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[Dancinggirl]

Hi ladies
Just need to share my current dilemma.  I have been back on Oestrogel and Utrogestan for 2 cycles now.  I am using one pump of gel each day which keeps my flushes etc away and using 10 days 200mg each month.  I have previously tried a long cycle with the 14 days of 100mg Utro and even tried 100mg daily on a conti basis - all these gave me spotting, erratic bleeding and cramps. 
Doing this UK licensed dose of Utro is giving me real problem in terms of dizziness and sedation.  I finished the Utro 4 days ago, the bleed started within 48 hrous and hasn't been too heavy but I am still feeling totally spaced out and dizzy.  200mg is clearly too strong for me and has a very cumulative effect that seems to take some days to clear.
Feeling as though I should take another break from HRt completely to clear the system and maybe then try again with Provera instead.
Whilst I coped with 100mg daily it clearly wasn't enough to control the bleed but I can't cope with 200mg.  DGxxx

[Cassie]

When you say the 100mg wasnt strong enough to control the bleed, can you explain? I find 100mg x 12 days per mth works very well, have you tried using them vaginally? I think you should give the 100mg x 12 days a chance, yes you will get cramps, it is one of the side effects. I am presuming you are post meno and that your own cycle is not still kicking in?

[Liz]

I get the same myself, DG.   I'm currently using 1 pump gel per day too and am wondering if 12 days of 200mg Utro is just a bit too much for 1 pump of gel.  This month I didn't use 12 days of Utro as I had a heavy bleed after just 5 days of Utro, so I cut this cycle short.  I, too, feel very sedated on the Utro phase, but don't want to use it vaginally.

[Liz]

When you say the 100mg wasnt strong enough to control the bleed, can you explain? I find 100mg x 12 days per mth works very well, have you tried using them vaginally? I think you should give the 100mg x 12 days a chance, yes you will get cramps, it is one of the side effects. I am presuming you are post meno and that your own cycle is not still kicking in?

I wish I could use 100mg for 12 days instead of the 200g I've been prescribed.  That may help ease the side effects, I would have thought.

[Dancinggirl]

Hi everyone and thanks for your responses.
To repsond to some of the questions:  I am 60 and very post meno - been on and off HRT for the last 25 odd years due to premature meno.  I want to stay on HRt because, when not taking HRT, the flushes, lack of sleep and horrible headaches I get every few days make my life really challenging  - I generally feel so much better on just one pump of oestrogen per day - more energy and alert which enables me to keep working.
I have tried using Utro vaginally but it really irritates my vaginal area, making me feel really sore and aggravating my bladder.   
When I first started back on HRT about 18 months ago now (I am seeing a private gynae regarding all this) I started with Oesrogel with Utro but on a long cycle of gel for 6 weeks and then adding 14 days of 100mg of Utro - so a 2 month cycle.  Unfortunately this resulted in a long bleed of about 10 days and then spotting during the oestrogen only time.  I then tried 100mg Utro continuously but still got spotting and bleeding.
I then took a break of 2 months to do a ‘reboot' - I had been on conti Utro for 3-4 months by this stage and when I stopped everything I still bled for 7 days, which clearly showed my womb lining had been building up despite such a low dose of gel and the Utro every day!!!!!

Stellajane - I think your suggestion is probably my wisest course at this stage before I completely abandon Utrogestan.
The long cycle is obviously not going to work for me but I might get say with 10 day soy 100mg if only using one pump of gel each day. Hurdity also suggested I try the 100mg on a knot basis but make sure I take the 3 day break to allow fro a bleed if needed.

What I can't cope with is this feeling of being completely spaced out and sedated even after I've finished the Utrogestan phase - both last month and now this month the effects are still with me 5 days after stopping the Utro!!!!

When I used gel and progesterone sequentially back in my 40s I think I was using Dydrogesterone, a progesterone one could get on it's own back then but is now only available in Femoston, and though I got a bit of PMT it gave me a predictable bleed and kept me reasonably on an even keel. One of the only things I haven't tried is the Medroxyprogesterone (Provera/Climinor) which I believe many women do well on, if Utrogestan doesn't suit them.
I'm really hoping the sedation wears off by tomorrow - I actually feel mentally good, so chilled - but it's not good as I need to work.
I feel stuck between a rock and a hard place - feel great for 2-3 weeks and spaced out for 7-10 days each month or come off HRT and put up with flushes, lack of sleep and regular horrible headaches.

