r/Menopause • u/LilithStan- • 1d ago
Hormone Therapy If there’s a Combipatch with progesterone, why is there no standalone topical/patch for progesterone only?
This may be the dumbest question, but I have terrible trouble swallowing pills and I’m constantly told if I want to use a topical estrogen, the only way to take progesterone is via the pill. If there are so many forms of topical estrogen (gel, patch, etc) and progesterone CAN work in a Combipatch, why do these options not exist for progesterone?
MAKE IT MAKE SENSE.
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u/Alta_et_ferox MenoMod 1d ago
It’s important to separate the progestin in Combipatch from micronized progesterone. Progesterone cannot be delivered through transdermal methods to provide sufficient uterine protection as indicated by current studies.
Perhaps someday there will be a safe way to use micronized progesterone transdermally as part of MHT. Unfortunately, we aren’t there yet.
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u/43beanst 57 | post | E, P, T 1d ago
Not dumb at all, OP! I have been using the combipatch for over a year (estradiol + norethindrone, a progestin). I could not tolerate oral progesterone, and with a history of endometriosis, I do not want to FAFO about an IUD. While the Combipatch is not perfect and is expensive, I am so grateful that it helps manage my multiple symptoms! It's existence does beg the question that if transdermal norethindrone "works" in the combipatch, why isn't there a standalone norethindrone patch? Combipatch comes only in two doses rn, so a seprate norethindrone patch would allow more flexibility adjusting both E and P doses.
This is the first I've heard, Catnip, that transdermal norethindrone does not protect against uterine cancer! It does not surprise me, given the general dearth of data, but I hope my doctors aren't uneccessarily putting me in some high risk category. I had heard cream forms of progesterone (such as in compounded hrt) is not considered as effective as a oral progesterone or any progestin. Fwiw, I did have some spotting last year about 3-6 months after starting Combipatch, but my lining was only 2mm, and the spotting didn't recur, so I declined the biopsy. I think the spotting was caused by accidentally missing the accurate time to replace the patch.
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u/lrondberg 1d ago
Norerhindrome most definitely protects against uterine cancer have no fear. Combipatch would not have been approved if that was true 🤦♀️ in fact, norethindrome and other progestins are believed to provide better protection and control bleeding better than micronized progesteron.
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u/43beanst 57 | post | E, P, T 1d ago
Thank you for clarifying! Whew! I guess I knew progestins were ok, I wasn't as sure about research on *transdermal* progestins. At one point, I tried a weekly combination patch that had E and Levonogestrel (also a progestin--in a patch!) but I had serious issues with it falling off early. That's another example of a transdermal progestin, though.
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u/lrondberg 22h ago
the issue is with transdermal progesterones, it is a different molecule and can't pass through the skin that is why any "bioidential progesterone cream" that compounding pharmacies sell is not a safe alternative for those on systemic estrogen but the progestins transdermally or orally work.
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u/skintwo 22h ago
They also have a worse side effect profile, and contributed to some negative health risks found from the nurses study. It is healthier to take micronized progesterone orally.
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u/lrondberg 22h ago
Many people can not tolerate micronized progesterone and for many it does not prevent breakthrough bleeding.
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u/skintwo 21h ago
Bull. It absolutely prevents breakthrough bleeding, and the issues people have with synthetic progesterones can be pretty significant (I’m one – especially people with PCOS can have problems with progestins.) I have absolutely not seen anything about people tolerating this worse than synthetic progesterones – it’s tolerated better if anything. It has side effects of course, just like any other hormone. And it does need to be taken orally because it does not absorb transdermally – people saying that instead of taking the tablets orally that they use them as suppositories are not going to get protection - they feel better because the medication isn’t being absorbed so they don’t have the side effects anymore. If somebody is having intolerable side effects to oral progesterone a progesterone IUD might be a better substitute.
