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[meno2016]

Hello, I used to use one patch of Systen-Conti (Evorel-Conti ?) every 3 days, but after 14 months irregular bleeding for 15-20 days every month (and feeling all pms symptoms along with the bleeding) I decided to change the treatment to Oestrogel 1 pump per day + Utrogestan 200mg. I was prescribed 2 pumps and tablets of 100mg continuosly, but bought it wrong and now wish to use all the medicine I have, as I bought a big package. I´m hardly having hot flushes withe Oestrogel 1 pump, since I started, 3 weeks ago, and I took the Utrogestan 200mg for 12 days, during which I was knocked out for the whole night, felt terribly sleepy and tired in the morning and also had constant headaches during the 12 days. After I stopped the Utrogestan, I got some spotting, which stopped after 3 days, and I got light headaches for about 3-4 days as well, then it stopped. I have not stopped the Oestrogel, which I understand I need to use continuosly. What I wish to know is if after the first month the strong headache and all the side-effects of the Utrogestan go away, or it happens every month for the 12-15 days? Also, I´d like to know how often I need to take the Utrogestan for the 12 days. Every month, every couple of months? I have an uterus, so I wish to have it protected. I went into menopause when I was 39. I´m 42 now. Also, does anyone know if the bleeding while using the patch (all exams ok) could have been because of not enough progesterone in the patch for my body, or it was the type of progesterone in the patch? The amount of estradiol seems to be less with 1 pump of Oestrogel per day than with the patch... so, I´ve reduced the estradiol and it seems to be fine. Thanks for your help!

[CLKD]

   I'm sure that someone will be along with advice.

[Mary G]

meno2016, my first thoughts are that you are taking a lot of Utrogestan for that amount of gel.  I can't take anything like that amount of Utrogestan without having bad side effects so that regime would be a complete no-no for me.  With me, the more Utrogestan I take, the worse it is and also it hangs around in my system for far longer than it says it does in the information leaflet.  Taking it orally has more side effects than taking it vaginally.

I am a patient of Professor Studd and his normal regime is 2-3 pumps of Oestrogel everyday and 100mg of Utrogestan vaginally for 7 days each month.  This kind of ratio works better than the one you are on now.  I would suggest you switch to something similar but of course you can continue with 1 pump of gel everyday.  I think that 7 days of Utrogestan would easily be enough for that amount of gel but you might want to get a womb scan to check the lining is clearing properly - you can't guess how much Utrogestan you need, you have to take it for a few months, have a scan and then you will know how well it is working.  You don't want to make you life a misery by taking far more than you need and equally you don't want to be taking too little either.  This regime really needs to be tailored to suit individual needs.

I hope that helps.

[Dancinggirl]

meno2016 - welcome to MM
As you have had problematic bleeding I believe you are doing the right thing in doing a sequential regime - so one pump per day of the Oestrogel continuously and then add 12 days each month of 200mg of Utrogestan - this needs to be done each month.  The 200mg dose is the licensed dose when prescribed on the NHS because it generally ensures an efficient withdrawal bleed and this should prevent the unwanted bleeding at other times.  In other words, you should get a period like bleed a day or so after you finish the 12 days of the Utrogestan which should shed the womb lining properly, so unwanted bleeding doesn't occur at other times. Some women are under the supervision of a private gynaecologist and are advised they can take Utrogestan in a different way - many take Utrogestan vaginally and some for only 7 days each month.  As these women are seeing the gynae privately they will be getting scans done regularly as well to make sure the lining isn't building up too much - I'm afraid this kind of regular scanning isn't available on the NHS. I think you have been advised to used the proper dose fro good reasons or the problematic bleeding may continue.
Having said all this, you are using a low dose of oestrogen and if in 3-4 months you are not getting problematic bleeding then you could possibly try 100mg for 12 days each month. Using it vaginally can also be effective but as mentioned by others this method doesn't suit everyone.
To answer you question about why you got the erratic bleeding on the Evorel Conti, well, there can be many reasons and I had this kind of problem bleeding because I used a lowish dose of Utrogestan.  I'm surprised they didn't offer a Mirena as this is usually the best option to really stop all bleeding.
As Stellajane has said - do follow your doctors advice as you need to be on HRT for at least another 10 years to protect your heart and bones so finding the with HRT is important.
Keep us posted.  Dg

[andius]

Just wanted to add:

I have read that use of progestin in some individuals (postmeno?) can cause too much thinning of endometrium resulting in endometrial atrophy which can cause intermittent spotting and bleeding. When the biopsies are done, there is no overgrowth, cancer etc, but actually the opposite with very little endometrial tissue at all!

