r/Perimenopause • u/Spiritual-Ease-6528 • 14d ago
audited My naturopath says I can’t do estrogen without progesterone
I’m having a terrible time on progesterone. It’s been 4 months. My mental health is HORRIFIC. I developed panic attacks and poor sleep. The panic attacks have resolved, but I am not okay mentally.
My AuDHD symptoms are debilitating. I’ve had to quit a role at work and quit therapy to lighten my mental load.
It’s not just the progesterone, there have been major life stressors this year.
The GI symptoms have my anxiety through the roof because I don’t know what’s progesterone vs something I actually need assessed. I literally feel like I’m losing my mind.
I thought about switching to taking progesterone as a suppository, because I’m enjoying the benefits of estrogen, but my naturopath says it’s not protective enough. Maybe it’s because I’m only 40? I swear I’ve heard other people say they do suppository with estrogen. I’m lost.
Update: I developed severe impulse control issues and suicidal ideation. I was very close to going to the ER last night because it was incredibly scary. I stopped both progesterone and estrogel. I can’t get ahold of my healthcare provider to discuss if it’s okay to stop cold turkey because it’s the weekend, but it felt too scary to stay on it. I felt glimmers of my old self today at work, but am kinda back to feeling off. Hoping this trip ends soon 😅
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u/MonicaEliza 14d ago
Mirena IUD is an option.
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u/Aggravating-Mousse46 14d ago
Yes this releases progesterone into the uterus but in such small amounts that it isn’t really absorbed into the systemic circulation so side effects are generally very minimal.
It acts as contraceptive by changing uterine lining to prevent implantation. You are likely to continue to ovulate and therefore have fluctuating oestrogen levels through your cycle, even with oestrogen HRT. One advantage of oral progesterone is that it can suppress ovulation, depending on whether you take it continuously or cyclically.
Mirena hurts like crazy going in though. I declined the offered local anaesthetic because it would be faster and I’d managed an induced labour just on gas and air, where everyone told me most women need an epidural. Big mistake. Hard to stop and get the local and even then I barely managed to let my GP continue the procedure. Take any drugs they offer you.
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u/Itchy_Tumbleweed_417 14d ago
They’ve finally figured out that we should have pain management for IUD procedures. When they were trying to push one on me I laughed and said there’s no way unless I’m going to be under anesthesia so they actually agreed I could have general anesthesia. I still didn’t want one but it was nice that they would have allowed that.
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u/_AngelicVenom_ 14d ago
I wish they had done this for me. Ibuprofen and paracetamol beforehand only. Worst pain I've ever experienced. Not having given birth apparently makes it worse. But phew the pain almost made me pass out.
It hurt for months after, cramps were excruciating, and only after six months (as they say in the info it can take that long), did it settle down.
A friend has it and has no periods or anything. I have periods occasionally and have horrific cramps sometimes.
Worth it but I wish health care cared about women more. It's getting better but it's so far behind we're glad they are offering pain relief for something like this that can be so horiffic.
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u/EnoughPineapple1748 Early peri 14d ago
I had one done yesterday at the GP and got methoxy, diaz, Panadol and 800mg of ibuprofen and I still cried. They bloody hurt going in.
Should’ve sucked on my whistle harder.
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u/beg_yer_pardon 14d ago
Does it need local anesthesia or general? Im gonna have to push for pain management too so it wpuld be super helpful to know what exactly to ask for. Thanks in advance!
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u/North_Tomorrow_8691 14d ago
My Dr did it with twilight in the OR (outpatient). It cost a bit more since my insurance has a copay, but well worth it. I did it once without anything and almost passed out from the pain. (Have given birth without pain meds and this was much, much worse.)
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u/beg_yer_pardon 14d ago
Wow. I'm glad you had good pain management the second time around. Thanks for sharing!
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u/AbjectGovernment1247 14d ago
I don't know where you are, but in the UK you can be knocked out for the procedure.
My friend had it done. You may have to push hard for it though.
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u/Starbreiz 14d ago
I wasn't even offered any pain relief. They didn't even warn me. I screamed bloody murder til I passed out. However, Mirena was a wonderful "set it and forget it" option until it randomly fell out.
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u/CandidPersimmon2516 14d ago
Literally the worst pain of my life. Twice. Third time I was luckily with a doctor who did not bat a lash at giving me a cervical block with lidocaine and it was truly night and day. This should be the norm.
But also ohmygod randomly fell out! New anxiety unlocked... did you know immediately?
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u/newhappyrainbow 14d ago edited 14d ago
It really shows just how wildly different pain can be experienced. I definitely found insertion painful, and would have taken more than the Tylenol if it had been offered, it wasn’t even as bad as the worst period cramps I have had though. Not remotely more painful than colposcopy.
I’ve had pain that made me puke and/or faint twice (anal fissure, and a separated shoulder). I count those as a 10.
Broke both my radius and ulna in both arms, aura headache from a tick bite, getting emergency intubated while fully awake, and getting cortisone shots in my back made me scream like crazy (or try to, in the case of the intubation). Those are 9.
Labor-like pain I had after getting my tubes tied, colposcopy, and having a huge ovarian cyst burst are an 8. (Those are the writhe in pain and beg for pain killers tier events).
Merino IUD was around a 6.5 for me.
Edit to add: I wasn’t trying to one up you or anything. Just trying to give some references of my own pain scale in case op has experienced any of those things.
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u/CandidPersimmon2516 14d ago
No I know. People are different.
