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[Sarai]

I'm hoping somebody is around. I'm seeing GP re a change in HRT, he is happy about that.
Dr Currie believes my monthly mucky discharge after 9 months on Evorel conti 50 is due to prog not being absorbed.
I prefer to reduce my oestrogen as I'm meant to be on the lowest dose.
So I go for Oestrogel, would 1 pump equate to 25mg ( or whatever it's called)?
I'm going to try a bleed and want the vaginal route. I'm a coward re side effects.
Do I just remove my patch and start the new regime the next day or should I have a gap? Not sure how I'd calculate when day 12 was when I'm on a patch.
#Mary G or anybody who u derstand this stuff. Thank you
I'm also wondering if I only used 1 pump if I would need less progesterone dose or duration?

[Linsey44]

Hi dont know what you would do re changing from patch and i hope someone else can help you.  I dont have womb and dropped the utrogestan.

I use oestrogel and dr currie told me 2pumps is a med dose.  Im only to have low dose so i try to use 1-2 pumps day.

If no one replys maybe you could ask dancing girl or hurdity or taz2 they are more likely to know.

Sorry i cant be of more help
Linseyx

[Mary G]

Sarai, you can just take the patch off and start the Oestrogel immediately, you don't need a gap in fact it would be better not to have a gap because your oestrogen levels will fall.  1 pump of gel is roughly the equivalent of a 25mcg patch but I find that gel absorbs/works much better than patches.

Are you post menopause?  If so then yes, you can do a long cycle.  I have always stretched my cycle to the limit (5-6 weeks is the most I can go before I get breakthrough bleeding) and use Utrogestan vaginally which works much better for womb lining clearance and has fewer side effects.  If you are only using 1 pump of gel, you could probably do an 8 week cycle without breakthrough bleeding.

How are you with progesterone?  Do you tolerate it well?  I have never adjusted my Utrogestan dose to match the amount of oestrogen I take but some women do.  I have always had to keep it to the barest minimum because I am progesterone intolerant so I don't have a choice but I do have regular scans and it has always been enough. 

The Utrogestan dose varies.  I have never taken more than 100mg for 7 days (as per the Professor Studd regime) but some women take it for 10 or 12 days each month. 

I think for you it will be a case of try it and see how you get on.

[Sarai]

Thanks Mary G, slowly a plan is formulating.
I've only been on Evorel and it was suiting me bar the mucky discharge and headaches but they were lifelong anyway. Then after the failed hysteroscopy I felt really bad boobs exploded so painful, no idea why that happened but it really upset my system. My measurement prior was 6.6mm and they wanted 6mm.
I did react to progestergen after pregnancy I had in injection form.
Beyond that I knew nothing about why my cycle did what so no idea what made me feel bad each month.
How do you get an 8 week cycle if prog needs using 12 days a month.
Do you count from day one of Oestrogel? I never had 28 day cycles anyway. Hell I sound so thick.
I can't imagine my GP being able to figure all this out. I want to use prog vaginally too, that will make his hair curl.

[Hurdity]

Hi Sarai

The first thing is that it is impossible to say what dose of patch will equate to what dose of gel - for you specifically, because women vary so much in how much oestrogen they absorb from the different methods. The approximate doses are based on average values for populations of women tested - and are given as low medium and high. Yes 1 pump of oestrogen gel is a low dose as is 25 mcg patch but if you are trying to REDUCE YOUR oestrogen dose rather than INCREASE I would suggest it is better to stick (!) with the method of delivery you are accustomed to because only that way will you know that you are giving yourself the decreased dose you seek.  Ideally you would stay with Evorel but Estradot actually comes in 37.5 mcg doses so you could give yourself a small reduction and see how you got on perhaps and later reduce to 25 mcg if you wanted to reduce further (although there have been supply problems with Estradot!). In your position (re osteoporosis) I would want to take the highest dose I could tolerate (up to the licensed dose to help protect against osteo.. of 50 mcg).

Secondly if you are on continuous combined HRT -  and are postmenopausal - you can start a cycle at any time and the first day of oestrogen only will count as Day 1 (although in a normal menstrual cycle Day 1 = the first day of the bleed) and then take it from there.

Mary G suggested a longer cycle - which is what I also suggest to some women, under medical supervision - especially if you are on a low dose oestrogen. This is what I do and it works well for me - post-menopausal and in my 60's. There are several unknowns for you here - how you will react to Utrogestan and how you will react by using it vaginally. Using it vaginally research shows that more will get into your system than used orally and there should be fewer sdie effects, so ultimately a lower dose may be needed. It might not be such a good idea to start with a reduced progesterone dose as well as a longer cycle. Better to start with a bit more than you need - to keep the lining thin, see what bleed you get - and if necessary either reduce the dose or lengthen the cycle or maybe both - but this must be done under medical supervision.

Just to emphasise that the NORMAL LICENSED dose of Utrogestan is 12 days x 200 mg orally per 28 days which is the starting point for any regime and for discussion about reduction. Varying this is likely to be the exception - but we hear about it more on here probably because women come on to the forum with problems! The 7 day 100 mg progesterone Studd regime for even high doses of oestrogen is the other extreme - very low and associated with increased risks of endometrial hyperplasia.

I can't imagine your ordinary GP sorting this out so best to inform yourself and tell him! You could suggest that you start a monthly regime using 100 mg Utrogestan vaginally for 12 days - if your oestrogen dose is reduced to 37.5 mcg - and see what sort of a bleed you get over the next 3 months - and then take it from there.

