Hi everybody, thanks for watching and coming back to my VLOG. This week I'm
going to talk about a topic that's been requested by the amazing women in the
Latte lounge on Facebook and in the Menopause Support Network, and I'll put
links to those groups in the comments afterwards if you want to join them. And
you can only do that if you're a woman over 40! So this week we're going to talk
about how to use progesterone in HRT and it's a subject that causes lots of
comments in the groups and confusion. And hopefully I can put that to rest today
and give you a resource to come back to. So firstly why is it important? Well in a
natural cycle, before you're perimenopausal or menopausal, a woman has oestrogen in
her body, which is the one that when it drops we get our menopause symptoms from.
But she also has progesterone in the second half of every month and the job
of progesterone in the cycle of hormones in a woman is to protect the uterus. In
the first instance, it's to to help the uterus prepare to accept an egg but if
that doesn't happen, if a woman isn't pregnant, it then has to make sure that
the lining of the womb is cleared away and is all clean and crisp and ready to
start the next month cycle. If that didn't happen
the lining of the womb would just build up and build up and the oestrogen
would encourage that. And eventually that can actually become what we call
endometrial hyperplasia. And that can become cancerous. And that's why it's
dangerous for that to happen, and that's why progesterone is so important. So
today I'm going to talk to you about how we deliver progesterone in HRT. And it is
essential that we do that for most women, but not all women! So for some of you, now
you can just turn me off and go and have a cup of tea! And those women are the
women that have had a hysterectomy. So if you've had a hysterectomy and you no
longer have a womb, and you've never bleed,
Again after hysterectomy, then you do not
need progesterone in your HRT. You're lucky, you can just have oestrogen which
will sort out all of your symptoms, and you won't ever need to bleed; so enjoy
your tea and I'll just talk to the rest of us! We do have a uterus,
so HRT estrogen and progesterone is delivered in tablets patches and gels
And I'm going to talk to you about the different ways that they work today with
progesterone. So in terms of tablets and patches, it's actually quite simple.. there
isn't a problem, because they contain all of the hormones that we need. Both
oestrogen and the progesterone to protect our womb. They come in two forms. That's
either sequential HRT; so you'll have two different patches; one that you use
in the first two weeks of the month and one that you use
in the second two weeks of the month. And the difference between those patches is
that in the first two weeks of the month there is only oestrogen in the patch and
that's sorting out your symptoms, that's the good hormone,the one that we like. In
the second part of the month you've got both oestrogen to sort these symptoms out
but also progesterone to sort the womb out. And what that does in sequential HRT
is, at the end of those two weeks when the progesterone stops it encourages you
to bleed, the lining of the womb comes away and it protects the lining from
that build that the oestrogen can cause. So in sequential HRT you will have a bleed
each month, and I'm not going to go into who needs to bleed because I cover that
in my menopause vlogs that you can watch, but just know that that's how it's
delivered. Then if women don't need a bleed anymore they use what we call
continuous HRT. So they only have one patch they use throughout the month and
that patch has both estrogen and progesterone all the way through the
month. And the role of progesterone in that scenario is to keep the womb lining
low, not building up for the entire month, and that's why you don't need a bleed.
And that's why it you don't stop taking progesterone, its just continuous. So if
you're taking tablets or patches in either sequential or continuous forms
your womb is being looked after and you don't need additional progesterone. The
only time that might become a question is if you are adding extra oestrogen
by gel or another patch, and the jury is out on that whether or
not you would need extra protection to the womb with progesterone. (So I'm getting
really tongue-tied aren't I with protection and progesterone, I apologise).
So at the moment, the general consensus is that no you wouldn't need extra
progesterone, but as I said it is under discussion and it may change, as with
science, things do, so watch this space, and if it does I'll just do another VLOG!
Okay, so some women prefer to take oestrogen on its own, either as a patch or
a gel that you rub in every day, and the reason for that is that it allows you to
increase the dose of estrogen to actually control your symptoms properly.
So that's the beauty of, for example, gel. Because you can have between one and
four pumps of oestrogel gel or increased additions of sandrina. And just make sure
that you've got your symptoms completely under control. Because it's oestrogen and
the lack of it that causes your symptoms so replacing it should take them away.
However, if you're having oestrogen in this form you need progesterone in one
form or another. So first of all I'm going to talk about the easiest form to
describe and that's the Mirena coil, the intrauterine system. So the Mirena goes
into the womb and it gives off progesterone all of the time in a small
amount to the woumb so it keeps the lining completely under control and
suppressed. So if you have a mirena coil you don't ever have to worry about
taking extra progesterone. You've got the protection that you need and you can
just use your estrogen as a gel or a patch to control your symptoms. So it's
probably the simplest way, but I do understand that some women don't like
the mirena so I'm going to talk about another way. But just to mention
that the Mirena coil is licensed for four years for HRT but you can actually
leave it in for five years so every five years you need to get it changed and
please don't let anyone tell you that you're too old, that you can't have it
anymore because you don't need it the contraception. It's not true, it's
licensed for HRT so you can have it as long as you need it and
because it's a contraception, if you're still in perimenopause you actually have
a contraception inside with it so you don't need to worry about taking another
contraception on top. So there are lots of benefits to the Mirena coil. But so
those women who don't want it (and I completely get it, I completely
understand) there is another way. So that other way is to take progesterone
as a tablet or vaginally. The one that we use in HRT is called UTROGESTAN,
and I will put all of this in the links afterwards. And it's a micronised, body
identical progesterone and it comes in tablets. And they're 100mg.
