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[Fullmoon]

Hi folks - Really flummoxed about how to reply to the replies I got to my initial post - found on page 52. There must be a simple trick to it so please let me know.

Hurdity - I was in Switzerland when first put on Estrogel and Utrogestan in 2012. I have been back in London and on the NHS since September, 2013. I have continued with one pump of estrogel daily and 100mg of Utrogestan vaginally three times per week, spread out through the week. Lining still below 5 with the twice-yearly scans provided by NHS.

I am also in Dr Panay's menopause clinic at the Queen Charlotte in west London but have only managed to see him once. One member of his team tried to get me to boost Utrogestan to 100mg per day but I experienced instant bloat and massive breast pain on a one-month trial of this regime.

So I reverted to the Swiss gynaecologist's advice: one pump estrogel and three 100mg utrogestan per week. She (gyro) assured me that this was the protocol successfully followed in France, Switzerland, Italy, Belgium and Germany.

My only problem on it was initial weight gain - boobs up a cup size and all over chubbiness. That settled down initially but is now back with a vengeance, even though i'm working out (resistance training / aqua aerobics / pilates / yoga). The only thing I have changed, on the advice of a doctor at the meno clinic, is applying the gel to my inner thighs instead of inner forearms. My thighs are chunkier than usual and layered in cellulite. Could the local application of estrogel be the culprit?

Await your advice everyone with many thanks!

Hi Smarlo

Can I ask - was Mr Panay OK with the treatment regime your Swiss gynaecologist gave you?  I ask because he makes positive reference in a paper he wrote to a study done in 2011 about taking progesterone on alternate days - which suggests that in spite of the UK protocol some UK gynaecologists will consider a 3 days a week/alternate days approach. 

By the way, I apply the gel to my inner thigh and have done for years and they are not noticeably chubbier.

Best wishes

[Michelle46]

Hi ladies
I just wanted a bit of advice really. I have switched from Evorel 50 patches to the gel. I use 2 pumps of gel each day and 100mg of utrogestan for 14 days of the month. Is there any way I could take say 10 days of utrogestan? Would I bleed after that like I bleed after 14 days? I just feel a bit strange on the utrogestan. Thankyou x

[Cassie]

Yes there is no reason why you shouldnt bleed much the same on that dosage, I am on 11 days at the mo was on 12 am cheating, had quite a heavy withdrawal bleed this past week, seems to be easing off. The important thing when using Utrogestan like this is to have an annual scan if possible of your uterus to see if the lining is looking ok, then you should be hunky dory.

[Hurdity]

Michelle - the licensed dose is 200 mg x 12 days but there is no oestrogen dose suggested to go with this so it is a bit of a one-size fits all - guesswork! I imagine it is probably for a range of medium oestrogen doses - which you are taking - but it also depends on how much oestrogen you absorb from the gel - which varies greatly between different women.

Research shows that there is some chance of endometrial hyperplasia when Progesterone is used for 10 days only (not as much as with only 7 days) but the risk is low so you could try 10 days - but if you are taking it orally then this is much less than the licensed dose so you would need to have a scan from your doctor say after 6 months to a year (timed to just after you've finished a bleed) to check whether you have any thickening. I can't remember what dose of progesterone this research covered but it was some time ago so before utrogestan was available.

Are you seeing a specialist through a menopause clinic because if so then changing the dose and organising a scan should not be difficult as I would have thought they would recommend it, if utrogestan is not agreeing with you?

Hurdity x

[Michelle46]

Thankyou Hurdity
That is very helpful. I've learnt more from this forum than years with my doctor. I expect this forum are soo glad to have a helpful lady like you. 

[Mary G]

Michelle46, you are taking a lot of progesterone and for a long time.  If you think about it, you are actually taking the Utrogestan capsules for 14 days, then you probably have a gap of 5-6 days before starting a period. which probably lasts about 5 days. meaning the whole process is taking up about 25 days of the month which gives you just 7(ish) days before you have to start the whole process again.  If you look at it like that, no wonder you don't feel good, I would have a permanent migraine if I took that much Utrogestan.  One other point, Utrogestan hangs around in your system a long time after you take the last capsule and some women feel stange for a couple of weeks. 

