Progesterone/Transvaginal ultrasounds

I have two somewhat related questions.  I am a 53 year old female, been menopausal for about two years - have been off and on bioidentical hormones for the last year and a half (currently on).

1.  I absolutely cannot tolerate oral progesterone.  Gives me horrible gas, bloating, cramping and diarrhea.  My physician recently gave me progesterone suppositories.  I tolerate it better than oral progesterone, but I still do have some gas, bloating, cramping and diarrhea.  What causes this?  Will my body ever adjust?

2.  Because of the aforementioned problems with progesterone, I took estrogen alone for several months, which I know is not advised.  Because of this, at my last pap a couple of months ago, I asked for a transvaginal ultrasound and was told everything looked fine.  I am self-insured so I don't have to worry about what tests the poobahs at some insurance company are going to allow me, and I found the cash price for a transvaginal ultrasound ($122) to be very reasonable.  Although I am not as concerned about my uterine lining now that I am taking the progesterone, I was wondering how often it would be reasonable to repeat a transvaginal ultrasound.  Every 6 months?  Yearly?  I also don't completely understand the difference between a pelvic ultrasound and a transvaginal ultrasound and I'm wondering if there are any other tests that it would be reasonable for a woman on HRT to consider.  I have seen too much cancer around me.  I would rather be safe than sorry.

[Machelle Seibel, MD]

Going the vaginal route for progesterone is a good way to reduce GI symptoms such as gas and bloating. If you still are having a problem, maybe the dose can be lowered or given every other day. Progesterone is a smooth muscle relaxer and it can slow the intestines that way.

It shouldn't be necessary for ultrasound more often than annually if the last one was OK. Transvaginal is closer to the uterine lining than one on your abdomen so it "sees" better.

For some women who do not want periods or can't take progesterone, the progesterone is given every three months for 10 to 14 days. Doing that should prevent any uterine build up that could lead to cancer of the uterus. It will give a big period.
Machelle M. Seibel, MD