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[Goosieloosie]

Hi, well I've now had my very first Estradot 50 patch only on for one week and haven't yet taken any of the Utrogestan as Ithough I would enjoy the effects of the nice oestrogen only for a while! Unfortunately thoughI've been ill for the entire week with a virus/cough/cold/bad chest  I'm feeling much better now though and I'm wondering when and how much Utrogestan I should use/take? Should I starton day 15 (that is 15 days after I first put the patch on) and as I plan to use it vaginally will 100 mg be enough for 12 days as opposed to jumping straight in with the licensed dose of 200 just incase of side effects? I'm worried 100 willnotbe enough to shed the lining properly? Or could I enjoy the oestrogen only patch for a bit longer or stick to 15 days? I'm 54 & post meno. Not sure what dose to use, my GP thought I was doing the 25 days of Utrogestan justbecause I'm post meno but I'm not keen as I'm a migraine sufferer.  Thanks for any advice on how to take the Utrogestan.

[Mary G]

Goosie, I would definitely use 100mg vaginally and see how you get on with it.  If you get a good bleed with that dose, then you will know it is enough but you might want to have a scan (preferably after a period) to check that you are not taking too little or too much.

I think the licensed dose is high because Utrogestan is only licenced to be taken orally in the UK - for no reason whatsoever.  Therefore, because about 50% of it gets lost in your digestive system, the licensed dose has to be high but you can take much less if you use it vaginally. 

Professor Studd would not be prescribing women 100mg of Utrogestan for 7 days each month if it was highly risky or dangerous.  I have proved that this is definitely enough for me by having a scan immediately after a period and having a lining measurement of 2mm and I take quite a high dose of oestrogen.  I would argue that had I taken any more Utrogestan, it could have caused me problems because the lining was already thin enough.  I realise that I am only one person and that everyone is very different but if it this works for me, chances are it will work for other women.

If you turn the whole thing on its head, it would be impossible for all women to need exactly the same amount of Utrogestan to get the same results.  Therefore, it is trial and error and the dose must be adjusted to suit the individual and yet again, once size does not fit all. 

If you are progesterone intolerant, you have to be realistic about how much Utrogestan you can take and if you set the bar too high, you will end up cheating like I did and ditching out after a few days - incidentally, it was still enough to give me a proper period.

[Goosieloosie]

Ok,Thank you for your advice Mary G and Stellajane.I think it probably would be sensible to start with the 100 and see how I feel on this and work my way up onto the 200 if necessary.
So...to clarify...I count the first day I put the Estradot patch on as day one? And use the first Utrogestan capsule on day 15 for 12 days, yes? How do you all keep track of the days you have to take it, stopping & starting? Do you mark it in a diary and count the weeks or days till you take the next lot?

[Hurdity]

My view would be to start with 200 mg and work down although if you are using it vaginally you will probably be fine on much less.  As Mary G says we are all different - so I use 200 mg vaginally for 12-13 days every two months with a 50 mcg patch and that is fine - but over the years I know my body and have had various scans for one reason or another so I know it's OK for me. When I first started using progesterone ( the vaginal preparation not licensed for HRT - called Cyclogest) I used the dose recommended by my gynae GP (who studied under Studd years ago) - but looking back I could have taken less - but good to have started with the max dose.

If 7 days per month were safe and effective for everyone this would be the licensed dose, but unfortunately there is no licensed dose for vaginal use. Even so in France and other countries where they can use it vaginally, there is no difference in dose given for vaginal vs oral use, although research has shown that less will probably so the job. It is not risky and dangerous - but could lead to increased incidence of endometrial hyperplasia ( which can lead to cancer) in some women - so personally I would recommend erring on the side of caution in the first instance.

If your side effects are just tiredness and foggy head and a bit of low mood - then that's just like pms sort of and if it's not severe then you may be able to tolerate it - like some of us who have posted on here. You would be very unlucky to be severely intolerant so hope you are OK with it

Re how you count - well I have always counted the dates I take progesterone (rather than saying what's Day 1 etc) so when I used it monthly I used to start on the Sunday every 4 weeks and took it for 11 days (that was the dose I was given). I just used to count out the number of capsules I had to take ( same as now) and when they were gone then that was it. You might decide to do calendar months ie slightly longer than 4 weeks - and then that becomes easier as you can just say the first of every months I will take my 12 days of progesterone. I have always kept it to the nearest weekend so that the progesterone withdrawal and start of bleed is always at the weekend when I don't usually have to work!