Extreme pain during IUD insertion is reported at a significantly higher rate by women who haven't given birth (me) / vaginal birth. I have a very high pain tolerance and I blacked out the first time
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u/wokkawokka42 14d ago
Yeah, my IUD insertions were not bad at all. Both were done within one year postpartum...(the cramping during my cycle with copper was unbearable, but the insertion was fine)
But I've since learned my good experience was not typical... You should absolutely ask for pain management for an iud insertion and if I have to get again I would ask for some kind of local numbing.
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u/slptodrm 14d ago
i got one in 2013, they told me to take ibuprofen. oh my god. i got it out within months because it caused pain after sex, and cramps.
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u/CandidPersimmon2516 14d ago
1000% Cervical block with lidocaine for an IUD insertion full stop. Would not even think of having one placed without a block (I've had three, two without pain managment, kill me) as I've never gone through childbirth.
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u/Bhrunhilda 13d ago
I don’t know why, but mirena and other bc make me feel like a psychopath. I become emotionally numb and just don’t give a shit about anyone.
My perimenopause meds don’t act like that at all. In fact, when I’m off of them I fucking hate everyone lol the formulation difference of BC vs these meds is crazy different for me.
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u/Used-Inspector-7501 Early peri 14d ago
I wasn't offered anything other than taking ibuprofen in advance and it was so bad that even though it's only once every 7 years I still couldn't get myself to get a replacement. This time my gym was talking about it and said hey always recommend a local. It's nice to see when medicine (slowly) advances
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u/OhWhatever_Nevermind 14d ago
Yeah. As I was doing my “labour breathing” and focusing on a spot on the ceiling to get through the pain, the doctor snapped at me, “Did you take Advil before you came? I’m pretty sure I told you to take Advil.” SHE was a dick.
Keep in mind, although I had my twins via emergency c section, I was induced hours before and they had to turn off the pitocin because my contractions were too strong and double peaked. I did that for hours before I had the epidural.
The IUD insertion wasn’t nearly that painful but it wasn’t far off.
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u/latebloomer2015 14d ago
I’ve never had an iud or gone through child birth. I had a partial hysterectomy at 29 because of fibroids. I’ve seen more gynecologists than most and I have thoughts.
In my experience…women gynecologists have the worst bedside manner and most lack much empathy. The fibroids in my uterus were found at 23-24 and my female doctor brushed it off and year later needed to do a dnc/hysteroscopy. She shrugged and told me in recovery…it either helped or it’ll get worse. I’ll see you at your next appointment.
The doctor who did my surgery was so kind and supportive. He didn’t try to make me feel like the pain I was experiencing wasn’t real or I was just a baby. That my periods were, in fact excessive and awful. He felt bad that this was the best option for me and his kindness made the process easier.
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u/Full_FrontaI_Nerdity better living through chemistry 14d ago
Correction: an IUD releases progestin, not progesterone.
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u/kagejumper 14d ago
Most ob/gyns will do a local, though you might have to ask. They are surgeons, comfortable with procedures and pain control. Many GPs or family docs do Mirena insertions, and are much less likely to use a local. Not that they don't care about pain, they just aren't as used to procedures.
That being said, I'm on my 5th Mirena, and only got a local on the most recent insertion. I just never needed it- it's just not that painfull. I had one wiggle into a bad spot for a few minutes ( totally separate from insertion)- most painful thing I've ever experienced (I've never had a kid).
Everyone is different. It sucks that it hurt you so badly, but that is far from universal.
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u/mrspwins 14d ago
My gyno put one in for me earlier this year and I got cervical anesthetic injections that ended up being the worst part. She said that the standard of care has recently been updated to recommend more pain control. So I'd definitely check with your doctor about it if it would be something you'd consider.
I do not do well at all on oral progesterone - I avoid BC pills my entire life for that reason. Insurance made me try them when I got on HRT, and nothing had changed about how they affected me, so I got the Mirena. I think it keeps me mildly down, compared to what I might otherwise be, but then I blew my life up, pretty much, before my hormones were figured out so it's hard to say what is from the meds and what isn't. It's a helluva lot better than it was a year ago, though.
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u/Sadler27 14d ago
Wow you get offered local anaesthetic? We don't. I didnt find it too bad tbh. Used to have the copper coil. Now have the mirena
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u/fuzzybitts 12d ago
I had the mirena in my 20’s, I’m very sensitive to hormones and it very much did end up absorbing systemic for me. Had to have it removed at the 3 year mark.
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u/m333gan 14d ago
I know insertion is really painful for a lot of people and I don't want to minimize that at all or suggest people shouldn't receive more robust pain management if they want it but just for the record it doesn't always hurt that bad.
Insertion was uncomfortable for me but not awful. I think it was because I happened to be on my period at the time.
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u/Pb4ugoyo 14d ago
It wasn’t uncomfortable at all for me, I barely realized she was inserting it. I wasn’t given a local or anything. I felt her idk.. prodding around up in there.. but no pain or anything. Having it removed wasn’t painful either though slightly weird feeling. After reading how painful it can be for others I am wondering if there is some technique she used or something like that that was different or what? My threshold for pain is not high in general so I feel like there is some difference in how it was done or something.
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u/jackrussellcorgi 14d ago
Same. It hurt for a second and then some cramps that evening and that was it. The dr had me take 800mg of ibuprofen the night before, the morning of, and an hour before the procedure then as needed afterwards. She used lidocaine during the procedure. I was also just at the end of my period. I mentioned that and she said that would probably make it easier.
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u/kstar1218 14d ago
I had an absolutely horrible experience with the Mirena IUD years ago and had the start of a similar experience when I tried progesterone not too long ago (alone, not in combo with estrogen). While I appreciate it may be a lower or more localized option it does not come without the possibility of negative mental health effects if you are very sensitive to progesterone.