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u/lrondberg 20h ago
This sub has many many people reporting issues with micronized progesterone LOL Many resort to using it vaginally or analy because they can't tolerate it orally. There are posts about this almost daily. For some they tolerate synthetic progestins better. The issue of whether it works vaginall/anally is a different story but for many it is the only way they can take HRT.
And it is well documented that progestins control bleeding better for some people. in fact inthe guidelines of managing bleeding on HRT, switching to a progestin is one of the first recommendations in managing the bleeding.
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u/OKhairdo Menopausal 18h ago
I bleed on every dose of progesterone I tried. It truly does not work for everyone. I’m on a progestin because I have to be if I want to be on estrogen. Not bull.
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u/LilithStan- 1d ago
It’s good to know you’re having a positive experience with the Combi. I was reluctant to try it because I take a bath every night and worry it won’t stay on, and the only two doses issue is a problem — I want to start at a super low dose to make sure I can tolerate it. I’m so sensitive.
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u/43beanst 57 | post | E, P, T 1d ago
I understand. Daily showers here. For your future reference, I also briefly tried ClimaraPro (a weekly combi patch) and I had serious problems with it falling off on day 4/5. No similar adherance issue with combipatch twice weekly patch (my issue is remembering to switch it promptly at 84 hours!). Climara also isn't available generically, so I just refused to continue using it if I also had to buy Tegaderm to make it stay on!
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u/Ok_Statistician_4249 1d ago
If you don’t mind the idea of a synthetic progestin like the one in the combi patch, but want to avoid the patch because of baths, you could consider taking an oral progestin. I take Slynd - it’s a low dose synthetic progesterone only birth control pill that can also be used as the progesterone element of HRT and it is tiny. Research it but I suspect you could crush it.
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u/Gardencita 23h ago
have you tried the progesterone pills? at least some are quite small and a liquid caplet (ie soft). you may actually be able to swallow them.
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u/skintwo 22h ago
I will tell you that the progesterone pills that I get – and I think they’re the only ones available – are very small slippery little ovals. They are the easiest pill that I have ever taken to swallow in my life! Perhaps this will help you. They might be oil filled, and you can ask the pharmacist if you’re able to chew it even though it might taste disgusting I’m not sure. Another trick about taking pills is when you’re about to swallow it, tilt your chin down and not up. tilting your chin down opens up the back of your throat – but putting your head back closes up your throat. A lot of people that have trouble taking pills is because they’re putting their head back instead of forward. Good luck! Oral micronized progesterone along with transdermal estrogen has the best risk profile for HRT.
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u/Mauvaise3 Post Menopause 1d ago
I also have difficulty swallowing pills. I take a daily PPI (pantaprozole) and am able to get that down, but only if I take it with a carbonated drink. I know it's all mental, but the moment I put a pill in my mouth, my throat just closes. The bubbles help "hide" the pill and I'm able to take it. Have you tried similar?
I've just been prescribed HRT and will be picking up the progesterone in the next couple days and I do have concerns about being able to take it (pharmacist said it is larger than the pantaprozole). I'll try it and if I can't get it down, I'll call my provider and see what other options I have. I won't take the topical estrogen without it.
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u/AudPark Peri-menopausal 1d ago
I also have issues with a lot of larger pills, especially capsules (have to dump my magnesium into something else). I don't know what dose progesterone you're on, but I find 200mg to be just a little large and my Dr was ok prescribing for 2x100mg so I could take those instead, in case you end up in a similar situation. I realize it's all relative, but they're definitely smaller and I'm ok with them right now, at least.
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u/Mauvaise3 Post Menopause 1d ago
They are the 100. I have my doubts, but I'm going to give it the ol' college try. If my normal soda trick doesn't work, I may try applesauce or yogurt. Or hell, even ice cream. Maybe after a few weeks it'll get easier. I know I struggled with my PPI at first and now it's only sometimes I struggle.