Hurdity x

[Peterspots]

I am on continuous Regime with 100 utgesteran everyday. I am only two weeks in & as before when I started Esteogen I am aching all over. I stopped for 2 weeks last time & tried a different patch. The Esteogel is really helping my bladder so I'm a bit to stop. I wonder if I carried on it would ease? Any experience. I just want to stick with a system & just get on with it if you see what I mean

[Sunnydays]

I know I'm a new user to Utro (just one cycle) but I can't be faffing around with a load of dates. Im finding that every moment of every day is filled with thoughts on hrt and my health and I need to move away from that.  I would either go by taking the tablets and 'when they're all used up they're all used up' basis or going by calender month.
My plan for my next cycle is to use Utro 1st of the month. So it'll be on the  1st March Utro for 7 days, then again on the 1st April etc etc. I can tweak that date by a day or so depending on what I have planned.   
Depending on how this works will depend on how I continue with it - either as above or a long cycle.
I'm conscious I'm 'breaking the rules' but I just can't do 12 days, then have to put up with a period for 4/5 days then have only a week or so of freedom before starting again!
As Stellajane knows I'm seeking out that scanty bleed!!! The only thing is, although prof studd says about a scanty bleed, if it's scanty, how do we know if it's done its job? I guess it has if there's no breakthrough??

[Dancinggirl]

Hi ladies - I would just like to throw in a word of caution. If you play around with how you use Utrogestan or any progesterone then you must expect to get problematic and/or erratic bleeding - anything you wish to experiment with should be under the guidance of a specialist gynae.  My gynae stressed to me the importance of taking any progesterone for at least 12 days to ensure that the womb lining sheds properly.  Those ladies who are under a private gynae will usually have an annual scan to check the lining is not building up or ensure other problems are not emerging. 
There have been many ladies on MM who have told us about their experiences with Prof Studd and sadly many have found he does not offer good ongoing support when problems arise!!! His regime of 2 pumps of Oestrogel with 7 days or Utro per month will not suit everyone and is certainly not licensed by NICE - my private gynae would not let me do 7 days as he knew this could result in problems.
I am really worried that many are simply trying this regime without seeking advice first.  I tried a slightly longer cycle of 4 weeks of one pump of Oestrogel daily with 14 days of Utro 100mg and this resulted in erratic and heavy prolonged bleeding by the second and third cycle!!! I then tried 2 weeks of Oestrogel with 14 days of 200mg Utro and still got problems.  I then tried Utro continuously and continued to have spotting on and off and nasty stomach cramps.  I also tried using it vaginally and it really effected my bowels in a horrid way - I felt really uncomfortable!!! I also felt rather sedated on the 200mg dosage.
I do hope you all find a good way forward but I'm afraid that Utro doesn't suit everyone and I've read other posts from ladies who have similar experiences to me.  Dg xxx

[Sunnydays]

DG I think your words of caution are wise and also highlight the fact how different we all are and how what suits one might be a disaster for another. I know that I wouldn't consider deviating from a prescribed medication for an illness but I'm becoming increasingly aware that in terms of 'treating' meno symptoms, there seems to be a shortage of flexibility. I've been trying to find the right hrt for the past 13 months. Fortunately we have this forum where we can make informed decisions/choices about trying out certain regimes. Waiting for GP appointments or simply having to ask the GP yet again for a different prescription to try isn't always welcome.  I think I'm very much the culprit for trying my own thing,  but as soon as I feel I've hit on something that suits me, I'll be visiting the GP for their support and prescribing x

[Kate50]

Lol I like the way some dodgy posts about prof Studd are starting to appear I Just payed out to see him!  I would just like to say at this point and I don't agree with it but 30 years ago a lot of women were just on oestrogen only and one of them was my aunty who was on it for 20 years and she's still alive!

[Kate50]

Anyway besides my last post prof Studd smeared 1 pump and a very large blob on testin on my arms yesterday and already today got some more energy but feel a bit jittery so will watch testin with caution.  O Jane been taking oestrogen only for the last 4 months. I will be very interested in advice and help in using them although I am one for using my intuition.  Side effects is usually my problem. The nurse said just breast tenderness! ? I get a headache from taking pain killers! !

[Sunnydays]

Makes sense what you're saying Stellajane, I hadn't thiught of it like that..... of course, the longer the progesterone cycle the less lining there is to dispose of. Ho hum! I need to rethink my strategy (again!) swear word swear word!!
 
And DG, I'm sorry too that you're having problems again. I recall you saying a while ago you were going to have a break from everything to let your body get sorted - how's that working for you? 