I know Utrogestan is hailed as the wonder progesterone by many on this site (I am fully aware that it probably the safest to use as well) but my experiences certainly show it is not always ideal or without it's problems!!!    DG xxxxxxx

[Cassie]

Have you had a scan lately to see what your lining is looking like, that may be your 1st step in helping to decide. I definitely had huge issues using the Utrogestan only every few weeks, it does cause breakthrough bleeding and spotting etc if you do not use it monthly well it did in my case and my lining also built up, its amazing how 1 pump of gel can build that lining up, it is accumulative though and I have also been on the gel for many yrs due to early meno as well. I hope you find a progestegin that suits you, could you not try using it vaginally again for say 10 days per mth on the 100mg and use something like Vagifem in order to prevent the burning and irritation you are experiencing....

[Dancinggirl]

I did try using Utro vaginally again last month, with Vagifem, but could only do 3 days as I became so uncomfortable
I had a scan 6 months ago when I was having all the bleeding and all was fine - my gynae couldn't understand why I was getting the erratic spotting!! I actually took the 2 month break from all HRT to make sure my lining was OK before trying the regime again but this time I've stuck to doing it monthly rather than 2 monthly.  I haven't had any spotting or breakthrough bleeding on the last 2 cycles, since the 2 month break, so clearly the 200mg Utro for 10 days is fine for shedding the lining but I obviously can't tolerate 200mg of Utro for more than 5 days before the heavy sedation kicks in and then goes on for several days after I finish!!!
I'm going to try one more month and do 10 days of 100mg Utro to see if this works OK before trying something different. Just hope the sedative effect wears off soon.  DG x

[Mary G]

For me it's Utrogestan or a hysterectomy because I can't take any of the synthetic varieties, they give me migraines. 

That said, I don't like it, it's terrible stuff and the only way I can handle it is to do the Studd regime.  I've lost count of the number of 'off the record' discussions I have had with my gynaecologist on this subject but what comes across loud and clear is that one size very definitely doesn't fit all and we really need to have tailored made regimes because all women need very different doses of it.  One thing's for sure, there is no question of my ever being about to take the NHS recommended dose.

Arguably I am lucky in that my lining sheds automatically once it gets to about 7mm which happens after 5-6 weeks of using two pumps of Oestrogel.  I found this out the hard way when I tried to do a long cycle but didn't get there because I had an elongated period from about week 5 that lasted for 2 weeks - I had a scan afterwards and the lining had gone down to 2mm.  Obviously I don't want to let this happen again so now I just stick the the Studd regime (7 x 100mg Utrogestan vaginally) every 5 weeks (stretching it a bit) but obviously I am fortunate that I can have regular scans and my lining goes back to 2mm just after a period so I know it is safe for me to do this and I never get any breakthrough bleeding or spotting with this regime. 

Because of my particularly difficult situation, the gynaecologist knows that it is either that or a hysterectomy and it is working well so we have agreed that we will stick with it.  The problem is not all women are the same and you can end up taking too much or too little so if you have a problem with it, you need to find your own threshhold. 

One other point... I think Utrogestan hangs around in your system for far longer than it says it does on the leaflet.  I still feel the effects of it a long time after I have inserted the last capsule.  I do think that using it vaginally helps enormously and certainly in my case, significantly lessens the side effects.  I am convinced it works better at clearing the lining when used in this way too meaning you can take less of it to get the same result. 

Because of all the scaremongering surrounding HRT, drug companies have not been developing HRT as much as they might have been and new products are slow in coming forward.  Why can't we have a lower dose of Utrogestan, 50mg for example?  That might help or better still, some kind of non-hormonal coil device that stops the lining building up.  I feel this area of health is very badly neglected thanks to the two deeply flawed and now discredited studies on HRT that did women no favours whatsoever. 

[Liz]

My gut feeling is that with 1 pump of gel daily, 10 days x 100mg per month is probably plenty if you are post menopause. 

I've always assumed that the licensed dose of 200mgs x 12 days is designed to be teamed with the standard medium dose of oestrogen which is 2 pumps.