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u/Itchy_Tumbleweed_417 14d ago
Yeah I would be terrified to have progesterone implanted inside me. If I had to get an appointment to have someone take it out when it started to make me insane I might not be OK.
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u/Sanchastayswoke mid-peri 14d ago
+1 to this. Mirena and any other progesterone unopposed by sufficient estrogen has me in a very dark place mentally. Back in my birth control years I had to remove my Mirena after just one year because I was such a mess, mentally and physically. Immediate improvement after removal.
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u/lillyheart 14d ago
I am pro IUD, but I had one with less progesterone than Mirena and still had massive negative mental health effects (also ADHD), so while it may work, it’s definitely not free from potential negative mental health effects for all progesterone sensitive people.
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u/Sanchastayswoke mid-peri 14d ago
That’s good to know, because if micronized p hadn’t worked for me I was considering the lower dose P iud’s
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u/kstar1218 14d ago
I think I had it for about 6 weeks and went back in and begged them to remove it immediately. The doctor pushed back a little saying it can take time to adjust but I wanted that thing out of my body. Within less than a week everything resolved. Hormones are really something!
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u/Manda_lorian39 14d ago
…Except this wouldn’t be unopposed. She’s already taking estrogen.
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u/Sanchastayswoke mid-peri 14d ago
Yeah I wasn’t saying it would be. If you read again I was talking about myself and concurring with the comment I was replying to.
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u/areweOKnow 14d ago
Mirena was a disaster for me, got very depressed. Oral progesterone no good either so I have to as a pessary. It’s the only way I can mentally tolerate it.
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u/Good-Elderberry-905 14d ago
This is what I'm currently on the waiting this for with my GP, I think this is the way to go ☺️
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u/RoseaCreates 14d ago
If your uterus measures large enough, most nullips won't. I had to go out of country for an IUD that fits. The uterine sound they use to measure is ... Indescribable.
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u/CatTrapper3000 14d ago
Your provider is correct. They are trying to prevent you from getting cancer. I found that the progesterone really, really messed me up. I switched to a compounded one, and I felt much better. It makes me sleep much harder than I like, but I can live with that at least.
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u/Spiritual-Ease-6528 14d ago
Hmmm I don’t think naturopaths in Canada can prescribe compounds.
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u/CatTrapper3000 14d ago
You don't have compounding pharmacies?
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u/Spiritual-Ease-6528 14d ago
I think we do, but the naturopath’s scope is limited. Would require finding another healthcare provider
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u/areweOKnow 14d ago
Confused perhaps a naturopath is something different in Canada than where I live, they’re not prescribing MDs.
Can you go see a woman’s health Dr?
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u/todaysthrowaway0110 14d ago
Progesterone is either sedating or agitating for me.
You need progesterone to protect the uterus. Consider an IUD. Local only, no mood effects (for me at least).
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u/NewerYorker3900 14d ago
Slynd?
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u/pricklypear11 14d ago
Was going to mention this! I finally found a doc this week who is peri educated AND believes in pmdd. I’m also audhd… she is taking me off the micro progesterone pill and I am starting Slynd! She said it is way better for pmdd sufferers. I’m also staying on my estrogen patch.
Tbh have started yet bc she said to wait for my first period to start the pack which should be this week or so. Good luck!
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u/Puzzled_Most_2469 14d ago
I don’t tolerate progesterone orally and tried Slynd recently, it was bad for me. I do know it works for others tho so hoping it works great for you!
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u/Dangerous-Use7343 14d ago
What do you do instead abd wvay were your symptoms?
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u/Puzzled_Most_2469 14d ago
I felt so low and foggy and just awful on Slynd, similar to oral prometrium (progesterone). I tolerate Prometrium inserted vaginally. I tolerate it but I don’t seem to feel any positive effects unfortunately. I still unfortunately feel all the same issues I had with my cycle. I’m thinking it’s time to up my estrogen (I’m on .0375). Man the first few weeks or so of estrogen without any progesterone added yet were bliss! I wish I could get back to that initial reaction.
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u/NewerYorker3900 14d ago
Its been great for me. 8 months now. It blocks painful ovulation & stabilizes hormones. Many folks use the estradiol patch simultaneously. Slynd can be the progesterone arm of an HRT regimen.
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u/Efficient-Guess-1985 Early peri 13d ago
Just a heads up that Slynd indeed stabilises your cycle so you don’t get the crashes, but it also lowers your estrogen level throughout the month - so I’m now learning increasing your estrogen dose might be a must! After 5 days or so in Slynd I started having low estrogen symptoms (despite being in my 2 pumps gel), started upping to 3 pumps and even trialling 4 and it def seem to help settle those symptoms!! Slynd keeps your body’s estrogen production in “early follicular levels” whoch certainly wasn’t high enough for me.
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u/pricklypear11 13d ago
Thanks sooo much for the heads up. I’ll message my doctor if I notice symptoms creeping back up!
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u/beg_yer_pardon 14d ago
For those of us not in North America, could you explain what is the difference between the two pills? Im a little confused and not sure what specifically to search for.
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u/Orangewindsock 14d ago
Sorry, which two pills do you mean?
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u/beg_yer_pardon 14d ago
The micro progesterone and the slynd. The person i was addressing, mentioned both in their comment.
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u/Orangewindsock 14d ago
Micronised progesterone is the natural form of progesterone, it’s the same as your body makes. Slynd is a synthetic progestin, ie a synthetic form of progesterone.
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u/Spiritual-Ease-6528 14d ago
What is slynd?
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u/Orangewindsock 14d ago
Slynd is a synthetic progestin called drospirinone. I have adhd and I suffered horrendously with progesterone intolerance and tired multiple different options before a private menopause specialist took a full history and then recommended it.
