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[Trufflecat]

Would 100 one day and 200 the next be worth a try? It might stop the levels from dropping too low

[Night_Owl]

Hi Goosieloosie - have you thought about: (1) a long cycle regime so you'll have a longer time with estrogen only - and take Utro every 6/7 weeks;  (2) maybe reducing your estrogen, if you can get by on a lower dose, to reduce the monthly bleed/cramps.  Or maybe both.  [I have migraine too and get by on long cycle, low dose but as we know, we're all different.]
 

[Night_Owl]

Just revising previous thinking on this, a long cycle may not be right on your current dose of estrogen - maybe reducing it would work better.  It is all annoying and draining trial and error!

[Night_Owl]

SJ, I can't drink any alcohol at all now as it brings on a migraine, anything sparkly is the absolute worst - as you can imagine, this is not a lot of fun at any celebratory occasion!  For quite some time now, I've been taking Magnesium and B2 (Riboflavin) for migraine prevention, which seems to work - or it may just be that the fluctuations have levelled somewhat.   Who knows with the mystery of meno - I certainly don't.  Next year it could all change again, as the process marches on.

Unfortunately I have found with the most recent uses of Utro that the side effects were much worse in terms of very low mood and irritability - almost as if I'm getting even more (if that's possible!) intolerant to progesterone with the passing of time - as if my body processes it even more poorly and is saying 'no more'.  Just great.  I'm going to discuss this all (yet again for what feels like 99th time) at next meno clinic appointment.  Like you, I have tried all other prog options and hyster is a no-go for me.

It's good that you've found a personally tailored regime that works and has good symptom control, upping the estrogen only when on Utro - and you are still able to cope with taking Utro (it's always such a relief when taking Utro to get to the last one though, isn't it).  Long may it continue.

[Goosieloosie]

Would 100 one day and 200 the next be worth a try? It might stop the levels from dropping too low

Hi trufflecat, this is exactly what i have done this month and I took the last 200 on day 7 ( as I'd had a particularly bad migraine the morning after taking it) & my plan was to continue taking 100 until day 12 but I began bleeding on day 10 three days after the last 200 so it seems I just can't take 100 for the full course as I always bleed early  .

 

Hi Goosieloosie - have you thought about: (1) a long cycle regime so you'll have a longer time with estrogen only - and take Utro every 6/7 weeks;  (2) maybe reducing your estrogen, if you can get by on a lower dose, to reduce the monthly bleed/cramps.  Or maybe both.  [I have migraine too and get by on long cycle, low dose but as we know, we're all different.]
 

Night owl, thankyou for your advice, oh how I would love to have a longer 6-7 week cycle!! I am on Estradot 50 so do you think this would be too high a dose to try this? I am absolutely feeling fine on the 50 and would rather not lower it and upset the apple cart so to speak  though it may be a case of having to try this, how long do you think it would take for symptoms to show if they were going to? Before asking the GP for the lower 37 patch could I cut a tiny piece off do you think? Just to experiment?? As I said though I'd rather stick with the 50 and not risk upsetting the apple cart. 

[Lizab]

Hi Goosieloosie. I have been on almost the same, with the 50 patch but 200 utro 10 days per month orally. I also bled a little early on the utro every time. I initially tried changing the timing of the start of utro to 15 days from the start of the bleed, to attempt lining up what could have been my own background cycle with the utro timing. It didn't work, still bled early, but my doctor assured me that bleeding early was not a problem, to complete the course and carry on. I stretched my cycle to 6-7 weeks some last summer to accomodate travels, and felt much better during that time. Because I only take it 10 days and couldn't make myself take it longer due to mood effects, I went back to every 4 weeks at the end of summer. I felt off in November, and hit bottom again in December. Like you, the migraines and low mood seemed to become progressively worse with time. In January I discussed with my doctor and attempted to lower to 100 continuously and about 10 days in began a bleed. I allowed a withdrawal with no utro for 5 days and began utro again at 100. Only a few days in, migraine and frightening depression. I have decided to quit the whole lot. I stopped the utro, and 2 days later, for the first time ever, began a bled after stopping utro, even though I had just finished a bleed a week before. I'm tapering the patch down now and expect I'll to have to go one more course of utro. I know this doesn't help you, but you're experience sounds so similar to mine I thought I sold share.