Whether you decide to use it that way is up to the individual.  If it results in a good bleed then its doing its job, and you can always arrange to have a scan to reassure yourself.

Thanks for that, Stellajane, but I'm not post-meno, peri (at least I think I am - been on HRT for a couple of years now, so don't know for sure but I suspect I am still peri, as my own cycle kicks in now and again). 

[Hurdity]

Hi Dancinggirl

So sorry to hear of the problems you are still encountering with side effects of utrogestan and I knjw we have discussed this before and recently. Yes that is what I would suggest - trying 100 mg for 25 out of 28 days - only because you said you felt fine and chilled on this dose as opposed to the high dose which sounds terrible for you.

As you know I have never taken it orally and who knows I could feel just as you do - I don't even want to risk it. Do you make sure you take it on an empty stomach?

Also re the vaginal use - if only you were able to tolerate it like this? Do you use Vagifem or similar on a regular basis? I wonder if you were able to use more local oestrogen, this might minimise the discomfort you experience from vaginal use of the utrogestan? I know I always increase my local oestrogen for a week before starting my utro cycle and as much as I can during it.

I can't remember why you have decided against another Mirena? Did you try again and not tolerate it?

Sorry I can't help more Dancinggirl and hope you manage to sort out something for the best but in the meantime

Hurdity x

[Dancinggirl]

Thanks Hurdity - all good thoughts from you as always. I did use Vagifem with the Utro vaginally but it didn't make any difference - I just feel really itchy and sore when I use the Utro that way - also tummy cramps and peeing a lot!!

I now remember feeling sedated for the first few months after having the Mirena fitted and had bouts of feeling exhausted throughout the 4 years with the Mirena - although this may have been more to do with the extreme stress I was going through as well.  The sedative feeling I felt back in the early days of the Mirena is very similar to the way I'm feeling now but it's more extreme with Utrogestan.
I have this sneaking feeling that my body just won't tolerate these hormones anymore - certainly not progesterone - I'm generally so much more sensitive to everything and maybe this is down to the ageing process.
What's worrying me at the moment is that it's 5 days since I stopped the Utro, the bleed has nearly finished and I'm still feeling wiped out.  I am wondering if it's an inner ear thing as my ear is aching slightly - often does at this time of year because of hay fever - sort of hoping it's a slight infection or something and nothing really to do with HRT.
Off to bed now - hopefully feel more alert tomorrow.   Thanks everyone - isn't MM great   DG xxx

[Mother bean]

Hi DG,
Hope you are feeling well? I have always been following your post with great interest and often think we are alike in our hormonal journey. I am still peri and I know you are post menopausal but believe we do not need such high doses of Oestrogel but enjoy the benefits that Utrogestan has to offer. You have been trying different ways. I suffer in a very Simular way and have been trying to find a good balance. A few years ago I was told I had very low progesterone and have PCOS but making loads of eggs for my age ( I was 45 at the time, now 53)
I have been looking at the way Qlaira pills are taken and wondered if I could adapt my Oestrogel and Utrogestan in the same way and wondered if this may help you. When I take my 200 mg Utrogestan tablet I split the dose between 100mg AM & PM 100mg. This helps from feeling of being overly sedated but whilst at work I feel chilled and not tired but sleep well when I take other 100mg at bedtime.

Day 1-2 use 2 pumps of Oestrogel only

Days 3 - 7 use 1 pump of Oestrogel and take 1 100mg progesterone tablet at bedtime.

Days 8 - 24 - use 1 pump of Oestrogel and AM 100mg progesterone and PM 100mg progesterone.

Days 25 - 28 - 1 pump of Oestrogel and no progesterone taken allowing for a bleed.

I have read up on the Qlaira website that their pill is taken as above to help with breakthrough bleeding.

I am going to give this ago to see I can improve the way my HRT is delivered.

