other day.

I can't agree more, NiteOwl, I am in the same boat. I feel much better after my period is over -1st 1/2 of the cycle and my problems starting to arise around ovulation time and peak around days 19-21, along with progesterone peak.
I am sure there are women who feel great on progesterone, but IMHO, progesterone is cause of PMS, not estrogen. Back when my estrogen level was normal, I had very mild, barely any PMS.
Prometrium alone had same effect on me: foggy brain, ravenous appetite and hence, weight gain, bad depression, drowsiness, bloating, and achy breasts. When I was taking Biest alone, 1st 14 days of the cycle, I was feeling pretty good: energy, mood, no craving, so I am sure it is progesterone in combination with low estrogen that caused all the symptoms.
Now, I know it is my low estrogen that causes all the symptoms, not low progesterone. But we all are different, I suspect that some women can "re-use" their hormones, while others "chew" through them so to speak, so nothing gets stored. I recall Dr.Schwartzbein mentioned something in her 2nd book, she made analogy with hormonal utilization with drain plug, suggesting to "plug" it. I believe it has more to do with overall endocrine system imbalance, so minor hormones being utilized inefficiently. I have borderline diabetes, so progesterone in any form spikes my blood sugar, and same happens right before my period without supplementing with progesterone, so may be insulin resistance has something to do with it too. I haven't tested my hormones for 2 years, only FSH which is still <10. I wish I knew the answer, but in general, estrogen alone made me feel good, too bad I can't use it as solo therapy.

Hi Iradan - Yep, when perimeno set in and my estrogen dropped too low, just before my periods - all my symptoms rushed in. About Day 5-6 things would start to settle back down, until the estrogen declined to the point of ending the cycles...then I felt like a limp dishrag every day! Life would feel great if I could take estrogen alone but I passed on the chance for a hysterectomy when things were at their worst, and just a few months later my periods were done. So now I am stuck finding a way to get the good effects of estradiol while minimizing the effect progesterone has on me. While I feel best on estrogen alone, I still feel better even with progesterone, than I felt using nothing. Not using estradiol was no longer an option if I wanted any ability to function in life. My blood glucose has slowly climbed over the years...just 1 point each time, but my last one in Oct. was 106...and my waistline has thickened over the last 5-6 years too. Dr. Vliet attributes this to the midlife decline in estradiol leading to more androgenic effects, while still maintaining a normal progesterone level. She recommends balancing the hormones and a diet similar to what I have seen you recommend - higher protein, healthy fats, and lower carbs to reduce insulin resistance. Unfortunately, I'm a carboholic....but I am trying to reduce them a bit by eating more salads and exercising more...old habits die hard!

Hi Oncourse - Prochieve & Crinone have sustained release properties with a half-life of between 25-50 hours, that is why it can be used every other day. I cannot find any data saying how long Prometrium stays in your system, the peak serum level is reached 3 hours after taking a dose but no where does it say what the half-life is or how long it stays in your system. From what I have read, when Prometrium was going through trials for FDA approval they only looked at 2 uses - to prevent endometrial overgrowth in postmenopausal women on estrogen therapy and in premenopausal women for secondary amenorrhea. Of course, any health care provider can prescribe it for off-label use and I know many OB/Gyn's prescribe it in high doses vaginally to prepare the uterus for invitro fertilization. I wish it came in 25mg and 50mg doses for vaginal use...but that would have to be tested first for endometrial protection too. If you need a different dose you might want to look into bioidentical compounding, if you are not using estrogens you shouldn't have to worry about protecting the uterus from excess hormone use so it is just a matter of finding what dose makes you feel your best.

I don't think researchers have pinpointed the cause of hair loss/thinning in women...if anyone says they have the "answer" they may be trying to sell a product..because no one can prove the reason yet! There are so many ideas and it may be one cause for one person or a combination of causes, including type of diet, stress level, general health, etc. I do know my hair grew it's fastest and thickest when I was on BCP and when I was pregnant - both conditions causing high hormones of both estrogen and progesterone. And during the years of peri when I started losing more hair than normal I blamed the harshness of highlighting my hair on my hairdresser and stopped having it done every 6-8 months. Then, when I tried estradiol & transdermal progesterone cream last summer for a few months I got compliments on how great my hair looked and many asked what I was doing...so, I don't doubt that hormones play a major role, we just don't know which one! It could also be an increase (relative or absolute) in androgens as estradiol drops that leads to hair loss. It may just be having a total balance, rather than one hormone over another...and they say what causes hair loss/thinning in men is not necessarily the same for women. Since they haven't figured it out for men yet, you can bet it will be a looong time until they get around to serious research for women!

Hi,

I had my own experience with hair loss when my periods stopped suddenly in April 2006 with no warning whatsoever.

My hair would come out in globs every time I washed my hair--two lemon-sized clumps at a time. I was terrified, but my GYN did every test imaginable, and chalked it up to hormone deficiency. My hair is very very thick and no one noticed the difference, but it certainly was disconcerting to pull out big clumps of hair a few times a week.