[Night_Owl]

GL, as far as I can recall, Hurdity is on long cycle Estradot 50, Utro 200mg x 12, v-route, 6/7 weekly - she will no doubt be along to give more information, she's expert.  It also depends on how far along you are with meno too.

Some women take Utro for 7 days per month, but I'm not sure of the estrogen dose.

From what I've read, the long cycle regime doesn't suit everyone and it depends how far post meno you are - sometimes women get breakthrough bleeding when the estrogen dose is high-ish - it also still means taking the Utro at the higher 200mg strength and regular endo scans - the pay off is a longer 'estrogen holiday'.

[I could never tolerate a high dose of estrogen due to having to match it with taking a high dose progesterone to counter it and the resulting cramps/bleeds - it created too much fluctuation and the migraines were worse - and I couldn't live with the constant merry-go-round of progesterone side effects/withdrawal/bleed/pain.  For my constitution, a lower dose works better.  But that's just me.  I still don't tolerate Utro at lower 100mg but I know it's an evil necessity as without any HRT, I have zero quality of life.  We have to experiment and we're all so different.]

Estradot are really tiny aren't they, so it may be difficult to cut off an even amount each time.  When altering estrogen doses, I've found it takes just a couple of weeks to notice differences.

Maybe mull it over and think about 37.5 with 6 weekly Utro 200.

It's never easy when you have meno plus migraine to manage.  It's even more of a juggling act.

Lizab, hope it goes well with the tapering down - some of us really struggle with Utro and in the end decide a break is needed to see how things are.

[Goosieloosie]

Thank you Stellajane, Night owl & Lizab, everything you have all suggested has given me something to think about....as much as I'd love the 6-7week cycle (which will actually be really handy for an upcoming holiday in June that needs juggling around with the utro business) I do realise lowering to 37.5 might be a possibility as I do suffer with terrible cramps & quite a clotty bleed on the 50 even though I generally feel fine on this dose (no meno symptoms). Yes the Estradot patches are very tiny but as I have loads of 50 ones left I would rather use them up & cut a slither off the end if this is possible & they will still stick as good as they usually do? 
Lizab...Thank you so much for sharing, I have often thought that I too would never be able to manage to take utro continuously as I would bleed for sure before I got past 10 days! And as I use it vaginally it isn't the easiest or most pleasant thing to be doing whilst having a bleed to be able to carry on with the course  .
It is also the same with me that the longer I have been using Utro the more I seem to not be tolerating it so well, when I first began this regime a year ago I was perfectly fine on the 200 x 12!! Now I have terrible sleeps (very very restless), irritable, as well as migraine.
Incidentally does anyone know why we bleed before we have finished the course of utro I always understood it was the withdrawal at the end that triggers the bleed and this month I was still actually taking 100 & had 2 more left to take (insert) when the bleed started? So how can this be?
Btw I am 2 & half years post meno & age 55.

[Hurdity]

Hi Goosieloosie

I see my name has been mentioned a couple of times - I've been away for the weekend - only just back so haven't looked at the forum!

Yes that's right - thanks Night_Owl you've remembered my regime exactly!!!

