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[Sunnydays]

Thanks Maryg. Just flooded through again  exactly same time as yesterday! This is gross  thank goodness I'm not at work today!

[Mary G]

Sorry to hear that Sunnydays.  It often seems to come in waves and sudden floods are quite common and you can soak through a superplus tampon very quickly.  You can then go a while with very little then it floods again.  I find the periods are over very quickly now, usually about 4 days.  On the positive side, the Utrogestan is doing its job. 

[Sunnydays]

It's good to know it's  'normal' and I'm not bleeding to death and of course, it's doing its job. Still jolly well gross and not factored to be in my daily life routine!
My next plan is how to get this to a 'scanty' period!

[Sunnydays]

Question: Utrogestan does not appear to be licensed in the UK to be used vaginally. I've done a small amount of research and the BNF arm of the NHS/NICE  refers to it being used vaginally at a certain time during pregnancy for some specific reason. So, in the countries where it is licensed for vaginal use, is this also connected with pregnancy or is it for hrt use? If it is the latter, then are there any trials that have been done in these countries  to check its effects on long term use as, with pregnancy, it oils only be used for a shorter period of time.
This leads me to my second question: I understand that Prof Studd and others are proponents of the use vaginally for hrt, have they instigated any research to support their commitment to its use in this way?
Just curious.....

[Cassie]

I also use the 100mg for 12 days, the first 2 days of bleed usually very heavy, clots etc, then it tapers off. Used to bleed for about 6 days have noticed the bleeds are getting shorter as I age.... & less violent....  one benefit I guess... and my gynae said this would happen...I am loathe to use it less than monthly though as my lining was thick and I was getting breakthrough bleeds on the longer cycle....its def working though as last scan lining was 3mm had come down from 7mm....

[Peterspots]

I am on this continuously (2 weeks so far) wondering when there is the faintest chance it would help with VA/Bladder pain and muscles aches/strange sensations.  Really fed up

[Hurdity]

Question: Utrogestan does not appear to be licensed in the UK to be used vaginally. I've done a small amount of research and the BNF arm of the NHS/NICE  refers to it being used vaginally at a certain time during pregnancy for some specific reason. So, in the countries where it is licensed for vaginal use, is this also connected with pregnancy or is it for hrt use? If it is the latter, then are there any trials that have been done in these countries  to check its effects on long term use as, with pregnancy, it oils only be used for a shorter period of time.
This leads me to my second question: I understand that Prof Studd and others are proponents of the use vaginally for hrt, have they instigated any research to support their commitment to its use in this way?
Just curious.....

Hi Sunnydays

As Stellajane says!

Yes it is licensed everywhere vaginally for fertility - to help maintain a pregnancy for those with insufficiency, and as Stellajane says elsewhere in Europe it is licensed for vaginal use as part of HRT.

A few years ago when I first started using it I wrote to the manufacturers and they sent me a translation of the French product info. They also sent me details of the research which allowed licensing for vaginal use - summaries anyway. If there was a facility to upload attachments or send them by pm I could do so! Also there have been several papers looking at blood levels of progesterone following vaginal and oral use as well as looking at the endometrial thickness. If you want I can look these out and give you the refs but it will take a while as they are either downloaded on my computer or maybe book-marked. This is why the private gynaes and some NHS docs are happy to prescribe it this way and at a lower dosage - depending on the woman of course.

Hurdity x

[Sunnydays]

Thanks both for feedback to my questions. If you have the spare time (?) Hurdity I'd be interested for any references you might be able to send through. I guess with so many leading gynaes in the UK prescribing Utro I'm surprised they haven't lobbied for lower doses and vaginally route in the the UK.
By the way day 4 of bleeding for me and niagra falls has eased thankfully!