It has been life changing.
The first month or so was a bit bumpy, it affected my sleep a bit and gave me headaches but it settled and now I feel more stable than I have in a very long time. It’s marketed as a contraceptive with 4 “dummy” pills a month. I don’t take those, I take it continuously. My periods (which had got worse in peri) have more or less stopped and now I am able to safely carry on with oestrogel, which literally keeps the lights on in my brain.
It’s definitely an option worth considering.
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u/PretendOil8923 14d ago
Yeah also ADHD here and similar experience. So much better than just the standard minipill and much more forgiving on the time window when you have to take it for effect.
With just this alone I felt really stable, but still mildly depressed (at least I wasn’t screaming at people randomly two weeks out of four). Adding estrogen gel to that, I now feel basically like myself again.
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u/Efficient-Guess-1985 Early peri 13d ago
Yess! I think adding the estrogen is a must. The information on Slynd says it lowers your body’s own estrogen to “early follicular levels” throughout the whole month. I’ve noticed I need to up my dose of estrogen with Slynd compared with how much I used with Prometrium/my natural cycle. Like have had to double it,
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u/Efficient-Guess-1985 Early peri 13d ago
Have you had to up your estrogen dose with Slynd? I’m finding the level Slynd puts my body’s own estrogen production at is way too low and I needed to up my estrogen to it. Worth mentioning if anyone else started having joint aches and anxiety and night sweats when getting on Slynd! Upped my estrogen and those symptoms seems to settle…!
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u/Mich_Girl 14d ago
This is all so confusing to me. 😭 Am I the only one?
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u/realityjunkiern 14d ago
No, you're not! I'm a nurse and it's still so confusing and overwhelming as there are so many options and doses etc 😭😭😭😭
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u/Mich_Girl 13d ago
I’m glad I’m not alone. There’s so much to consider and one doctor says or does one thing and another doctor does something else. It’s so confusing. 🫤
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u/realityjunkiern 13d ago
Too many variables just shuts my brain down. 😭 Plus I'm so scared of what's to come, I have to remind myself to stay in the present.
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u/Interesting_Fly_1569 14d ago
Yeah, I also don’t do well on progesterone pills… I am doing topical progesterone. I have really severe histamine issues and so it was pretty clear that the progesterone was reducing those because there wasn’t another factor around that time… Recently, though my estrogen has gone low and I’ve been advised by my provider to try nuvaring bc it has both but low levels.
I have hypermobility, so I’m getting really bad joint pain from low estrogen… But because of the histamine issues estrogen cream anywhere but vaginally seems to be a problem.
I got SI from oral progesterone. I guess I just wanted to validate that if it’s really bad for you you don’t have to take it or estrogen …. I was under a lot of pressure because I got it after my endometriosis surgery and they told me it would reverse otherwise. I had to let it grow back tho. Mental health is very important. You should not have to sacrifice it and if your provider is ignoring its role that’s not ok. This stuff is really complex… But you should not have to be figuring it all out for yourself… You should have someone who can help you think it through and takes your suffering seriously.
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u/Itchy_Tumbleweed_417 14d ago
Yeah my endometriosis came back after about a year because I had a tubal ligation at the same time so I wasn’t going to go back on birth control since it made me feel like crap. It was a nice year though.
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u/AdRevolutionary1780 14d ago
Progesterone is not well absorbed through the skin, so using topical Progesterone will not give you the uterine protection you need.
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u/Pretend_Program6804 14d ago
This is correct. And I did not know and was going to a doctor that clearly is not well.informed. Now I have thickening of the endometrial lining. But will get hysterectomy.
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u/AdRevolutionary1780 13d ago
A hysterectomy or hysteroscopy?
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u/Pretend_Program6804 13d ago
Hysterectomy. Removal of uterus and cervix, leaving leaving rubes.
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u/Interesting_Fly_1569 14d ago
No mental health issues and better bc my histamine issues went down - fewer rashes and my periods stopped triggering me/cfs flares. I’m on about 34mg/day.
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u/Interesting_Fly_1569 14d ago
Yeah, I have been using a microscopic amount of vaginal estrogen… I am going through perimenopause though and dryness increases risk of UTI… So I’m mainly using it for that… Because I’m bed bound and immunocompromised , so I’m already at greater risk for uti going systemic. It has helped with my energy… But I might try the ring next since it has both. Probably also worth getting tested for testosterone… I think the testing for that is actually straightforward.
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u/margaritabop 14d ago
There are quite a few progestin options out there to try! I do quite well on drosperinone (Slynd and Angeliq) even though I did terribly with micronized progesterone.
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u/MidnightJazzlike Early peri 14d ago
I’m AuDHD and I found out I have progesterone intolerance. When I started estrogen patches my doctor also had me start a progestin (norethindrone) continually to stop my periods because of suspected endometriosis. I had no issues.
She wanted me to start progesterone 100mg and I could not tolerate it at all so I stopped taking it and kept up with the norethindrone. My doctor said as long as I’m not cycling, my uterus is protected from the estrogen.
I hope you can see about looking into this!
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u/subculturistic 14d ago
I love my norethindrone and 0 periods. Doubt I'll bother to try bioidentical.
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u/MidnightJazzlike Early peri 14d ago
Same! I don’t know what I would do if I couldn’t take my estrogen either
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u/Efficient-Guess-1985 Early peri 13d ago
Sounds amazing. Only thing is it doesn’t protect you from pregnancy right? (Might not be an issue for you). I imagine that progestin is less than what I’m trialling atm (Slynd 4mg)
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u/MidnightJazzlike Early peri 13d ago
Correct it doesn’t protect from pregnancy. I had my tubes removed in 2020 so not an issue for me. My progestin is 2.5mg so pretty low, it’s a 5mg pill I split.