MY first thought on reading your post earlier was that 50 mcg should be absolutely fine for a longer cycle - since it is for me- but of course we all absorb oestrogen differently and maybe you are absorbing more than I am? Also maybe you have the odd fibroid? These can affect bleeding patterns (last time I was scanned I had a very  small one but not enough to make any difference). I was very surprised that 100 mg vaginally for 12 days is not enough to prevent your having an early bleed - since limited research has shown (small study though) that approx half the dose was need when used vaginally than orally and also the dose is far more consistent as it goes directly to the uterus. I have never bled early using progesterone of any description. Also I am now actually ( unofficially) on 62.5 mcg and still on 6-7 week cycle (occasionally 8 ). My bleeds are never heavy, although since I now have more cycles nearer to 7 weeks and have upped my oestrogen dose, I have a heavy day or day and a half ish with the odd clotty bit.

I can't imagine using it vaginally while bleeding! I would be worried that the flow and general yuk would prevent proper  absorption since the flow is going the other way.

When I do shorter cycles I do find that I tolerate it less well - as if the physiological changes brought about by the progesterone haven't had time to reverse - and then has even more pronounced side effects.

I agree I also would have though that alternating the doses should work - again there are studies showing that on a medium dose of oestrogen alternate day progesterone at 100 mg is sufficient to protect the uterus when used vaginally (very small study).

It wold be unfortunate if you are one of the exceptions and bleed early.

That being the case I would go back to your doc and ask - for example say you are worried about the heavy bleeding and bleeding before the end and that you are concerned about fibroids. You could say you feel you need a scan to know what to do next. Also although blood tests don't tell you a lot - it might be illuminating in your case - so for example if your oestrogen levels are very high on 50 mcg patch then this could also explain the heavy bleeding - and could indicate you might be OK to reduce the dose a little.

When I reduced my dose to 37.5 mcg at the suggestion of my  doc when I had some bleeding/spotting - the flushes came back within weeks but they always disappear on 50 mcg +.

I now ease into my cycle (well I did the last couple of times) so the first and last dose of 200 mg I take over two days so I now do 2 days x 100 mg, 10 days x 200 mg, 2 days x 100 mg. Maybe overkill but at my age it should be silly to get an overthickened lining and potentially endometrial cancer which should be entirely preventable on HRT.

Why not go to the doc anyway, but also try for a slightly longer cycle eg 5 weeks and see what happens to your bleed. I presume you insert the utro at night?

Sorry I can't be of more help - bit of a ramble or thinking aloud....

Hurdity x

[Goosieloosie]

Thank you so much Hurdity for your very informative reply. There's alot to mull over but I am definitely keen on trying a longer cycle rather than reducing my patch strength,  as I said earlier my 50 patch has been working fine for me and I definitely feel the Utrogestan has got worse with the side effects the longer I have taken it (over the past year) so you could be right that it is building up in me and not completely clearing out of my system by the time I'm due to start the next course. I still really don't know what to do regarding taking the utro ie: 100 or 200, to ease myself into it like you are doing (100 x 2) or to carry on alternate days of 100, 200, 100 until the end. I will have a think but I may try this with a 5 week gap next month (particularly as February is a very short month as I start my utro on the 1st of each month) before going to my GP. I will see what the bleed is like on this slightly longer cycle & see if I can make it to the end of the utro course , though I'll have to mull over what way to take it  .....such alot to process...this whole thing gets a bit wearing doesn't it  Oh and yes I insert the utro at night, last thing before bed! Thank you once again, you a such a great help and full of knowledge 

I just thought it maybe worth mentioning that I have bled during the early weeks in all of my pregnancies (and I have six children) so it could be that I am ultra sensitive to hormones perhaps?? No one knew what caused the bleeding during the pregnancies, I never got any explanation, I guess no one knew in those days. Would this be a possibility do you think as to why I bleed on utro? I also had breakthrough bleeding on the synthetic conti patches that I tried at the start of my HRT journey and this went on for weeks.

[matildamouse]

This trial and error is exhausting GL, I get that! I am on Estradot 50 mcg patch and continuous vaginal progesterone on alternative days. I am 2 years post menopausal and have no spotting or bleeding. My scan in Dec showed multiple fibroids (always had them) with a thin 3mm lining. I recently tried to increase my progesterone by taking the same dose (100mg) every night ORALLY as I wanted to increase my Estrogen . THe result was horrible stomach cramps and irritability with crying for stupid stuff like using the last tissue in the box. So I have now decided to cope with the odd breakthrough hot flush and stay on the 50mcg patch.  Will this be a regime to try with a regular annual scan?

