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[SarahJane1234]

thanks Sheila - as I'm using it vaginally I thought the dose was lower.  I'll check with the GP

[DS68]

Hi

I've been struggling with the utrogestan part of hrt - makes me feel awful. I had Tel appt with docs and she adviced me that as I am using 1 pump and a bit of gel.each day along with my age (52) I could take 100 ustg everyday instead of the 200.  As this may ease the symptoms. Does this sound right? Also does.that mean no gaps in taking.
Just want to be clear !
Thanks ladies

[sheila99]

If you use utrogeston every day it's 100mg anyway, the 200mg is if you use it cyclically (12 days per month). As conti it should be 25 days a month so you can bleed if you need to but I think many people take it every day. If you feel bad on utro the other option is to use a long cycle if you don't have a strong cycle of your own so you more utro free days. Again it's off licence so should be done with medical supervision. Would be worth trying vaginally if you don't already as there can be fewer side effects.

[Hurdity]

Anyone know of any research/papers about the dosage of utrogestan virginaly ? D xx

Hi Dawn20 - I dont know about virginally!!! (I love some of the autocorrect errors!!) 

However vaginal use of utrogestan - yes there are lots of papers. I made a thread of them which I bump every now and again so I will do so for you. I haven't updated it recenty with any later studies but the research is still valid.

The thread will appear at the top of this board but will soon drop down again if you don't see it.

There is this one about utrogestan being manufactured for oral and vaginal use: https://www.menopausematters.co.uk/forum/index.php/topic,45782.msg738193.html#msg738193

and this is the main one with all the studies:
https://www.menopausematters.co.uk/forum/index.php/topic,43633.msg696198.html#msg696198

Hope this helps and do ask any questions if you need to

Hurdity x

[Hurdity]

Anyone know of any research/papers about the dosage of utrogestan virginaly ? D xx

Hi Dawn, just wondered if you found anything?  I asked my GP about this, he looked into it and got back to me saying he is happy for me to use it this way, every other night.  He also gave me the option to use either the Utrogestan 100mg that I already had or to try Lutigest which is a vaginal pessary, (licensed for IVF treatment), same progesterone dose but less leakage.

befuddled - see the bumped thread...

Hurdity x

[befuddled]

Thanks for bumping this, Hurdity - really useful information.

Just a couple of other questions.  The studies seem to be talking about low or meduim doses of estrogen.  I'm on Estradot 50, is this low or medium?  What dose is a high dose?  Also, when i read that i should be having regular scans, how often is regular, and how long into hrt should that start?

This bit I've read a few times but not sure if i properly understand it -
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).

It seems to be saying  that  if you are post meno, with low levels of estrogen in the blood, the progesterone levels in the blood from oral and vaginal use don't differ much?  - But absorption is higher with vaginal use, isn't it?  I must be reading it wrong.

[Hurdity]

Hi befuddled

To answer your questions:

- 50 mcg oestrogen patch is regarded on average as medium dose - but absorption varies between different women.

- When does it mention about having regular scans? These are advisable for anyone who is using an off-licence regime and doesn't yet know how their uterus lining behaves under different progestogen regimes. Unfortunately the are only available on NHS under certain circumstances - notably abnormal bleeding.

- Your quote of the scientific paper. We need to unpick that a bit. The figures you quoted are referring to systemic concentration of progesterone from oral vs vaginal use. However when  the general words "Absorption is higher with vaginal use" are used to signify that protection of the uterus lining is better when used vaginally, this is referring to absorption directly to the uterus lining. So with vaginal application you avoid the "liver first pass effect" and the effect of digestion, because the progesterone is absorbed directly into the cells of the uterus lining - called I think the "uterus first pass effect" - ie it gets there before it is absorbed into the bloodstream.

In terms of uterine protection - research generally shows from limited studies so far- that this is the case: vaginal application of progesterone in general provides better protection of the uterus lining.

This is different from systemic absorption - which is quoted as serum concentration. It is the systemic absosption which generally accounts for the side effects that women experience from progesterone elsewhere in the body.

Some of the side effects ( eg the sedative effect of progesterone) arise from progesterone itself - so if systemic absoprtion from vaginal use is greater (in women with higher oestrogen concentrations), you might expect - on averge - the sedative effect to be slightly greater ( in sensitive women maybe?).

However the metabolic by-products from oral intake are far greater and at higher concentrations than with vaginal use and it is some of these metabolic by-products which also give rise to significant adverse side-effects in some women - hence the manufacturer's giving of the vaginal route as an alternative if side effects are experienced from oral use.

I must say I had not noticed (or remembered - I presume I must have read it once!) that difference in systemic absorption was minimal when women had low oestrogen concentrations - eg when post-menopausal. In practice though, most women would not be taking progesterone without oestrogen would they, if post-menopausal, so mostly oestrogen concentrations would be higher than this? I'm not sure therefore of the significance of that particular finding.

Does that help explain?

Hurdity x

[befuddled]

Thanks, yes, that makes more sense now. 

It's interesting  that the sedative effect may be higher with vaginal use,  i'd assumed it would have been lower like the other side effects. I wonder how many others are thinking the same, i'm sure i've read some posts from users who were thinking of changing to vaginal use because they were struggling with the sedative effect from oral.

That bit about the scans, i could have sworn there were a couple of other sentences in that paragraph when i wrote it!  I don't know what i did with them.   What i meant to ask was this.

 
i had spoken to my gp re vaginal use and he said to take it on alternate days, no mention of scans, but as you have said " These are advisable for anyone who is using an off-licence regime and doesn't yet know how their uterus lining behaves under different progestogen regimes."  I've only been using it this way for one cycle so far, so am reluctant to change things again and i'm due to speak to gp for review at the end of january,  but  is it safe to stick with alternate days until then?   How soon after starting this regime would a scan usually be done? How quickly could the lining build up and cause problems?