[Niamh]

I use utro vaginally and just wondered if anyone had any tips for the groggy heavy head feeling you get on it. Tbh it's mansgeable just a nuisance when I'm running round with my 2 little ones but I just push through it and have a strong coffee! I'm sure I read somewhere that someone used it about 7pm in the evening rather than bedtime to help with this?!? Thanks x

[Hurdity]

Sunnydays I have just copied and pasted some notes I made some time ago from various papers. I haven't re-read them before posting. I'm sure there are others too:

http://www.ncbi.nlm.nih.gov/pubmed/22321028'

Endometrial response to concurrent treatment with vaginal progesterone and transdermal estradiol.
Fernández-Murga L1, Hermenegildo C, Tarín JJ, García-Pérez MÁ, Cano A.
Author information
Abstract
ABSTRACT Objective To describe the effect of the intermittent administration of vaginal progesterone and a low-dose estradiol patch on endometrial stability, as assessed by the rate of amenorrhea and endometrial stimulation. Methods This was an open study in which 64 moderately symptomatic, postmenopausal women were treated in the outpatient clinic of our University Hospital for different intervals up to 1 year. The treatment consisted of a combination of patches delivering 25 µg/day estradiol and intravaginal pills containing 100 mg of micronized progesterone. Patches and pills were administered concomitantly in a twice-a-week protocol. The endometrial response was assessed by endovaginal ultrasound completed with suction biopsy when required. Results Both cumulative amenorrhea and no-bleeding rates increased progressively and reached 88.9% and 100.0%, respectively, by the 12th month. Isolated or repetitive episodes of bleeding, bleeding and spotting, or only spotting were reported by three, four, and 12 women, respectively. Endometrial thickness remained unaltered. Endometrium was atrophic in the seven women in whom a biopsy was performed. Conclusion The substantially reduced progestogen load determined by this combination achieved an acceptable incidence of spotting or bleeding when associated with a low estrogenic dose. There was no apparent endometrial stimulation. Additional studies are required to confirm this observation.

http://www.ncbi.nlm.nih.gov/pubmed/15222511

Efficacy of oral micronized progesterone when applied via vaginal route.
Choavaratana R1, Manoch D.
Author information
Abstract
The aim of the study was to compare the efficacy of oral micronized progesterone when applied by the vaginal route. The comparative study of serum progesterone levels between oral and vaginal micronized progesterone administration was conducted in sixty female volunteers. The subjects were equally divided into two groups to receive the drug either via the oral or vaginal route. The subjects' profiles showed that there was no significant difference in general characteristics between these two groups. The blood tests for estrogen and progesterone levels were performed on all volunteers before and after the drug administration. The data collected from the experiment revealed that the serum progesterone levels achieved by oral administration (5.06 +/- 2.95 ng/ml) differed significantly (p < 0.001) from those achieved by vaginal administration (8.26 +/- 4.09 ng/ml). The data also revealed that the serum progesterone levels of the oral administration group (4.23 +/- 2.68 ng/ml) did not differ significantly (p = 0.925) from the other group (4.15 +/- 3.40 ng/ml) when the serum estrogen level was less than 30 pg/ml. On the contrary, when the serum estrogen level was at least 30 pg/ml, there was a significant (p < 0.005) difference in the serum progesterone levels between these two groups (6.32 +/- 2.99 ng/ml for the oral route and 9.76 +/- 3.23 ng/ml for the vaginal route).

http://www.ncbi.nlm.nih.gov/pubmed/20575654

Transdermal estradiol and oral or vaginal natural progesterone: bleeding patterns.
Di Carlo C1, Tommaselli GA, Gargano V, Savoia F, Bifulco G, Nappi C.
Author information
Abstract
OBJECTIVE:
To evaluate the effects on bleeding pattern of two different doses of natural progesterone (NP) administered per os or per vagina in association with transdermal estradiol in a continuous, sequential estrogen-progestin therapy.
METHODS:
A prospective, randomized trial was conducted on 100 patients randomized into four groups. Each group received transdermal 17beta-estradiol treatment at the dose of 50 microg/day. Groups A and B received NP per os at the dose of 100 mg/day and 200 mg/day, respectively. Groups C and D received NP per vagina at the dose of 100 mg/day and 200 mg/day, respectively.
RESULTS:
After 12 cycles of treatment, no significant differences were observed in endometrial thickness between groups, suggesting that all treatments are effective in balancing the effects of estradiol on endometrium. Regarding bleeding control, patients in Groups C and D showed a higher number of episodes of regular bleeding than patients in Groups A and B and fewer episodes of spotting. The better control of bleeding was associated with a higher treatment compliance in patients who received vaginal NP, with a larger percentage of women completing the study.
CONCLUSION:
Transdermal estrogen replacement therapy combined with 100 mg of micronized NP administered per vagina from the 14th day to the 25th day of each 28-day cycle leads to good cycle control and provides excellent patient satisfaction without serious side-effects. This therapy could be a treatment of first choice in early postmenopausal patients.