[Dancinggirl]

andius - there are many reason for unexplained spotting and bleeding when on HRT but meno2016 was using a standard combination dose patch, when her bleeding problems happened, that would have given a good balance of oestrogen to progesterone, so endometrial thinning was highly unlikely.  The advice she has been given for her new HRT regime of 200mg each month is very wise, particularly for the first few months to try and stabilise her situation. Insufficient progesterone can result in the thickening of the lining which is likely result in further problematic bleeding.
I think that once she has done 3-6 months of her current regime then she should ask if she can reduce the amount of Utrogestan she uses or move to the conti version which may well give her fewer headaches and side effects.
We haven't heard from meno2016 since she started this post so I hope she gets back in touch.  Dg x

[Mary G]

andius, you are right.  I spoke to my gynaecologist about overdosing on progesterone and she said it is something to watch out for on the scan.  It can cause all sorts of problems if you start to erode the lining and because my lining goes right down to 2mm, I definitely must not take any more progesterone than I do now. 

[meno2016]

Helly eveyone, and thank you so much for all your inputs. I have been feeling extremely isolated because I´m in that 1% only women who go into the menopause too early (I did at 39) and I havent´ been having any sort of support. Nobody in my circle seems to understand the issues I´m going through, nor I´ve found a good doctor who I trust to supervise me. So, thank you so much for giving attention to my query.
I was prescribed Oestrogel 2 pumps per day continuously + Utrogestan 100mg continuously, because I didn´t want to have any bleed. As I said, I´m postmenopausal.
Unfortunately, I bought the wrong dosis of Utrogestan (the 200mg) and it is a 60 capsule pack, which I want to use it all before I buy the 100mg pack.
In 10 days I´ll complete a month since starting this new treatment (Oestrogel + Utrogestan). I took Utrogestan 200mg in the first 12 days of this combined treatment, and have been on Oestrogel only since.
I´d like to continue the 1 pump a day of Oestrogel, as I´m not currently feeling much of the menopause symptoms (not sure if this will change next month, in which case, I can increase to 2 pumps daily), and take the Utrogestan 200mg as far apart as possible (while protecting my uterus), because of the strong headaches/sleepness/ extreme fatigue/shortness of breath that it gave me during the 12 days + the 3 days after I stopped it, until the 48 capsules left are finished.
I had wondered if the Utrogestan side effects would get better after a couple of months of treatment, but someone already said that they continue, probably due to progesterone intolerance. So, the less often I take, the easier I can handle it.
Once the 200mg Utrogestan capsules are finished, I´d like to to switch to 100mg and see if it gives me softer side effects or (hopefully) none, and see if it´s possible to take it for the minimum acceptable number of days just enough to protect the uterus, as this is the point of taking the progesterone, right?
So, something like 1 pump of Oestrogel daily + 1 capsule of Utrogestan 100mg for 7 days only every couple of months would suit me best, with regards to frequency, if it does not give me any bleeds, and the the uterus is protected. Is anyone doing something like this? Does anyone know if this a balanced combination? I mean, if i´m not having any menopause symptoms with 1 pump Oestrogel, am I ok to use the Utrogestan 100mg for only 7 days and for only every couple of months? Or this varies from woman to woman and it would depend on the scan result?
The other thing that I wanted to ask is: I still have like 6 packs of the Systen (Evorel) conti patches. It is possible to use it with the 100mg Utrogestan capsules somehow, in a safe way, without having the constant bleeding I was having? I mean, because all my recent gyneco exams were ok (while I was on that patch treatment), I´m assuming the bleeding I was having is related to lack of progesterone. A gyneco had said it was because of not enough hormone. Has anyone combined both of these medicines (patches of Evorel-conti + Utrogestan)?
I´m sorry for all the questions, but it would be great to hear more about your experiences. Thank you so much!