And this is not to be confused with the vaginal pessary which does exist and
that's 200mg, but that is not licensed for HRT and it is used only in
fertility. So I know sometimes people have got a prescription for that and
been confused, it's wrong; the only micronised progesterone we use in HRT is
the 100mg tablet. Now even though it's a tablet and
it will be prescribed as a tablet to take orally, it actually can be used
vaginally. So one query that i often have is; is it the same tablet that you put
into your vagina as you take orally and the answer is yes. There are different
doses, depending on whether or not you need to bleed. So if you need to bleed
you need 200 milligrams of Utrogestan, so that's two tablets and they can either
be taken orally, so you swallow them, or they can be placed into the vagina. Both
of these at night time because it is sedative, it can help you sleep. Now if
you need to bleed you only need to take that progesterone for 12 days of
the month. So you would take it on days 15 through to 26 and then stop. The
oestrogen you would carry on the whole time. So it's mimicking the patches
that are sequential. So you are just doing your own sequential HRT and when
you stop that at day 26 you should have a bleed. Some women bleed slightly before
they finish, some women after, but as long as you're bleeding and it's taking
away the lining, you are stopping any problems building up inside your womb. If
you don't need to bleed you only need a 100mg of the progesterone
but you need it every single day. Now in the BNF, which is the doctors Bible, it
actually says take it from days 1 to 26 or 27. Don't, you don't need to. That's
messing around, you'll never remember when to take it again. Take it every
single day. So it's a 100mg every single day and again it can be
taken orally as a tablet or vaginally. And so it's just one tablet then that
you either swallow or pop into your vagina. And again at nighttime. And that
stops the womb from building its lining at all so you're still getting the
benefits of your daily oestrogen but it's not building up the lining of the womb,
it's just sorting out your symptoms, and you take that continuously. That's why
it's called continuous HRT. So some women (you're asking yourself why am i
suggesting you take it vaginally). I'm not suggesting it, but some women don't
get on very well with progesterone: it gives them progestogenic side effects,
they don't like it. It can cause bloating, breast tenderness, mood changes and so if
you take it vaginally, that sometimes solves the problem. And the progesterone
is just absorbing locally, so you don't get those systemic side effects. So
that's why some women use it vaginally. So what issues do we have
around this that we need to remember? well you can't take progesterone for less than 10
days in the month, so we say 12 because we know that's the best number of days.
If you take it for less than 10 you won't necessarily shed the lining of your
womb and that's dangerous that means it could be building up and as I said it
could lead to cancer. So 7 days is not enough and there are some people out
there who are prescribed it for seven days and it is not enough. It must be more than ten,
preferably twelve. If you're not tolerating the side effects of taking it
orally you can change it to vaginally and it's the same tablet, it's not a
different tablet at all. Some women don't even tolerate it vaginally
and we can use another progesterone called Provera. iIt's not licensed for HRT
but it is used, not often, but I have seen it used successfully and so that's another
option. Body identical progesterone creams: please don't use them. They're not
licensed, they're not regulated, we have no way of knowing how much progesterone
is being absorbed through your skin, what dose you're getting and we have no
evidence to suggest that they protect your uterus enough to stop you getting
cancer. So please don't use them. I'm not going to go into any more than that but
I do have a vlog on this, it's the body identical versus bioidentical HRT so you
can pop over and watch that one if you want more clarity. And then sequi verses
combi, what's the difference? It's just about bleeding and your GP will be
able to guide you as to whether or not you need to bleed. But a quick rule of thumb
is - if you haven't had a period for a year you can probably use continuous HRT
and if you have had a period within the last year you can't, because you'll just
bleed too much it's not that it's dangerous either way but it's just about
bleeding. If you've still got your own hormones circulating in the background,
however low they've got you'll probably bleed if you try and take continuous. So
that's progesterone in HRT and hopefully now I've clarified for you guys out
there how you take it and when you take it. And those are the two
questions I get all of the time. If you've got any questions just pop them
in the comments under the VLOG and I would always answer them as you know. And
if you've got any topics you want me to cover in the future for you, again put
this in the comments after the VLOG and I will happily cover them for you.
And I will put some information in the comments as well about what we've
discussed today so that you've got some reference points if you need them I hope
that's helped. Thanks so much for watching, it's always appreciated and
I'll see you again in a couple of weeks bye.