Progesterone trial for severe PMDD after GnRH treatment, mirenas etc

I'm 40 and have been in an out of gynaes for over 20 years for PMDD and suspected endo. I've endured all manner of treatments, in the early days having one of the first Mirenas fitted and using estrogen patches to trick the body into menstruation. I've been on Prozac for 15 years and also tried taking it for the recommended luteal phase with no difference. For the last 6 years I've had first 3 years on GnRH analogue treatment with add back HRT, a break followed by severe return of symptoms and a return to the GnRH suppression treatment until now. Although I have had a good result of no premenstrual cycle as I have no cycle, I have had side effects of the suppression treatment .... bone/ joint pain, weight gain, exhaustion and general malaise (all similar to the PMS itself but without the severe pelvic and breast pain)I was given tubes of testosterone gel to counter tiredness but not sure they helped.
Where I am now - moved to another country and consulted with new gynaes. Here they do not prescribe the suppression treatment long term for longer than 4 injections, mainly for IVF (regardless of add back HRT for bone mineralization) They do not give Mirena to women who have not had children and they don't perform hysterectomies on women until late 40s/50.
What they have given me is a tube of Progestogel and told me that here they use this!
Given no alternative ... I will now try progesterone! Currently I am still in ovarian suppression as seen on MRI but 3 days of progesterone and feeling those familiar heavy, dragging cramps. Question - Should they have prescribed a progesterone whilst I have a mirena?
Anyway, this is a story in motion as I need to return to MY normality of the painful cycles I had previously to begin this progesterone regimen.
I've tried countless, nutritional and herbal supplements over the years with no relief.
I am now sticking with vit D oral spray and transderm magnesium.

Comments for Progesterone trial for severe PMDD after GnRH treatment, mirenas etc

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Jun 30, 2013
Progesterone trial for severe PMDD after GnRH treatment, mirenas etc
by: JL

Wow!!! All I can say is thank goodness you moved to another country you would have been in a far worse state had you stayed!! You were certainly put on a cocktail of drugs which have a potential to cause harm and of course all so unnecessary!

All your symptoms point to Estrogen Dominance. The Mirena is probably the worst contraceptive - see here. Please read the side effects of the Mirena as well.

Thank goodness you were given Progestogel however, at only 1% stength it is not nearly enough progesterone. It means 1g of cream will contain only 10mg of progesterone. Most of the successful studies find between 100-200mg progesterone is needed to alleviate symptoms, possibly more depending on how severe symptoms are.

The minimum amount of vitamin D recommended is 5 000iu's per day more if one is extremely deficient. Do you know what your level is?

I am sure that Wray will advise further on all of this.

I wish you well.

Jul 01, 2013
Thankyou for your response.
by: Anonymous

Thankyou for your response.
I paid for a test service 18mths ago. Total vit D was 118.4 nmol/L - 115.6 was D3 and 2.8, D2 Results paper said adequate.
I'm not sure about the effects of the Mirena as I have had it so long, back to back, 3 or 4 times.
I just remember the pain, PMDD symtoms and extremely heavy menstruation without it, therefore can't attribute the blame directly there. One thing it might be responsible for is cysts on my ovary, but then again I didn't have the diagnostic ultrasound without it fitted so again cannot be certain it's a cause.

Jul 02, 2013
Progesterone trial for severe PMDD after GnRH treatment, mirenas etc
by: Wray

Hi there You have been through the mill! I find so many treatments women are subjected to so bizarre. Imagine giving you a GnRH antagonist to suppress LH and FSH, which of course drops both testosterone and oestrogen levels to zero or near zero, and then adding back the HRT for your bones, daft. Bones need over 30 nutrients to grow, oestrogen is the least important. In fact all it does it gives us old bones, as it prevents the osteoclasts from removing old bone. This is essential for the renewal of bone, without this no new bone can form. So on an x-ray it appears bones are healthy, but in actual fact they are old. There's more info on our Osteoporosis page. And the Mirena, I have strong views about that too, maybe you'd like to read these comments from other users here. And as for a hyst, that often causes more problems. It appears you've always been short of progesterone, strange they haven't checked for it. And had high oestrogen which it seems they did check. Did they check testosterone levels? As high levels of that cause severe PMS. If bound to SHBG (sex hormone binding globulin) testosterone becomes inactive, progesterone raises levels of SHBG, see here, so preventing the rise of free testosterone and severe PMS. And if you have suspected Endometriosis, then it all likelihood you are deficient in antioxidants too, as this is caused by oxidative stress, and it's exacerbated by Stress and excess oestrogen. Testosterone should never be given to a woman, see here, here, here, here and here. Continued below

Jul 02, 2013
Progesterone trial for severe PMDD after GnRH treatment, mirenas etc Part 2
by: Wray

Hi there And more here, here, here and here. If you have Breast Tenderness please take a look through this page, and another we have on Breast Cysts. Oestrogen is more often than not implicated, but so is a lack of iodine. As JL says, the Progestogel is only a 1% cream which is laughable, and I'm not surprised you're getting those familiar cramps. For any pelvic pain, which sounds like endo, I suggest you increase the amount to 500mg/day. One site says the tube has 100g, another 80g. I'm not sure which you have but the 100g tube would last you two days and the 80g 1.6 days. It's excellent to use progesterone whilst you have the Mirena, as it will counter the adverse effects of it, but not at the amount Progestogel recommends. Please have a vitamin D test done, it is a potent anti-inflammatory, and low levels reduce the benefits of progesterone, see here, here and here. For more info on vitamin D levels, test kits etc see the following websites, Vitamin D Council, GrassrootsHealth and Birmingham Hospital. Blood levels should be 70-100ng/ml or 175-250nmol/L, and not the 30ng/ml or 75nmol/L most labs and doctors regard as adequate. The minimum daily dose should be 5000iu's per day, although the latest research indicates it should be 10,000iu's per day, see here. Transdermal magnesium is good, as it is absorbed, see here. But I also suggest taking some to bowel tolerance. Both magnesium and vitamin D will help the pain. Take care Wray

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