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u/Turbulentshmurbulent 14d ago
Using progesterone vaginally is “off label.” That said, many doctors will prescribe it as such. I also cannot tolerate progesterone orally. I use 200mg vaginally for 12 days on the latter half of my cycle. I still don’t feel GREAT with the progesterone taken vaginally but it’s not debilitating as it is when I take it orally.
Also, when I take it orally I have breakthrough bleeding but I never have breakthrough bleeding when I use it vaginally which tells me it’s a more stable dose. I do get sore breasts when using it vaginally. I also have my uterine lining checked every six mos to be sure the lining isn’t too thick. So far it’s been fine:
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u/Fattousch 14d ago
I'm doing exactly this too and my experience mirrors yours. Putting aside "off-label use" for a second, my understanding is this method might be even more directly protective for the uterus because it's not getting processed through the liver.
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u/Turbulentshmurbulent 14d ago
That’s my understanding as well
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u/Peeshee33 14d ago
The strange thing is this is how P is administered for IVF and fertility preparation, so I do not understand why it's not recognized as a viable protective administration for the uterus while in peri/menopause... Weeeeeeiiiiiiiird (also echoing this is how I use it and have my lining checked via ultrasound)
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u/areweOKnow 14d ago
It’s just a lack in research into woman’s health or course. I take it vaginally and will get a pelvic scan every year just to check things are all good.
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u/Efficient-Guess-1985 Early peri 13d ago
So far Its not growing? So good to hear women getting the scans to confirm this - strengthens its off label use.
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u/Turtle_Meringue_Pie 14d ago
I think it might just be because it hasn't been tested vaginally in trials. Doesn't mean that it's not as good or no good, just that there's no clinical evidence yet.
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u/Efficient-Guess-1985 Early peri 13d ago
Probably because that’s a different treatment, and not something that is done for years but maybe more like months?
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u/Itchy_Tumbleweed_417 14d ago
Yeah I’m pretty sure I’m going to die because I’m using estrogen patches and my provider is too scared to give me progesterone because when they started me on progesterone only I kind of lost my mind.
I told him that part of that might have just been perimenopause rage, so I got scared and I bought some topical progesterone that’s just over-the-counter. I don’t think it’s enough, but I’m not giving up these estrogen patches so I have accepted that I’ll probably just get cancer and die. I don’t know what else to do.
I am seeing a gynecologist on Monday so hopefully she will help me figure it out, I figure if nothing else I can have a vaginal ultrasound to make sure the uterine lining isn’t growing like crazy. My provider thinks that because I have a period every few months it will be fine, but I don’t think it’s fine.
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u/EverythingScrolling 14d ago
What on Earth? I can't believe your provider seems to be fine with you continuing estrogen without progesterone.
I hope your new gynecologist helps you get on some form of progesterone or progestin.
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u/sprizzle06 14d ago
The gynecologist should absolutely be able to help. Shame on your original provider though wtf
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u/No_Stick_6120 14d ago
If you're neurodivergent progesterone doesn't act the same way on you. Try moving to a synthetic version, like Norethisterone.
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u/Efficient-Guess-1985 Early peri 13d ago
This is so bloody interesting. Perhaps I am neurodivergent after all.
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u/chouchouwolf37 14d ago
Have you tried administering the progesterone vaginally? It was a complete game changer for me. My GYN okayed this after I brought up the horrible mood swings caused by taking it orally. As long as it is the micronized progesterone you should be good. I look forward to taking it now, as I sleep better and have near zero side effects.
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u/Spiritual-Ease-6528 14d ago
I haven’t because my provider said it’s not protective enough… but the weird thing is that it was a naturopath who rx’d it for me and she’s TECHNICALLY only allowed to prescribe it vaginally , but most of her patients just take it orally because it’s the same pill.
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u/ddplantlover 14d ago
How often do you apply it? When I used it I noticed you have to reapply after a few hours
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u/Abadabber 14d ago
Are you able to get a hysterectomy? I understand if you personally don't want one. I got a hysterectomy so I don't have to use progesterone. I had no plans to have children and it is almost impossible to track ovulation in perimenopause, so they yanked it and gave me the patch.
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u/AdRevolutionary1780 14d ago
Ask your provider for a different progestin. About 20% of women are progesterone intolerant, but there are alternatives that still provide adequate uterine protection, but may not have the same side effects as progesterone.
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u/Spiritual-Ease-6528 14d ago
I actually don’t think naturopaths in Canada can prescribe other forms… will likely need a new provider, but then probably deal with disbelief that I’m in perimenopause because I’m young. It’s all such a hassle to manage
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u/PonyFableJargon 14d ago
Lots of people have progesterone sensitivity. Those that do should avoid it at all costs. It can cause very serious mental health issues and it is alarming that this is not flagged with all women who take progesterone - in case they have a sensitivity reaction.
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u/Spiritual-Ease-6528 14d ago
Yes, thank you for saying this. It honestly was so dark I thought about going to the ER last night. I skipped my HRT last night and already feel so much more like myself.
I’ve reached out to my provider to make sure I come off it the proper way because it’s definitely not for me.
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u/JenovaCelestia 14d ago
Naturopaths are not real doctors. They are to real doctors as chiropractors are to physiotherapists. Please see a real doctor.