The above I just wanted to share with you as an idea on how to improve things for you? Massive hugs and have a wonderful bank holiday! Joy xxx

[Dancinggirl]

Hi Mother bean
Very interesting post. I can see your logic and it may well be worth giving this a go.  As long as one uses enough progesterone to ensure the womb lining doesn't build up I do think there is some leeway. What you are proposing to try has plenty of progesterone in the mix so might work OK. Unfortunately for me, taking the Utro at 200mg, even if it were split to morning and evening, I now know would be too much as I seem to be really sensitive to this high dose.
My last stint of Utro at 200mg for 10 days left me feeling dizzy, shaky and feeling really odd generally and the feeling took a few days to subside after I had finished the 10th day of Utro.  The bleed wasn't too bad, lasted 5/6 days, but I still got quite a bit of cramps. When the bleeding had almost stopped, I decided to stop using the Oestrogel(so come off everything) to see what happened and within 24 hours the spotting/slight bleeding started again and I have had slight bleeding for the last 3 days!!!  This leads me to think that the withdrawal bleed following the Utro phase hadn't completely shed the lining - however I don't fully understand the biology of all this so not sure.  When I stopped all HRT back in January I had 7 days of bleeding - not heavy but non the less what I would deem a withdrawal bleed.
I am baffled as to why just one pump of gel per day should build my lining so much!!!! Maybe my lining is just spontaneously shedding and won't hold a lining now I'm so old, (I'm 60). I actually think I store oestrogen really well, I haven't used oestrogen for 4 days now and flushes haven't returned yet and in fact back in January the flushes didn't return for over 2 weeks!!!! Some women can't go a day without oestrogen before the flushes return!!!
Like you I am wondering if I should try a different regime -
Possibly try doing alternate days of the Oestrogel, using one pump one day and half a pump the next  for 2-3 weeks. Then do 14 days of 100mg Utrogestan with one pump of gel.
Then possibly take a complete break from gel and Utro for 7 days before starting again. 
This would essentially give me a lower dose generally, I'd probably get a withdrawal bleed that would hopefully shed the lining properly and this would end up a longer cycle with fewer side effects.
I really don't need much oestrogen to keep my flushes and headaches under control.  Without any oestrogen the headaches and lack of sleep are particularly difficult to cope with.

I MUST STRESS THAT I WOULD NOT ADVOCATE THAT ANYONE SHOULD EXPERIMENT WITH HOW THEY DO THEIR HRT REGIME WITHOUT THE GUIDANCE OF A GYNAE.

Keep me posted about your progress Mother bean.  DG xxx

[Dancinggirl]

Stellajane - I too get very odd dreams on the Utro. Love the idea of labradors though

When I tried using Utro continuously at 100mg per day, I felt very slightly sedated and euphoric, almost ‘high' - not a bad feeling but not really in touch with life.  If I hadn't had the problematic spotting and bleeding I would have been quite happy to trundle happily along in this euphoric state - only problem being, I wasn't really getting an awful lot done as I was so ‘laid back'.   Dg xxx

[Mother bean]

Hi DG,
My own GP has said she was happy for me to try as she knows that I didn't get on with the daily dose of ultrostan taking 100mg from Days 1-25 plus my daily Oestrogel .
I think my estrogen can be too much as I was using a 50mg patch and just didn't feel good so my GP said she was happy for me to increase to taking 200mg daily because knowingly my progesterone was too low and agreed I needed more.

My problem always seems to happen just after my bleed and the week to ten days after.  I went to my GP a while back asking if I could try Qlaira but due to my age said it was not advisable.

Sometimes when I have been taking a higher dose of estrogen i.e. 50mg patch with my 2 X 100mg progesterone I haven't felt balanced so asked GP for the 37.5mg estrogen patches and had found some relief from the lower dose but still some months when my own cycle is at play I feel that one pump a long with my progesterone tablets has helped. I still have some Oestrogel in my stash so I can alternate between my patchs and the gel if this happens. Sometimes it is always just trial and error as we are all different. I am so lucky having a wonderful GP who is really interested in the menopause and supports me and even last year when I went to visit Dr. Danni Evans for some advice she also mentioned that I had a good GP who supports me so well!

I am so sorry that you wouldn't be able to cope with splitting the 200mg dose between AM & PM as I certainly can't cope with taking 200mg in one go as I found it hard in focusing at work as I was akways tired.

It was only when I have read the Qlaira website and the reasons behind what they prescribe and why that it just made a whole of sense. I will let you know how it goes for me!

Good luck with what you are trying. xx