[Dancinggirl]

Hi again meno2016 - I have responded to you on your other thread.
You don't say where you live - I assume you aren't in the UK? If you were UK based you would be getting you HRT on prescription which would be a small outlay financially.
Firstly don't mix your different HRTs - really not a good idea.
You ask quite a few questions and I'll try to give you some answers.
If you don't want to have a bleed then you will probably have to take 100mg Utrogestan everyday to ensure the lining doesn't build up and give bleeding or spotting. However, if you are doing well on one pump of the Oestrogel each day then you may find you get little or no bleeding if you take 100mg Utrogestan for 12-14 days each month. 200mg can give quite strong side effects but you may find you will get some of these side effects taking 100mg Utrogestan every day.
Before you do any changes, I would definitely try 3 months using 200mg for 10-12 days each month to just get your cycle settled.  You may or may not get a bleed because of the low dose of oestrogen but, if you are like me, one pump per day can build the lining quite efficiently in some women. Have you done one full cycle and did you get a bleed after you finished the Utrogestan part?
The point I am trying to make is; we are all different so often what works for one women won't work for another.
The strong side effects you are getting from the Utrogestan makes me wonder why your gynaecologist/doctor hasn't suggested a Mirena as this might be easier for you, especially if you don't want to have monthly bleeds - after a few initial side effects e.g. spotting, feeling a bit tired, there are usually few problems until it needs changing after 4 years. If you have a Mirena you just use the Oestrogel every day.

As you have had problematic bleeding due to the womb lining building up, I really urge you to :NOT CHANGE ANYTHING UNTIL YOU HAVE CHECKED WITH THE DOCTOR. I am concerned you will get more erratic bleeding through too little progesterone.  There are ladies who are using 100mg Utrogestan for only 7 days each month but they are paying privately for specialist gynae support and if they develop problematic bleeding they will have to pay for a scan.
Incidentally, early menopause is far more common than 1% - my meno started in my mid 30s, I was lucky as I had a good GP at that time but there have been many ladies on MM who have had trouble getting diagnosed with premature menopause due to the idea that it rarely happens!!!
Do tell us where you live - there must be a specialist or meno clinic relatively close to you that can give you better advice??
Do read up all the info on this site to get really clued up.  Dg x

[meno2016]

Hello. Thank you for your comments and advices. I will not mix the HRTs, then. I cannot handle the side effects of Utrogestan 100mg daily, if they end up not being a lot softer than the 200mg dosis. I have not done a full cycle yet. I started this treatment on the 24/03/16. Took Utrogestan on day 1 for 12 days and stopped it, only using 1 pump Oestrogel now. For the 3 days after I stopped Utrogestan I got some brown spotting, almost nothing, then nothing up to now. No Mirena coil, thanks. What the gynaecologist had originally prescribed was FEM7 patches + Utrogestan 100mg. But FEM7 is no longer sold is this market. So, she changed to Oestrogel. I´m in South America, not in the UK. When I stopped my period totally, I started having some mild symptoms, with the hot flushes getting gradually stronger and irritability, and I knew I was in menopause. I had all exams done at the time and it was confirmed. Soon it became unbearable, then I went into HRT 14 months ago.  My mother had it when she was 45, and I didn´t know it. To be honest, I had never thought about this phase of life and knew nothing about it apart from the stop of periods and hot flushes, which I had the impression would be good, as I´ve always felt colder than most people and hated my periods. However, it´s a whole new world to me. I was always very healthy, never had headaches, colds, very active, nothing, perfect mind functioning (apart from the periods). However, these 3 last years have been the hardest of my life, with this sudden body change and complete mind blur, I can get scans, if needed, that´s not a problem, as everyone has private health insurance here and you pay a gap only. The medicines are the expensive part, as there is not help from the government. So, based on the information I got here, I think I´ll keep with the 1 pump Oestrogel daily and 12 days Utrogestan monthly for the next two months, then I´ll try taking it every second month to see how it goes, until the box is finished. Then, I´ll switch to 100mg daily, which was the dosis originally prescribed. If I get headaches, etc, on the continuous dosis, I´ll switch to 12 days per month. I´ll see how it goes. I can have a scan in 4 months, to see how it is. But I haven´t had bleeding (apart from the spotting) since I started the treatment 20 days ago, and I think this is a progress, considering that I did not bleed for only 3-5 days monthly in the past 12 months (which the gynaecologist said it was body adjustment to the HRT). By the way, is there any patch available anywhere int he world that contains bio-identical progesterone? Thank you so much. I´ll have a look on the info on the website.