I'm sure some women can take endless amounts of synthetic/micronised progesterone and not be affected by it but if you are one of the unlucky ones who are, then you need to limit its use.  Unfortunately, I have found all the progesterone used in HRT preparations have dreadful side effects and even though Utrogestan is supposedly the closest to our own progesterone and in my case, the lesser of several evils, I still don't think it is a particularly successful product and certainly nothing like the progesterone that I used to produce myself - I didn't have any migraines, PMS or period problems pre-menopause.

I really wish there was an alternative to progesterone in HRT preparations but sadly there isn't, well not yet anyway but we live in hope.  Therefore, I have found that the only way to make it bearable is to limit its use and I take 100mg vaginally for 7 days every 5 weeks and I can just about tolerate it, at a push and with a huge amount of reluctance.  For me, it is either that or a hysterectomy. 

If you do decide to do the 7 days Utrogestan regime, i would recommend you have a scan every now and then to make sure you are getting proper clearance but frankly, all women need to have scans anyway because there are all sorts of other things to look for that only show up on a scan.  You can get this on the NHS or privately.

Hope that helps.

[Michelle46]

Hi Mary
Thankyou so much for your detailed reply. I haven't found that many ladies on 14 days of utrogestan now you've said that. I'm on my 9th day today but I am going to Majorca tomorrow and I want to feel ok ish. I'm wondering if I should just take 10 this month. Would my bleed come a few days after stopping?

[Mary G]

Michelle46, it's a pity you didn't delay the Utrogestan phase because if you stop now, you will probably get a period in about 5-6 days from now which will probably last for about 4 days.  I was about to say that you could have stopped taking it sooner and had the period before you leave but even that would have clashed with your holiday if you are going tomorrow. 

You can either stop now and put up with a period on holiday (it will probably be light because you take so much progesterone) or another option would be to carry on until day 14 or longer if you can stand it in order to delay your period until after your are back.

It all depends on how much you want to avoid a period and how long your holiday is!

[Smarlo]

Hi folks - Really flummoxed about how to reply to the replies I got to my initial post - found on page 52. There must be a simple trick to it so please let me know.

Hurdity - I was in Switzerland when first put on Estrogel and Utrogestan in 2012. I have been back in London and on the NHS since September, 2013. I have continued with one pump of estrogel daily and 100mg of Utrogestan vaginally three times per week, spread out through the week. Lining still below 5 with the twice-yearly scans provided by NHS.

I am also in Dr Panay's menopause clinic at the Queen Charlotte in west London but have only managed to see him once. One member of his team tried to get me to boost Utrogestan to 100mg per day but I experienced instant bloat and massive breast pain on a one-month trial of this regime.

So I reverted to the Swiss gynaecologist's advice: one pump estrogel and three 100mg utrogestan per week. She (gyro) assured me that this was the protocol successfully followed in France, Switzerland, Italy, Belgium and Germany.

My only problem on it was initial weight gain - boobs up a cup size and all over chubbiness. That settled down initially but is now back with a vengeance, even though i'm working out (resistance training / aqua aerobics / pilates / yoga). The only thing I have changed, on the advice of a doctor at the meno clinic, is applying the gel to my inner thighs instead of inner forearms. My thighs are chunkier than usual and layered in cellulite. Could the local application of estrogel be the culprit?

Await your advice everyone with many thanks!

Hi Smarlo

Can I ask - was Mr Panay OK with the treatment regime your Swiss gynaecologist gave you?  I ask because he makes positive reference in a paper he wrote to a study done in 2011 about taking progesterone on alternate days - which suggests that in spite of the UK protocol some UK gynaecologists will consider a 3 days a week/alternate days approach. 

By the way, I apply the gel to my inner thigh and have done for years and they are not noticeably chubbier.

Best wishes

[Smarlo]

Hi Fullmoon - apols for delayed reply, only seeing now.

Yes, Mr Panay seemed cool with it. He seems cool with everything though. Since my oestrogen blood reading was 74 and my progesterone was just 1, I asked him what the optimal ratio should be and he just said there is no optimal, we're all different.

I'm thinking I have been oestrogen dominant for such a long while. Have been off estrogel for three weeks now and breast lumpiness vanished within days. Breast size also nicely reduced. Boobs were huge and I was feeling puffy all over even with just one pump of estrogel and utrogestan thrice weekly. I just don't know what the right formula is for me. Perhaps I am so sensitive to hormones that nothing would be best.

Thighs still ridiculously chubby and meno pot is well rounded (nothing to do with bad calories as I've been no sugar, low carb, high fat for years).

Any ideas anyone?