[brynton]

Hi there,
New to all of this and have a question about timing, which I'd be grateful for some advice on. Due to terrible peri-meno symptoms my doctor has advised Estrogel/Utrogestan. I was planning on starting estrogel on day one of my period (still having periods, sometime every month but often every 15 days). My plan is this:

Start estrogel, one pump per day, on day one of period
Start Utrogestan, 100mg to start with, from day 15 until day 28

My questions are:

1. What happens if you get a period on say day 15 - do you still proceed with the Utro? Doesn't this mess things up?
2. What happens when you stop Utro on day 28, do you geta bleed then?
3. Regardless of 1 and 2, do you take Estrogel every day?
4. Is it correct to start Estrogel on day one of my period?
5. Are there benefits to taking Utro every day, 100mg, rather than on days 15-28?

Sorry for all the questions but I'm confused and my doctor said to just start taking it! Of course as soon as I put down the phone I then had loads of questions and this group seems so much more knowledgeable than my doc, frankly, as so many of you have lived through this.

Thanks a million for reading.

[Dawn20]

Many Thanks Hurdity!  I’ll have a read of these papers and let my GP know.

I’m using utrogestan vaginally every night with no problems at the moment.

Thanks again, Dawn xx

[befuddled]

Hi there,
New to all of this and have a question about timing, which I'd be grateful for some advice on. Due to terrible peri-meno symptoms my doctor has advised Estrogel/Utrogestan. I was planning on starting estrogel on day one of my period (still having periods, sometime every month but often every 15 days). My plan is this:

Start estrogel, one pump per day, on day one of period
Start Utrogestan, 100mg to start with, from day 15 until day 28

My questions are:

1. What happens if you get a period on say day 15 - do you still proceed with the Utro? Doesn't this mess things up?
2. What happens when you stop Utro on day 28, do you geta bleed then?
3. Regardless of 1 and 2, do you take Estrogel every day?
4. Is it correct to start Estrogel on day one of my period?
5. Are there benefits to taking Utro every day, 100mg, rather than on days 15-28?

Sorry for all the questions but I'm confused and my doctor said to just start taking it! Of course as soon as I put down the phone I then had loads of questions and this group seems so much more knowledgeable than my doc, frankly, as so many of you have lived through this.

Thanks a million for reading.

Hi brynton, sorry i can't be of any help, i'm quite new to all this myself, but just thought i'd bump it for you, maybe someone else can help.

[sheila99]

You take oestrogel every day. Usual to start on day 1 but probably doesn't matter if you start before. Normally in peri you use a sequi regime, as your gp suggests, so it works with your own body. You normally bleed a couple of days after stopping utro though what your body is doing can put a spanner in the works. The timing of utro is more important so the hrt cycle stays in step with your own. I can tell when I ovulate so now I take it after that, for me sticking to a 28 day cycle didn't work. The manufacturer's dose is 12 days x 200mg, any variation should be done under medical supervision. Less need to worry if you're on low dose oestrogen (1 pump is low dose). If I bled early I tended to think my body had produced enough progesterone of it's own so I stopped utro and started the cycle again. I'm not sure this is recommended though, some people carry on with the 12 days. As long as you have a proper bleed I wouldn't worry too much. Using a conti regime can work well if you're late peri or meno. In early peri you're likely to get break through bleeding.

[brynton]

Thank you so much, Sheila, that's a great help.

And also to @befufddled for the bump.

[Arty22]

I am a bit like you @brynton and was put on low dose of one pump of Estrogel and one 100mg of progesterone as peri-menopausal and still having regular periods. I was advised to start the gel on day one and the tablets from day 15 to 26. To begin with I started my period after taking the tablets as expected then as the months went on my own cycle broke through and I was starting my period mid way through taking the tablets. I read on an earlier thread that some people take their tablets the same days every month I.e. 15th to the 26th of the actual month then you don’t get so confused. I do this now as my period comes when it wants to but at least I’m still taking the recommended (low) dose. Not sure if this is right or not but helps me remember! I’m due my first review next month so see where I go from there. You’ll certainly notice a difference with an ease of your symptoms though, the Estrogel works wonders for me 

[violetbat]

I am a bit like you @brynton and was put on low dose of one pump of Estrogel and one 100mg of progesterone as peri-menopausal and still having regular periods. I was advised to start the gel on day one and the tablets from day 15 to 26. To begin with I started my period after taking the tablets as expected then as the months went on my own cycle broke through and I was starting my period mid way through taking the tablets. I read on an earlier thread that some people take their tablets the same days every month I.e. 15th to the 26th of the actual month then you don’t get so confused. I do this now as my period comes when it wants to but at least I’m still taking the recommended (low) dose. Not sure if this is right or not but helps me remember! I’m due my first review next month so see where I go from there. You’ll certainly notice a difference with an ease of your symptoms though, the Estrogel works wonders for me 

This happening to me. I’ve been on this regime for a year now. Was still have periods when I started but they were not arriving every month.
For months I would just have a bed a couple of days after stopping the utrogestan.
These last 2 months my period have been annoying.
Last month I started bleeding just as I was about to start the tabs, so only 2.5 weeks after my last period. This month I have started bleeding 7 days into the utrogestan- 20 days after my last period.
Clearly my own cycle is breaking through. Pre HRT my periods were coming roughly 21 days apart. So the pattern is roughly normal for me.
I am hoping they will stop again soon.