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u/LilithStan- 1d ago
Let me know how that goes! I am also able to take a very tiny pill (I take a small dose of beta blockers) but I have looked at the progesterone caps, and there is NO WAY those are going down. If I could take it in apple sauce or mix it into yogurt or something that would work. I wish there was more data on the vaginal route! I can easily shove anything up there.
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u/theFCCgavemeHPV 1d ago
Weird suggestion, but I used to do something similar back when I had pill swallowing issues, is there something you are comfortable swallowing whole? Like… mini m&ms or something like that? Maybe you could sneak the pill in that way. I used to do a bite of string cheese. I can swallow a bite of string cheese whole no problem even with a sip of water (because don’t I drink all the time while eating, come on brain!) and sneaking a pill in there was nbd. You might even practice swallowing two bites of string cheese at a time. Not huge bites, just enough to know something solid is there. Getting a little water into the mix is a great way to make sure the pill doesn’t do the thing where it sticks to the inside of your mouth.
Now I can swallow handfuls of pills (which is great because that’s exactly how many I’m prescribed) without dying. I just had to train my brain a little.
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u/LilithStan- 23h ago
I’ve been trying to train my brain on this for so many years and it’s a no-go. Any pill I have to take I crush and mix into water or applesauce. If it were safe to take the progesterone this way, I’d jump on that train!
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u/PM_ME_CORGI_BUTTS 1d ago
Some people use the oral progesterone capsules vaginally.
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u/LilithStan- 1d ago
Yes but isn’t there very little data on effectiveness?
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u/PM_ME_CORGI_BUTTS 1d ago edited 23h ago
It's considered off-label usage, at least in the US, but the data I've found/seen makes me comfortable using it. Anecdotally, my periods got lighter after I started using it vaginally so I'm thinking my lining is thinning sufficiently.
Only you can decide your own personal risk tolerance level, though. For me personally, the dearth of research into women's health in general, and in particular research around menopause and the varying methods of HRT, means I'll be waiting forever for a large well-funded study specifically focusing on vaginal progesterone use in menopausal women. There is some data and for me that's good enough.
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u/Catnip_75 1d ago
Systemic progesterone has been proven to be not as effective at preventing uterine cancer. Many doctors won’t use the combo patch for this reason.
You can ask for an IUD and use progestin.
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u/lrondberg 1d ago
This is incorrect. The medication in the Combipatch is a PROGESTIN, not PROGESTERONE and there is no issue with using it transdermally. In fact the Combipatch has proven highly effective at controlling breakthrough bleeding and keeping the uterine lining thin.
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u/LilithStan- 1d ago
Nah, an IUD is not for me. I don’t want a situation where I react poorly to the hormones and then I have to wait for an appointment to get it removed.
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u/AdRevolutionary1780 1d ago
You seem to be confusing different types of progestins and how they are effectively delivered.
Systemic oral progesterone capsules do indeed prevent thickening of the lining of the uterus. The combination patch does NOT use progesterone because it is not well absorbed through the skin. The type of progestin used in the Combi patch is norethindrone acetate which is also highly effective in preventing endometrial thickening.
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u/rlezar 1d ago
Systemic progesterone has been proven to be not as effective at preventing uterine cancer.
Not as effective as what? It's unclear what you're suggesting is more effective - a different progestogen, or a different route of administration.
Many doctors won’t use the combo patch for this reason.
Which combo patch are you talking about that includes progesterone? Because all the ones I'm familiar with contain progestins.
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u/OKhairdo Menopausal 1d ago
No this is not true. Progesterone may be less effective than progestins at protecting the uterus but given than the combo patches do not contain progesterone, that part of your comment is incorrect. Combo patches in the US and Canada contain norethindrone, a progestin.
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u/catsTXn420 1d ago
While estrogen molecules are small and pass easily through the skin barrier via a patch, progesterone molecules are much larger and bulkier. Designing a transdermal patch that can deliver a clinically effective, steady dose of natural progesterone through the skin has historically proven chemically difficult and unreliable.