[claude66]

I'm using Estrogel daily and taking 200mg of utrogestan for 12 days a month. However it's now been about a year since my last period, suggesting I am now post menopausal.

Should i now be altering the way I take it does anyone know?

[Hurdity]

Thank you so much Hurdity for your very informative reply. There's alot to mull over but I am definitely keen on trying a longer cycle rather than reducing my patch strength,  as I said earlier my 50 patch has been working fine for me and I definitely feel the Utrogestan has got worse with the side effects the longer I have taken it (over the past year) so you could be right that it is building up in me and not completely clearing out of my system by the time I'm due to start the next course. I still really don't know what to do regarding taking the utro ie: 100 or 200, to ease myself into it like you are doing (100 x 2) or to carry on alternate days of 100, 200, 100 until the end. I will have a think but I may try this with a 5 week gap next month (particularly as February is a very short month as I start my utro on the 1st of each month) before going to my GP. I will see what the bleed is like on this slightly longer cycle & see if I can make it to the end of the utro course , though I'll have to mull over what way to take it  .....such alot to process...this whole thing gets a bit wearing doesn't it  Oh and yes I insert the utro at night, last thing before bed! Thank you once again, you a such a great help and full of knowledge 

I just thought it maybe worth mentioning that I have bled during the early weeks in all of my pregnancies (and I have six children) so it could be that I am ultra sensitive to hormones perhaps?? No one knew what caused the bleeding during the pregnancies, I never got any explanation, I guess no one knew in those days. Would this be a possibility do you think as to why I bleed on utro? I also had breakthrough bleeding on the synthetic conti patches that I tried at the start of my HRT journey and this went on for weeks.

I don't know the reason for bleeding in early pregnancy - I think it's something to do with lack of progesterone which is why women susceptible to miscarriage are given large doses of prog early on to maintain the pregnancy?

Re what to do next - you can only try and see ie stretch the cycle or ease into the progesterone but be sure to keep in regular contact with your doc too if you find a way that suits you. Mine is a non-conventional regime but my GP is happy with it.

Yes it does get wearing - even now after 10 years!

Hurdity x

[Hurdity]

I'm using Estrogel daily and taking 200mg of utrogestan for 12 days a month. However it's now been about a year since my last period, suggesting I am now post menopausal.

Should i now be altering the way I take it does anyone know?

If you are not bleeding at all on this regime then it does suggest you could be post-menopausal or nearly so. Do you take it vaginally or orally?

The same thing happened to me about 5 years after starting cyclical HRT. I was in my late 50's and not getting a bleed with 11 days of Cyclogest (Utrogestan was new and GP had not come across it), so my GP suggested I went onto conti HRT and reduced my oestrogen. I tried this but the flushes returned after a while so i went back up to 50 mcg but did not want to increase the progesterone dose so instead I lengthened my cycle (with her approval).

Depending on how you feel on the utrogestan phase - this could be a possibility for you eg stretch to 5 weeks rather than 4 and see if this still prevents a bleed.

Also - do you feel the estrogel dose is sufficient? If not the other alternative is to increase the dose of this and keep to the 4 weeks cycle. Personally I would choose the former if the oestrogen dose is OK though.

If this works OK then you should inform your GP that this is what you are doing and why so that they can record on your notes!

Hurdity x

[claude66]

Thanks for the replies.

Stella Jane - I did have periods when I first started this regime of Estrogel and Utrogestan but it has been a year (using it in same way) since I've had a bleed.

Hurdity I take it orally. Yes, I do feel the estrogel dose is sufficient. It keeps the flushing at bay and has minimized (but not eradicated) the night sweats