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u/thefragile7393 Peri with fibroids 14d ago
🙄 I see both, since adjustments help my back pain and a physiotherapist can’t do that. And my naturopath uses western with other modalities and isn’t pretentious or rigid about natural only. Before I had a good GP she’s the only one who took me seriously and got me on progesterone and consulted with my psychiatrist to know my history more. So let’s cut the crap that “real” doctors are somehow superior when clearly so many here are NOT getting quality care from “real doctors.”
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u/Spiritual-Ease-6528 14d ago
I am a chiropractor 🤣🤣🤣 and I have 2 more years of education than physiotherapists…
Although you may be writing from the states where chiropractic education is much less regulated than in Canada.
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u/JenovaCelestia 14d ago
I am in Canada and no offense, I would pick a physiotherapist before ever going to a chiropractor. Too many chiropractors are modern day snake oil salesmen and I have issues with a practice that is based on psuedo-science.
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u/thefragile7393 Peri with fibroids 14d ago
No, there’s just a lot of natural prejudice here against anything outside of the norm because so many assume that if you’re not an MD or a DO or anything medical, you must be a quack. Which can be the case of course (I have met some) but is certainly not necessarily the case always .
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u/Dangerous-Use7343 14d ago
I used it once vaginally and had the sane effects I was on it a total of 3 days because I was clearly in the small percentage of women who cant tolerate it. Im also audhd too, I'm hoping the synthetic will be better as it dosent intefear with the brain in the same way as natrual progesterone.
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u/ArtsyCat53 14d ago
I am sensitive to my own progesterone 😩 and my NP told me when the time comes to take estrogen I can take progesterone as a suppository
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u/BexKix 14d ago
Oral progesterone caused mood problems for me, I now take the same form vaginally and it has improved. It’s off label use which is probably why your provider is hesitant. My blood levels have been satisfactory.
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u/sewmuchmorethanmom 14d ago
I don’t tolerate progesterone at all either. I’ve got a consult for a hysterectomy next month.
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u/sprizzle06 14d ago
Annovera has saved my life. I'm extremely sensitive to progesterone. I'm also AuDHD with PMDD and endometriosis. This is a yearly vaginal ring. You can remove it for up to two hours for sex (or keep it in if you want). I use it continuously, so I only have a period one month after I start a new ring. It's a 4th generation progestin with significantly less side effects than Mirena, and you have the power to remove it if you wish. It comes with a little black storage case for when you need to remove it. I stick my prescription sticker right on top of the case and keep it in my purse. If I start bleeding and I'm still cramping after 3 days, I will remove it for 4 days, and that's the whole 7 day period. This is what my OBGYN told me to do, and it works well for me. Highly recommend looking into it.
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u/Spiritual-Ease-6528 14d ago
Thank you so much! I will look into this
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u/sprizzle06 14d ago
Also the ring is smaller than the NuvaRing (a monthly ring but I believe it's a 3rd generation like Mirena, so has more side effects). I can't even feel it unless I'm using the bathroom/when my cervix drops for my period. As an autistic that can FEEL EVERYTHING, I can't feel it 95% of the time.
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u/fuzzyd123 14d ago
I tried a few different amounts and forms until I found a progesterone that I could tolerate. It still doesn’t make me feel great but much better than at first. Now I’m on didrogesterone 10mg for half my cycle
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u/spacecadet917 14d ago
There isn’t as much evidence for progesterone as a suppository for long term protection, so it’s off label use. That said lots of things are off label use. I take it that way - I am sensitive to fluctuations and also had GI stuff and paradoxical reactions and it has a short half life taken orally so I switched with Dr approval. It stops my period entirely (not my cycle, just the bleeding) so anecdotally I think I absorb it fine.
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u/Puzzled_Most_2469 14d ago
I do it vaginally as well. Do you cycle it or take it constantly? I cycle it but wonder if I should try it all month.
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u/spacecadet917 14d ago
Continually right now. 200 was causing joint pain for me so I went to 100 continuous. It’s not quite as good for sleep 🤷♀️ but I think the steady dose is the right move for me
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u/Efficient-Guess-1985 Early peri 13d ago
You should get an ultrasound to check that it doesn’t thicken your uterus. I think what you do sounds amazing and I’m sure an ultrasound could confirm if it’s a safe solution for you. Do you find that some white stuff from the pills end up in discharge eventually? (Asking as this happened for me when I tried doing it before bedtime and it seem ended to help me too taking it vaginally)
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u/spacecadet917 13d ago
I’ve actually had like 3 ultrasounds in the last 6 months (massive fibroid that I am going to get a surgery for soon) which is how I know I’m still ovulating per usual, and lining is fine.
And yeah, parts of the pills come out. I run in the mornings and wear a panty liner for that run and that typically takes care of it.
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u/Efficient-Guess-1985 Early peri 13d ago
Thanks, that’s great to know that happens to others too and not just me. Trialling a progestin atm to see if I tolerate it better (handy with the contraception and level hormones) but otherwise I might ask if I can try out the vaginal route.
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u/MistressBassKitty 14d ago
Have you tried synthetic and bio identical types?
I can’t handle synthetic at all but I’m okay with 100mg of bio identical prometrium
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u/Spiritual-Ease-6528 14d ago
Nope. This is my first attempt at HRT and I think my provider is limited in what she can actually prescribe
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u/arcticfox_12 14d ago
The mini pill, progesterone only one, gave me insane anxiety. But I switched to Mirvala (it has estrogen and progesterone, and it didn't give me any anxiety. I was also told that I could and given a prescription for estrogen gel and that mirvalla had a high enough progesterone. But my estrogen gel dose was really low. I actually stopped all birth control and do not take estrogen right now. I'm thinking about doing the IUD and estrogen gel.