Incidentally, 18 months later, after a horrible meno story, I had a flood of a period (therefore producing hormones). A few months thereafter, I went on HRT for intractable depression and anxiety. Since the hormones have returned my hair seems even thicker than before.

I have no doubt that, barring some underlying pathology, hormones are the reason.

Marcy

Hey Kathy, just wanted to let you know I have switched back this month to using Prometrium 100mg vaginally. I did not like the compounded vaginal progesterone at all - it was messy, it was stinky, and I felt like some of it got wiped away if I had to use the bathroom after taking my dose. I went off of it and did not get a bleed after several days and that really scared me, especially with using such a high dose of estradiol! I haven't decided if I will use it continuously or cyclically but either way I know I am getting plenty of Prometrium to protect when used by vaginal route. Maybe my insurance company will eventually approve Prochieve for coverage, but until then I feel much safer with an FDA approved form of bioidentical progesterone!

Hi Niteowl - Is 100mg the typical dose for vaginal use? I use 100mg oral and always thought the vaginal dose was much lower.

Nightowl, to add to the questions to you, were you told by your Doc that the Prometrium is as safe vaginally as it is orally, because if I end up on BHRT, I want to use the Prometrium vaginally. And do you take it every night? I posted a thread in BHRT as I was tired asking about this type of thing.....and the embarrasssing part of does Progesterone get placed in before or after sex? Oh my, that is a difficult question to ask, but I do not want DH upsetting my Prometrium. I think that Progesterone taken vaginally targets the place it is supposed to protect; the uterus.

This is so difficult, but if taking revival doesn't work for me, then BHRT is the way I will go.

I am glad this is working for you, NightOwl.....I love your user ID.

Viktoria

Hi ladies! Yes, Prometrium at 100mg vaginally is probably a higher dose than I need. A dose of 25mg by vaginal route should be sufficient but Prometrium doesn't come in a lower dose. I did have breast tenderness using 100mg vaginally when I was on a lower dose of estrogen but I have not had any tenderness since increasing my daily estrogen. I was originally ordered Prometrium 100mg by oral route daily but could not tolerate the side effects of taking it orally. I told my doctor I was using it vaginally with less side effects and asked to be switched to a compounded vaginal progesterone at a lower dose of 25mg daily ...but after one month of use I didn't care for the cream and I went back to the using the Prometrium vaginally. I did not have a withdrawal bleed after using the compounded vaginal cream and that scared me.
I have only been using BHRT for 8 months and haven't decided whether to use it continuously or cyclically. I don't like going back to "periods" but I keep reading that using progesterone daily is not good, it is not natural to have progesterone in your system all month long, can lead to insulin resistance, etc. I used it daily for several months then switched to cycling...I guess I keep feeling the need to test whether it is working well by producing a good withdrawal bleed too. When I have switched taking the Prometrium from vaginal route back to an oral route, without missing a dose, it triggers a bleed. That tells me I am getting a higher blood level by vaginal route compared to oral, probably because it is a direct route and doesn't lose as much without the first pass through the liver.
I may try the compounded cream again...I have 5 more refills on the Prometrium and 11 refills on the compounded until my next appointment in April. Hopefully I will know by then what I want to do...Prometrium versus compounded...continuous versus cyclical. My doctor is pretty flexible in what I want to try and knows I have difficulty tolerating the progesterone.
I use the Prometrium just before I am ready to 'sleep' for the night. I don't use anything vaginally within the hours prior to sex because a man can absorb hormones through skin contact also.

How many days are you going to use the Prometrium vaginally? Maybe since it is 100 mg you will not need it as many days? When I used to use Prometrium vaginally I was not having trouble with progesterone and the dose did not bother me but now I have a hard time with progesterone and I think 100 mg would give me side effects (the last time I used V progesterone I used 35 mg/day for 12 days—but I do not think that was enough, I think I need to take it twice a day). I did get a pregnancy line on my abdomen wile using too much progesterone though (more than 100 mg/day). It is still there over a year later. The line was my clue that I was taking too much.

Kathy

Linea nigra...yep, I had that during pregnancy. Would probably scare me too if I developed it with HRT!