[Dancinggirl]

Hi all - following my erratic bleed problems with Utro (mostly brownish spotting with period cramps but non the less very irritating) I have now done 4 weeks without any systemic HRT - I've gone back to using Vagifem alone for the time being (3-4 times a week).  Flushes and night sweats are not too bad but I've had at least 6 nasty headaches lasting 24-72 hours and finding these really debilitating.  I'm going to persevere for a while to see if the headaches settle but I think I may have to try a different progesterone that will control the bleeds better - maybe Provera as I've heard other women who had my problems switched to Provera with better success. DG x

[Niamh]

Sunnydays thought it might be useful/reassuring to know I use utro 100mg vaginally for 7 days a month starting on 1st. I'm severely progesterone intolerant I can just about do 7 days and vaginally is a million times better than orally. I also get a pretty heavy bleed for 5-7 days. I should note I see Prof Studd who ive found excellent so I'm little unsure about any negativity about him surely he's the leading voice and pioneer on this. He can be a little brusque but he's dedicated his life to this and I really can't see that he would recommend anything unsafe, infact for those of us who can't tolerate progesterone it's unsafe for us to take a longer and bigger dose!! Also to note I raised a question with Dr Currie and her view was 7 days was safe so long as I had a decent bleed it was doing its job. I get no erratic bleeding outside of this. I hope that helps x

[Mary G]

Niamh, it's interesting that Dr. Currie thought that 7 days of Utrogestan was enough too.  I think the time has come to review the guidelines/licensing on Utrogestan.  It is pretty well established that it is much more effective when taken vaginally so the manufacturers should take this into account and not state the same dose for oral and vaginal use, it doesn't make any sense.  The UK also needs to licence it for vaginal use, does anyone know why they have not done this? 

I agree with what you have said about Professor Studd and would add that his input has helped get the NICE guidelines changed.  He has made hormones his life's work and carried out extensive research of his own and I don't know where I would be without him, no other doctor helped me or had a clue how to deal with severe synthetic progesterone intolerance.  He has long advocated the use of bio identical transdermal HRT and Utrogestan and knew before others that the risks (albeit very small) of HRT were hugely exaggerated.  He also understands the need for a broad approach to HRT with as much in-built flexibility as possible so that women can find a regime that works for them and are not put off taking HRT altogether. 

You make a very good point about the perils of taking too much synthetic progesterone if you are intolerant.  If I take any type of synthetic progesterone or Utrogestan in large quantities, I get silent migraines which consist of a blind spot, followed by about 25 minutes of disturbed vision during which I cannot drive or do anything at all.  This is extremely disabling, I am virtually blind and there are a whole host of jobs I would not be able to do because of it.  This could be doing me serious harm if it happened too often not to mention ruin my quality of life.  In my case, synthetic progestins or too much Utrogestan are the sole cause of these migraines. 

The medical profession hasn't exactly covered itself in glory when it comes to the menopause and HRT and this has been made much worse by two extremely flawed and badly conducted studies that have since been discredited but nonetheless caused a lot of damage and set HRT back by 10 years at least.  I wonder how many lives have been ruined because of it.  All guidelines should be subject to constant review. 

[Hurdity]

Just to add the ref you were referring to Stellajane:

Progestogen intolerance and compliance with hormone replacement therapy in menopausal women. Panay and Studd (1997)

The incidence of endometrial hyperplasia is reduced to 4% with 7 days of progestogen, 2% with 10 days and 0% with 12 days of progestogen if prescribed at an adequate daily dosage (Sturdee et al., 1978; Paterson et al., 1980)

Later in the same paper:
The minimum recommended duration of progestogen required to prevent endometrial hyperplasia completely is 12 days Sturdee et al., 1978). However, if a patient is progestogen intolerant the duration of progestogen can be reduced to 10 or even 7 days per month. This will increase the risk of endometrial hyperplasia, particularly if implants are being used, so it will be necessary to have a lower threshold for endometrial sampling should there be any suspicious bleeding

http://humupd.oxfordjournals.org/content/3/2/159.long

I haven't read this for ages but always remember the info re the progestogen.

On Prof Studd's website it used to quote that there should be a lower threshold for endometrial sampling if 7 days progestogen were used reguarly but it's either buried somewhere or he has removed that statement.

Re Dr Currie's comments - I imagine these comments referred to your specific case Niamh that you wrote to her about and are not generally applicable? If I remember rightly you are not yet at menopause and started treatment when your periods are still regular and possilby closer together indicating the late reproductive stage when you will still be ovulating? If this is the case you will be producing progesterone as per the normal menstrual cycle, which may be why there is greater flexibility in the progesterone dose for women in your position?  I stand to be corrected here though re her comments and your situation!!

Hurdity x