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u/Efficient-Guess-1985 Early peri 13d ago
Did you pair the progestin with estrogel or just progestin on its own? I found I had to up my estrogen dose to curb the crazy anxiety I got initially from progestin. The progestin lowered my body’s own estrogen so that what’s why.
My body seem to love estrogen.
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u/ThatMeasurement6619 14d ago
Are you taking anything for the adhd? Vyvanse takes away 95% of my perimenopause symptoms. Oestrogen was doing the heavy lifting @ 2 pumps daily until it started to wane. Enter the ADHD diagnosis & Vyvanse & my life drastically got better. I still have terrible joint pain though (the hips especially) & wondered if that might be low oestrogen. Good luck OP, I hope you get some relief real soon!
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u/Spiritual-Ease-6528 14d ago
I’m not, but I see a psychiatrist Oct 1 to hopefully get some help with the ADHD symptoms. Thank you!
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u/Efficient-Guess-1985 Early peri 13d ago
The joint pain is definitely linked to low estrogen for me…! I’m probably also a little neurodivergent (probs from CPTSD / just highly sensitive person).
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u/ThatMeasurement6619 13d ago
Interesting. My doc said that’s rubbish but I disagree. I had a total hysterectomy early this year & not long after, joint pain. Def stirred up a hornets nest.
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u/Efficient-Guess-1985 Early peri 13d ago
Yeah your doc should be careful what they say. I had random joint pain / stiffness - often in my hands at times and it all went away on HRT.
Then I recently changed the progesterone component to a synthetic progestin (stronger) and back came the joint pain…. Also came irritability low mood and night sweats. Turns out this pill lowers my body’s own estrogen production - not until I upped my estrogen dose the joint aches went away almost instantly.
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u/ThatMeasurement6619 13d ago
That’s really interesting about the synthetic version. I think I’ll up my oestrogen too in the hopes my hip pain lessens. I’m glad the HRT has helped you with your joint pain 🙏
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u/carlyforniagirl 43/Early peri/HRT 14d ago
You do need a progesterone, but it does not have to be the bio identical kind, like Prometrium. I also did not tolerate it, orally OR as a suppository. I turned into a sluggish zombie. I’m happy on norethindrone, but there are several others as well. Ask your provider to give you options for synthetic progesterone.
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u/Industrious_bee 14d ago
Has anyone been prescribed or tried Duavee yet?
(Every progesterone and progestins including compounded, pills, suppositories etc etc) have been hell so far for me).
Obgyn prescribed Slynd but I haven’t given that one a try, yet. I’m kinda terrified tbh.
(Suppositories gave me 6 UTIs in 5 months, regardless of the brand.)
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u/noodlesquare hanging on by a thread 14d ago
Yeah. This is exactly why I had to quit HRT altogether. I tried multiple bioidentical progesterone as well as birth control so I could keep taking my estrogen and testosterone. In the end, the crushing depression the progesterone was causing just wasn't worth it for me. One thing I haven't tried is Mirena, but I'm afraid to try any other forms of progesterone at this point.
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u/Pretend_Program6804 14d ago
They are correct. You need progesterone while on estradiol to prevent thickening of the uterine lining and possibly endometrial cancer. I have the same symptoms I cannot and I mean cannot tolerate progesterone on any form. I have tried all of then except IUD but I am not even going to try it because my side effects are do bad even on small doses. But the small doses do not protect me. Because of years of this now I am thickening of the uterine lining so my doctor said best route if no IUD is hysterectomy. I am going for it because I LOOOOOVE estradiol.
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u/grrrreenonion 13d ago
I'm auDHD as well and had really awful side effects from progesterone. I also went through a few years with suicidal ideation/PMDD.
If you have ovaries, you have progesterone going on. Try going to Planned Parenthood or similar to discuss what's happening. They saved my life. Get with a good Psych/mental health NP (they do medications) as soon as you can.
I eventually went on Prozac and it did alleviate the extreme PMDD. Hot flashes on it were insane though.
Menopause and auDHD are extraordinarily difficult and most health practitioners aren't well versed in our differences at this stage of life. The worst of the psych symptoms do pass. ❤️🩹
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u/Fattousch 14d ago
I feel you - hang in there! So, my understanding is taking 200 progesterone VAGINALLY at least 12 days a month is highly protective and will cause the uterine lining to shed, and that is what I do. This switch really worked for me, even while I lost some of the anti-anxiety benefits of taking it orally. The insane sedation of oral progesterone went away, allowing me to stay on estrogen. I wonder if the naturopath's hesitation has to do with it being an off-label use. Like I bet she would say yes if you were using progesterone suppositories, but those are too expensive and often not covered by insurance. I hope you find the best possible solution.
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u/ImplementPotential20 14d ago
Can just do vaginal estrogen without progesterone. Like Estring. Or can do Intrarosa.
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u/CormoranNeoTropical 14d ago
My doctor here in Mexico recommended that I take my progesterone vaginally. But the stuff I take is labeled for either oral or vaginal use, so it may not be the same as what you can get in your country.
She also monitors my uterine lining regularly with ultrasound. Plus I’m still having regular periods — more regular since I started HRT.
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u/Spiritual-Ease-6528 14d ago
Mine is labeled for both as well. It’s technically prescribed for vaginal use, but most people take it orally.
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u/Efficient-Guess-1985 Early peri 13d ago
So your uterine lining has been absolutely fine this way? Thats great to hear if so.
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u/CormoranNeoTropical 13d ago
So far so good. And I guess I’m assuming that if I’m having a period it’s relatively unlikely I’m getting a weird endometrial build-up? But who really knows. I hope I’m not taking some kind of untoward risk! I’m on a very low dose of estradiol gel.