I haven't been following a real strict schedule, I'll go for several weeks without it, then I'll take the Prometrium for at least 12 days. I have a withdrawal bleed around 24-48 hours after stopping it. If the timing is not good for having a 'period' I will continue it for another week or so. If I go too long without starting it (just using estradiol alone) I will start spotting so I don't think I could do the once every 2 or 3 months cycle. That happens after about 4 weeks off of it and I imagine it is because I take a pretty large dose of estradiol...I must build up quite a bit of lining without it. I can stay on the Prometrium as long as I want without any spotting.
The side effects of fluid retention, increased appetite and weight gain seemed to be the same with the 25mg of compounded progesterone as it is with the 100mg of Prometrium vaginally, however I only tried the compound for one cycle and maybe didn't give it a fair shake. I just didn't feel like it was absorbing well. It seemed like the next morning I was still wiping some away after using the bathroom and after about 10 days I noticed an odor like it was just sitting in there. Although I didn't have any spotting while using it, when I didn't have a withdrawal bleed on stopping it I remembered your admonition and decided it was safer to stick with the Prometrium.
I wish I didn't need to use progesterone, it would make this so much easier...but I am stuck between a rock and a hard place. In order to benefit from the quality of life improvements that estrogen offers I have to also adequately protect the uterus. I've been reading that one of the biggest reasons women stop their HRT is because of the side effects of progestogens. I am not giving up my estrogen so I will keep trying to find the right mix that works!

I found an interesting article talking about vaginal progesterone in menopause - specifically an extended release gel called Crinone. They discuss using it cyclically versus daily, and even a twice-weekly regimen:

http://www.gfmer.ch/Presentations_En/Vagin...rogesterone.htm

Hi NightOwl,

Thank you so much for your input. I am finding the Estradiol part of the decision easy, and the progesterone part so hard. I "think" I want to cycle it, as I would rather put up with a bleed and know my uterus is cleaning out the lining. I am a real coward that is falling apart at the seams over this BHRT thing. My problem lies in the fact that peanut oil gives me stomach aches, and that is enough to make me rethink Prometrium at all. I am tending towards Cyclogest at the moment, although I can only find it at 400mg per pessary, but it IS said to protect the uterus well. But 400mg? That is going to be too much.

I am scared to take the P, but as scared not to. Oh, and thank you for the tip on DH. I hope you work all yours out in the end, and you keep us updated.

Hugs,
Viktoria

I finally found that research article on using Prometrium vaginally. You can search for it at pubmed.gov and the study was titled "Efficacy of oral micronized progesterone when applied via vaginal route."

Just bringing this topic back up because Dr. Vliet addressed vaginal Prometrium in her blog talk radio program this week. A caller asked if it was safe to use Prometrium vaginally instead of orally due to side effects experienced. Prochieve was not covered on her insurance, which is my situation also. Dr. Vliet states that studies have shown using Prometrium by vaginal route is safe and effective, but this information is not available to the general public because when Prometrium went through testing for FDA approval it was only done for oral route. She states your doctor &/or pharmacist can get the safety information on using Prometrium vaginally by asking for it specifically from the manufacturer. Dr. Vliet states she has patients that use Prometrium by vaginal route and in those patients she recommends 100mg for 12 days every one or two months. She did not discuss using it on a daily basis, probably because she is a big proponent of cycling. She feels it is best to only use progesterone for the minimum time possible that will still provide endometrial protection. The blog talk program is from the show done on 2-4-08 regarding heart health, and the question was about 35 minutes into the hour long program if anyone wants to listen to just that specific info. Her weekly programs can be listened to by going to blogtalkradio.com/drvliet - just add www.

Very interesting topic. I have been taking Estrogel and prometrium for about 6 weeks, maybe closer to 7...I was feeling just fine, better than I had in a long long time. Then I started having some rage issues, and wondered if it could be the P. So I decided to cycle off the P for one week and see what happened. I am now on day 5 without P.

I am not sleeping as well, or for as many hours, I have been feeling headachy, my energy levels are lower, and I have had a few hot flashes...and no bleed. I have to assume I am in need of P to feel well. I know the Estrogel makes me feel better, so I seem to require both.

I went to see my regular doctor yesterday and told him I had gone around him and gotten myself hormones Thankfully he was not upset at all! Whew!! He was insistant on my taking a baby aspirin a day...even though I found I was bruising really easily...he said it was ok, keep taking them! He agreed to a estradiol blood test also, so I will finally be able to see where those levels actually are.

I hope my doc is this understanding when I tell her I went around her. I don't know though - taking the estradiol with breast cancer in our family might make her freak!

Sorry you aren't feeling well Floater. Very interesting about the P. I always thought the the P is what made people feel yucky, but I guess it's different for everyone! I am afraid to take the P because of headaches, but I know I gotta. Or do I? I'm still having periods. I am always so confused on this. Anyway, I may try the Prochieve vaginal stuff instead of the Progesterone oral pill.

M

I took the Prometrium last night, slept like a baby and for 8 whole hours! This morning I was feeling that creepy anxiety crawling over me, a feeling I haven't had since I started the BHRT...so for me, no more missing Prometrium! I obviously need the P! I possibly need a higher dose of the E. I will see how things go. I haven't had any negative side effects from the hormones...unless the rage of last week was hormonally driven. I feel way better on them, much more like me. I still have some tough mornings, but by lunch time I am generally fine, and am for the rest of the day too.

Would someone mind explaining HOW to use Prometrium vaginally? Insert with capsule with finger? Pinhole or open capsule?