[clare663]

Hi everyone I have a question. Im 5yrs meno and started on this form of HRT a couple of weeks age. I must admit I was experimenting with the amount of gel so that I could get rid of the flushes but not take so much that I have sore breasts or anxiety. I use 100mg vaginally 1-25 but after 15 days I was so foggy with sleep I took a 2 day break and have now got spotting. I have used the utrogestan for last 2 nights but I am still spotting. Now the question I have is when I am supposed to take my break on days 25-28, am I going to spot/bleed anyway? If this is the case I may as well go on a sequi regieme and take less utrogestan!!

[Fullmoon]

Hi Stella and Smarlo

I'm one month into the three-day regime and all was going well and I was feeling great until last weekend when I had a very small bleed and have been spotting ever since.  I'm going to have a scan next week just to check it is not anything other than a breakthrough bleed.  I'm going to stick with this a bit because I feel my body is slightly in shock after having taken continuous utrogestan for so long - but I just can't do that any more.  This week I've noticed on the days after I've taken the utrogestan I have a headache and I feel really very emotional and a bit weird - which is disappointing to say the least.  However I don't have the awful low mood that has dogged me for so long.  I'm waiting for an appointment at the meno clinic to review it all.  I've looked up all the research I can find on this and it seems there were a number of small scale studies in the last 90s on alternate day progesterone regimes which suggested they can lead to a no-bleed regime - but no big study was ever done and I wonder if the 'Million woman survey' scuppered all of that? 

Reading all these posts tells me that this is all so experimental and trial and error.

[Fullmoon]

Thanks Stella

My comment abut it being experimental is more directed at the medical profession in fact - but because services for menopause are so poor we too are often left to try and work it out for ourselves.  I am not committee to a no bleed regime at all - it is just that is what i was presented with when all this started and now I realize i just cannot bear to take progesterone all the time.  I am going to stick with this method if I can and until I can get to the meno clinic - but headaches on alternate days is proving a little tiring...but it is only this week so maybe this is a phase which will pass as my body gets accustomed to this - we'll see!

[Mary G]

Fullmoon, you are right, many women are effectively left to rot (myself included) and have no option but to do their own research and work it out for themselves.  I was forced to seek help privately in the end.

The two studies that were carried out have more or less been discredited.  They were badly conducted on the wrong women, at the wrong age using outdated forms of HRT at the wrong dose which were also heavily laden with synthetic progesterone.  I would dismiss them completely.

Things have moved on and as you know, the guidelines have been changed to reflect this.  HRT is now considered safe and should be the first line of treatment for menopause with no time/age limit.  Some experts now believe that oestrogen alone (or with very low dose progesterone) REDUCES breast cancer risk. 

Re progesterone, it is the progesterone component of HRT that carries all the breast cancer risk albeit a limited risk.  That, coupled with high levels of intolerance for so many women means that it is sensible to limit its use.  We have this discussion on here at lot, I was never intolerant to my own progesterone but I have serious issues with all the synthetic varieties and micronised progesterone in high doses - they give me silent migraines.  I find that progesterone has a cumulative effect, builds up in my system with a kind of tipping point.  It also seems to hang around in my system a long time after I finish taking it.

If you can tolerate a period (I know it's difficult) I think you will get more out of your regime and feel better for more of the time if you take HRT cylically. 

If you find you have to wait a long time for the Menopause Clinic, it might be worth seeking help privately and getting a more tailor made regime.  Unfortunately, the NHS will always try you on the cheapest form of HRT first whereas privately you can be fast tracked to the best and most suitable type of HRT immediately. 

[Fullmoon]

Thanks Stella and Mary

I have been battling with this for over ten years - a veteran of the campaign.  I have periods (no pun intended!) when everything is good and then it is not - and I seem to have entered one of those now.  I have been on the continuous regime since 2010 - oestrogel/utrogestan 100mg orally and until recently it was OK although I did suffer from low moods which I now put down to the utrogestan - but since I have had a lot of other stuff going on in these times - significant bereavements etc - its been difficult to know what has caused what.  However earlier this year it just felt that I was permanently down and 'pre-menstruel' hence researching alternatives.

I would go privately but getting an appointment is a nightmare - the earliest for Mr Panay is december now and ironically I might get to see him quicker on the NHS.  I'm going to stick with this a bit longer and see if it settles down.

We really need to campaign for better - what we need is the equivalent for what the National Childbirth Trust did for childbirrth but now for menopause services...