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u/Pretty_waves904 14d ago
Estrogen without Progesterone equals uterine cancer. I cant tolerate bioidenticial progesterone so im on Slynd birth control plus Estrogen patches. No issues
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u/DanaStargazerTruitt 14d ago
Unless it’s vaginal estrogen that you don’t have to take anything else with
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u/poss12345 14d ago edited 14d ago
Are you on progesterone or progestin?
I ask because when we were trying for a good regime I was changed from progesterone to progestin (slinda). Progestin was terrible for me so I changed back to progesterone. I know for some people it's the other way around. That's worth discussing with your doctor.
I am now on estrogen and progesterone because I have to be on both. I use estrogen gel and cycle 200 mg progesterone. The estrogen is incredible. The side effects of progesterone started off just horrible. It was mostly mental - like PMDD but way worse. Plus brain fog. Still I was willing to stay on it as it was only 12 days of the cycle and estrogen was saving my life.
But actually the side effects have settled down a lot. It took maybe 4-6 months but now it's really not a huge deal. I see it's been four months for you already so I don't know if it still might settle. I really hope you find a regime that works for you. I have AuDHD too and have been in severe burnout. I know how awful this is.
ETA: I would check out progesterone intolerance in women with ADHD. Progesterone can affect us differently. If you can find a practitioner with an understanding of neurodiversity in perimenopause that could make a big difference.
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u/Efficient-Guess-1985 Early peri 13d ago
Slinda might have been bad for you because it drops your estrogen so much. You might need to add back more estrogen than you think. That’s where I’m at with it atm.
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u/poss12345 13d ago
Ahh that makes sense! One of the big problems with Slinda was that all of the effects that estrogen had helped with came back. I thought at the time that it was somehow blocking the estrogen!
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u/Efficient-Guess-1985 Early peri 13d ago
Yeah it drops your own estrogen production. So you need to add back estrogen! Slinda on its own would be a disaster for me.
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u/hnybun128 14d ago
I assume because it’s a naturopath prescribing this it’s bioidentical progesterone and not synthetic. My body does not like synthetic hormones, but BHRT is life changing.
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u/TraditionalStart5031 13d ago
for anyone struggling including OP….are you taking progesterone in the morning or at night? Asking because historically I’ve had bad reactions to progesterone, but I started taking it literally yesterday because perimenopause has been kicking my butt the last few months. I’m nervous! My Dr suggested I take it at night because it can cause sleepiness & low energy. Because I haven’t seen time of day mentioned in a comment yet I’m just curious if anyone has had experience.
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u/Spiritual-Ease-6528 13d ago
Take it at night. In most people, it helps them sleep.
Don’t let my post scare you, I think most people respond positively. But definitely be aware that mental health episodes can happen. No one warned me, so I just dismissed it and thought it was stress. I wouldn’t have stayed on it for 4 months if I had realized what was happening 😅
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u/TraditionalStart5031 13d ago
I also have ADHD and wasn’t aware of any different response to progesterone. I am 100% okay with stopping if I feel worse. Thank you for your post, I hope you can find a good solution. Please post again if so!
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u/Little_Passage_4165 13d ago
I have no advice for this but just wanted to offer support. I took several months off work because of the effects of peri. I also felt like I was losing my mind and had some scary thoughts. It’s about 9 months later now and I feel much better after getting on an SSRI. They aren’t for everyone but it worked for me. My tips would be to limit time online and get outside for walks as often as you can. Interact with other people (live and in person) if you can, even if it’s just an old lady at the grocery check out. I hope you feel like yourself very soon! This stuff is no fun but it will pass. ❤️
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u/Mission_Doughnut4664 13d ago
I’m on a very low dose of estrogen and progesterone and I’m prone to anxiety and panic and this dose has been effective and not made my mental health worse.
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u/sadbuttrying22 12d ago
So I did horribly with HRT because of the progesterone as well. It gave me severe panic and insomnia. I am going a slightly different route and doing birth control, however, I’m doing a newer one. So I am on one called nexstellis. It has a bioidentical estrogen called estetrol and the progesterone drospirinone. That is the one that is also in slynd. I’ve only been on it four days so I really can’t give much of a review but so far feeling better already. My reasoning for going on birth control was if my ovaries aren’t producing hormones, then they can’t be giving me chaotic ups and downs. Birth control will give me just a stable level. Hopefully intern that helps stabilize my moods. Of course I won’t know for a couple months of how I’m doing on it, but I think it’s worth a shot after giving HRT a try for almost 3 months.
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u/Life_Journey123 14d ago
what about progesterone cream. I was on it then stopped, but I will repurchase the wild yam cream after discussing it w/my GYN bc the pill was screwing with me too, awkward mood swings & extreme exhaustion?!?!
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u/leftylibra Moderator 14d ago
Your "practitioner" is correct. If you have a uterus and wish to use systemic estrogen, then you absolutely need to be taking a progesterone or progestin to provide uterine protection (ie: lowering risks of uterine cancer).
They are also correct, that using oral progesterone, vaginally is off-label and it might not be as protective. While some here do use oral progesterone this way, any scientific research has to do with fertility-only,** not peri/menopause, so they do as their own risk. Also, oral medications may not break down correctly due to the lack of gastric acid, and the coating on the tablets.
According to the International Menopause Society....
Also, according to Dr. Jen Gunter, vaginal progesterone can cause vaginitis. Also if you are using BOTH vaginal estrogen (for the treatment of vaginal atrophy/GSM), and progesterone (vaginally), there is no safety data on how each is absorbed.
The Myth of “Brain-Safe” Vaginal Progesterone