[Dancinggirl]

Sadly, there are no patch with bio identical progesterone - as yet.  Many of us wish there was.
What you are planning regarding your HRT sounds sensible.  Hope it goes well.  Dg x

[meno2016]

  Thank you once again for taking the time to answer my questions. I´ll let you know later on how I go!

[meno2016]

Hello! I just wanted to give an update of how the new treatment is going for me... I started it two months ago, Oestrogel 1 pump daily + Utrogestan 100mg daily for 12 days then continued with Oestrogel only for the rest of the month. Then, same thing for the second month, except that I decided to take 1 pump in the morning and 1/4 at night Oestrogel, as I noticed my hair was falling more. On the first month, I got some spotting for 2-3 days after stopping the Utrogestan. On the second month, I got a period for about 5-6 days (plus period symptoms like headache, tiredeness, heavy legs, etc). In the first month, I had strong headaches, sleepiness and I was knocked out an hour after I took the Utrogestan. The second month, these symptoms were smoother, but present. So, I intend to take the Ultrogestan again after two, instead of one month, to see how it goes. This new treatment has been better than the Systen (Evorel)-Conti, but not as good as I expected. I do feel tired, have ups and downs, and I´m not 100% mentally. I thought I´d feel lively as I used to before menopause, but it hasn´t happen. Are you supposed to feel like this when on HRT? When the menopause is over, does everything go back to normal or it doesn´t ever again?

[Dancinggirl]

meno2016 - what you are describing is pretty typical I'm afraid.  Do be careful using such a long cycle regime as this may result in a build up of the womb lining and then problematic bleeding can result - regular scans are good idea when using a long cycle.  I use 12 days of 200mg alongside one pump of gel each day over 4 weeks - still get a proper bleed each month with cramps and headaches but when I tried doing a longer cycle I got breakthrough bleeding and spotting.  Maybe try a 6 week cycle?
I firmly believe we can't expect any HRT to be perfect or make us feel good everyday - very few of us felt good everyday when we had a natural cycle in our fertile years.  As long as the benefits of HRT outweigh the side effects then this is very good. I am now 60 and resigned to pacing myself better these days - even with HRT which makes me generally feel better I still get very tired.  DG x

[Mary G]

The problem is, the Oestrogel is brilliant but the Utrogestan is horrible!  It's the Oestrogel that gives you the feelgood factor but the Utrogestan then comes along and spoils the party and undermines all the good work the oestrogen had done.  It's about time something better came along or at least the Utrogestan dose was changed to something like 50mg instead of 100mg to lessen the side effects.  Obviously you need to take Utrogestan for lining clearance but some of us on here are on the Professor Studd regime which means taking 100mg for 7 days each months instead of 12 days with the NHS.  It would be completely out of the question for me to take it for 12 days each month because I would cease to function.  My advice is always the same, if you have a problem with Utrogestan and it's making your life a misery, do the Studd regime and them make sure you get your lining checked periodically either with the NHS (tell them you cannot tolerate the stuff and need a more tailor made regime) or pay to get it done privately.  It's a good idea to have a scan anyway because there are other things that need to be checked too, not just the lining.

By they way are you taking it vaginally?  It not only works better at lining clearance when taken in that way but it also has fewer side effects.