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[Mary G]

Fullmoon, agreed, we need to raise the profile.  I think Menopause Clinics and Family Planning Clinics should merge to offer a joined up service - there is a definite overlap between the two with many women using the BCP and Mirena coil for both.  They should also offer uterine scans. 

GPs need to be better informed and the scaremonging surrounding HRT needs to stop - now.  You only have to read the comments section of any HRT article in the national press to see that people still think HRT = breast cancer.  The ignorance is truly frightening and women are suffering life ruining and health ruining symptoms because of it.  Those wretched studies have a lot to answer for and now we are in danger of having a lost generation of women who are either being denied or denying themselves HRT because they are scared and ill-informed.  I wonder how much all those extra hip replacements and osteoporosis cases will cost the NHS?  Then there is the human cost in terms of broken relationships and job losses because some women find themselves unable to carry on working.  The more you think about it, the more unbelievable it is that this is still happening in 2016 and it is all completely avoidable with the right treatment.

Re your case, you could try Professor Studd although he is in demand too.  I think he would probably suggest you drop to just 100mg Utrogestan each month with the possible addition of testosterone. 

One more point, Utrogestan has more side effects when used orally.  It is far more effective at lining clearance/thinning when used vaginally which is vital if you are only taking it for a short time.  You can lose about 50% of it when it is taken orally and I found it caused breast pain. 

[Fullmoon]

Hi Mary, I switched to vaginally in early July after reading this thread - I used to get breast pain and terrible indigestion (like gastritis) both of which have stopped now I realise  but maybe as a result I am getting more progesterone than my body has been used to on the days I take it and hence both the bleeding and the headaches?? 

I so agree with you on everything else - it really is a scandal which has gone virtually unnoticed. This forum has been a life saver for me over the years (I'm on my 3rd or 4th log in now as i kept forgetting my details...).  My hope is that now we have new NICe guidelines we will have a new generation of medics willing to research this issue and new and customised forms of treatment

[Michelle46]

Is it correct that the utrogestan tablets you take orally can be used vaginally as well?

[Hurdity]

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.

Hi Fullmoon - yes there have been some small studies - I posted summaries of the abstracts of the papers (can't get hold of the full copies of most of them) about vaginal progesterone and different regimes as well as the Frrench prescribing info for vaginal use ( which is the same as oral!). Will try to find the thread. I think andius requoted it a few months ago.....

What dose of oestrogel are you using. Progesterone works on the endometrium on a dose dependent (and time dependent) basis so the 100 mg alternate day vaginal regime may not work for higher doses of oestrogen - depending on how much you absorb too!

Hurdity x

[Hurdity]

Is it correct that the utrogestan tablets you take orally can be used vaginally as well?

As Stellajane says they are - but are not licensed in UK to be used vaginally - although the French prescribing info gives vaginal use (at same dose as oral) as an alternative to oral use if side effects such as nausea or dizziness occur with oral use.

Hurdity x

[Trufflecat]

When I took Utrogestan orally I didn't get a bleed (gp wasn't concerned though). When I started using it vaginally I got a normal period three days after stopping, so I am sure that for me absorption is better with fewer side effects

[Fullmoon]

Hi Hurdity

I'm taking 2 pumps a day - I've tried to reduce that but whever I try all my symptoms return pretty quickly so I have concluded that I definitely need 2 pumps - and I agree that it may well be that is too much for the three day regime.  I've got a scan this week and then a GP conversation the next and I'll review at that point. I'm waiting for a menopause clinic appointment - but I expect that will be my Christmas present!

When you start digging into the research it is remarkable how little there is - yesterday I looked up research on menopause funded by the UK research councils in the last few years - 3-4 results came up - so the evidence bases for a lot of the prescribing is very questionable and not surprising I find that we are having to do a certain amount of experimenting ourselves...and I suspect many of us on here have unwillingly become more expert than the average GP (certainly that has been my experience to date).

[Fullmoon]

Will do!

[Hurdity]

Hi there - Fullmoon said I'd look this out and in fact it's further down this thread - I haven't read them recently so won't comment at the moment as the details aren't in my head  !!! Stellajane and Smarlo one of these studies may be the one you were referring to? I am sure there have been more studies since but I just haven't looked recently.

Hurdity x

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

[Fullmoon]

Thanks Hurdity - very helpful and interesting. 

[Sleepy]

Hi all
Can anyone on Estrogel help please?
I'm wondering how long it took to get relief?

I went privately to a meno clinic and he's put me on this. I was told to increase the dose every 2 weeks Upto 4 and see how I do.

I've been on it 6 weeks & now on 4 squirts a day but still no relief from symptoms,

I see him again in 3 weeks, but wondering if This isn't working for me or I need Testosterone too, after reading here I seem to have all the symptoms of low testosterone!

Any help gratefully received I could do with being armed with questions when I see him, it's so expensive I can't keep going indefinitely...
Only ended up here because docs gave up on me after trying 4 different pills and patches, but all aggrivated migraines. 
X

[clare663]

Hi Sleepy. I would think 6 weeks of it would of stopped the flushes by now if it was having any effect. How are you applying it? Where are you applying it?

[Dancinggirl]

Sleepy - do tell use what meno symptoms you are trying to control or help?  If you are still getting flushes and night sweats whilst using 4 pumps of Oestrogel, then I would assume you are either not absorbing the gel at all or your flushes may be more to do with a poor thyroid function.
DG x

[Smarlo]

Hey Fullmoon, Stellajane, Hurdity, Mary G - Apologies for disappearing but I never get alerts when there are new posts to threads. Guess I just need to keep checking the most recent pages of the Estrogel / Utrogestan group.

To clarify: the Swiss gynaecologist - a surgeon schooled in Italy and France, - put me on one pump Estrogel and 100mg Utrogestan, vaginally, three times a week. I was taking the Utro on Sunday, Tuesday and Thursday nights. No bleed. No spotting. Regular lining checks and last one (memory here) was 4mm.

My experimental one-month holiday off both has produced mixed results: hot flashes arrived after two weeks; boobs smaller, less dense; mood same, which is medium to low; lack of motivation; hair shedding seems to have stopped but that is likely because I have resumed taking 2 grains natural desiccated thyroid; meno pot is thriving - basketball form and never goes down, even when keep carbs to 15grams per sitting. Frustrating but many deal with much, much worse.

The most telling development one month after quitting Estrogel is that my RA has flared across the knuckles of both hands. Late at night, joints are warm to the touch, painful, and skin is a bit red, inflamed and squishy.

I think my bio-HRT keeps my inflammation in check, in combination with my ridiculously saintly eating and exercise regime. (There are only the rare three-glasses-of-wine evenings out with friends).

Libido is still a distant memory.

Anyway,, good luck with the 3 x weekly Utro regime Fullmoon.

It worked very well for me for about two years and I'm resuming it again to get rid of the RA symptoms and get my thermostat back on an even keel.

[Smarlo]

And  thank you so much for digging out those studies Hurdity. Very interesting and reassuring.