Hope this helps

Hurdity x

[foreign body]

thanks Mary G. and Hurdity for your reply.
I have only scant bleeding with my regime, and not even every month. Hence my conclusion that i might need to increase the estrogen dose. I did try to add testosterone (androfeme) a couple of years ago but had to suspend it after 6 months due to its side effects (severe acne, hair thinning, sex libido that was out of control). We are all different and that's what makes finding the right dosage and combination of hormones so difficult. I am very thin, with little body fat, so maybe i don't absorb estrogen well. I settled on 10 days of utrogestan (100mg) because i i take it for longer, the side effects become unmanageable (slow digestion, bloating, constipation, headaches, acne, insomnia)

[Sarai]

Thanks Hurdity for that comprehensive reply. I am going to ask for estrodot patch 25 as I know it's the lowest. And see if the GP can cope with 100mg utrogestan for 12 days. Vaginally lol.
I'm worried because I never got a second hysteroscopy due to nhs changing dates and Drs. So in my head I still have the knowledge of a 6.6mm lining, which luckily Dr Currie said wasn't worrying. And the spotting which true to form came back exactly a month after the failed hysteroscopy, so like you said I clearly have a cycle back.
Assuming I get a bleed off the new regime how do we know if the lining has gone down? Do we need regular scans?
I'm seeing the gynae in March but not sure how it will go as he didn't approve of me being on hrt at all, but my rheumy agreed it.

[Hurdity]

Sarai - you won't know if your lining has gone down or not - but as HC says that was not particuarly thick. You are more likely to shed it on a cyclical regime if it slightly thickened on the conti one, but if you have unpredictable bleeding at any time - and you are post-menopausal - then this could indicate a thickened lining.

For instance I am on a 6-8 week cycle and I have never had any bleeding other than after withdrawal of the prog (exceot one year after intimacy but that wasn't due to thick lining) so I can safely assume my lining is fine - especially as my bleeds are not heavy.

You don't need to have regular scans if you are on a low dose oestrogen and the standard dose of progesterone - and that should be sufficient if used vaginally with that dose of oestrogen. Be guided by your bleeds. However if you want to put your mind at rest then no harm in having one once a year, if funds permit. Rememebr if you have a scan the best time to have it is immediately following your bleed otherwise the lining will have started thickening as part of the cyclical process of growth and shedding ( like in our normal menstrual cycles).

Hurdity x

[Hurdity]

Hi again foreign body - you don't need to have a heavier bleed as such - as this is only shedding whatever lining has built up over the month. If your usual monthly bleeding is light, then that means it mght be possible to increase your oestrogen dose to see if your general symptoms improve, without needing to increase progesterone too.

Hurdity x

[Kkay]

Hi

Ive used oestrogel for a few years, at the beginning it was the original oestrogel pump but now I only get the generic Oestrodose.

Is it my imagination or is this just not as effective?  Also thicker in formula, takes lomger to absorb etc.

Just thought I would ask others for their views.

Thanks

Linsey x

Hi - I realise your post was from a while ago and I'm not sure if you ever got a reply. It appears that Oestrodose is indeed not as effective for a small subset of women. There are a few of us on here who have remarked on it, Tempest and Annie and a few others. I feel the same way as you do. There's  a separate thread on this problem, perhaps you've seen that by now.

[knorman]

Hello I am due to start utrogestan/estrogel in a few days.  Trying the estrogel, as after a few false starts with Elleste Duet/Solo and a Femseven patch, it appears that oestrogen is causing me a problem (very intense burning, tingling tongue and lips), although originally we thought it was the progesterone in the combined tablet and patch. I should take the utrogestan 25 days out of a 28 day cycle, but in order to see if the oestrogen really is the problem, was going to delay taking the estrogel without the utrogestan for 7 days to see if symptoms reappear. I have had andomyosis in the past, so concerned about womb thickening.  This only occurred to me once I had left the Dr surgery so didn't ask the question at the time. Very nervous about the new combination as if this doesn't work, I'm not sure there are any other options left for me. I hope this makes sense!

[Linsey44]

Hi Klay or any other ladies getting oestrodose instead of oestrogel

Iff its any help here is topic /saga as to how i got my hands on the proper oestrogel


https://www.menopausematters.co.uk/forum/index.php/topic,38257.msg608939.html#msg608939

Linsey x

[Bellababe]

Hello Dr has prescribed Utrogestan to replace Provera as too many side effects with this. She wouldn’t advise taking it vaginally as not licenced for this,  but I read people are taking it this way so presuming it’s ok to do so? I would rather avoid going through liver, same as being on Estrogel.

[jillzrz]

Hi - I am 61 and after battling for 3 years of menopause torture, to get any hrt I have finally been allowed it!
But the doctor had no ideas and just gave me oestrogel and  Utrogestan With no instructions. Could I please get some ideas? So I am using 1 pump of gel ( I have read I can go to 2), and flushes went immediately. Last period was 18 months ago. So the utrogestan ? To take about day 21 for 7 days? So do I stop the estrogel when taking the utrogestan? Many thanks

[Dotty]

You can use up to 4 pumps of gel.

Post meno dose of utrogestan is to take for 25 days out of 28 although some ladies take it every day. Take it at night before going to bed . You use Oestrogel every day.