E-mail from information manager at Ferring ( previous manufacturer of Utrogestan)

The product monograph talks of two trials of vaginal use as part of HRT – they're small patient populations – 20 and 30 patients in each.

One study used 100mg once daily vaginally for 21 days of 28 day cycle – the study lasted a year and was undertaken in 20 patients. Symptoms were significantly reduced, bone density remained and no adverse effects were seen. The endometrium was safely protected from the estrogenic effect of 1.5mg transdermal Oestrogel.

Another of 30 patients over 36 months studied the use of 100mg vaginal Utrogestan every other day. For most patients there was absence of bleeding and good patient satisfaction. There was a reduction in mean endometrial thickness and at the end of the study endometrial atrophy was seen in all cases. Five of the 30 women dropped out due to vaginal bleeding.

The references are:

Spritzer et al Exp Clin Endocrinol Diabetes 2003; 111 (5) 267-273

Vilodre et al Gynecol Endocrinol 2003; 17 (4) 323-328.

Hope this helps

Hurdity x

[Hurdity]

Hi Niamh

Sorry I don't have any suggestions - I couldn't put it in earlier because it would fall out but I can see that would be an option if you are - er - tight up there  !

I'm afraid I do just put up with the groggy head - if there is a twinge of headache appearing I take an Ibuprofen or an aspirin and that helps. For me this side effect from temporary doses of utro is preferable to having it all the time or any of the synthetic ones. Yes must be difficult with little ones - how old are they? We mums tend to manage to push through when they are young - including illness and all sorts - by sheer will power and necessity!

Hurdity x

[Niamh]

Hi they are 2 and 7 and full on busy boys 😂 it probably helps tbh!

I might try the earlier time and see.

Today is day 1 so always worse  from that initial hit but like you I'll deal with it for a short period of time and I tolerate it well considering im prog intolerant!x

[Tangerinedreams]

Hello ladies, I am now joining you in this group as I managed to persuade my Dr to prescribe the oestrogel/utrogestan earlier this week.  It was a complete battle!  I saw a lady Dr in her early 30's.  I said I had started getting menopause symptoms about 9 months ago and am going through peri menopause and having a terrible time.  She looked at me and said yes but its a very natural process and you don't need to medicalise it!  I almost said to her I will come back when you are 50 and see how you feel then!!

So I told her I wasn't happy on Femoston 1/10 any more and am progesterone intolerant, she wanted to know all my symptoms and kept asking me how long had my periods stopped for.  I kept telling her I was in peri and the Femoston would give me a bleed anyway, she just didn't get it.   She then had to look up the oestrogel/utrogestan as she didn't know a thing about it.  Finally gave in and offered to give me a months trial.

She has given me 100mg of the Utrogestan so I am wondering whether to just take 1 capsule from days 15 - 26 instead of 2, as I am dreading any bad prog symptoms.  Also thinking of trying 1 pump of the gel as I was only on Femoston 1/10 which dealt with sysmtoms ok, just didn't do well on 2nd half of the packet.

Can't wait to start trying out the new regime, just need to get my bleed now!! 

[Cassie]

Yes that sounds fine 1 pump you can always push it to one and half and 12 days of the utrogestan should give you a bleed about 4 days after you stop it...will you use it orally or the other way 

[Mary G]

Tangerinedreams, well done for persevering and getting the right medication.  Once you have had your period, you can get started on it.

If you are only planning to use 1 pump of gel then I think 100mg of Utrogestan will be enough.  I would also recommend you take it vaginally because it has fewer side effects when taken that way and it is also more powerful because most of it hits the spot.   

I am currently using 2 pumps of gel every day and only take 100mg Utrogestan for 7 days each month (vaginally) because I am severely intolerant to all types of synthetic progestin and to high doses of Utrogestan so I cannot take any more than that.  I had a uterine scan recently and the lining measured 2mm so it is definitely doing the job in my case but everyone is different and the only way you can know for sure is to see what kind of bleed you produce and have a scan - preferably straight after a period.  That way, you can gauge whether or not you need more or less Utrogestan.

Good luck with the new regime!