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[Diamonds and pearls 53]

Hi Ladies, I am back for a bit of advice please..I saw my G.P today after finally receiving the follow up letter from the NHS Gynae consultant I saw 6 weeks ago re some light bleeding on conti hrt which had ceased when I stopped the hrt. ( all scans,examinations etc were normal) Having been off hrt now for about 10 weeks and been suffering all the usual miserable symptoms of withdrawl I was very keen to resume,hoping to perhaps try a kinder hrt-patches or gel plus Utrogestan.
 I was worried my G.P would not want to prescribe this as we had already spoken about the Guidelines for over 60's  and I knew she wasn't keen. The consultant had referred me back to her care so now it was down to her! Well, armed with the info from this website and the advice I have gleaned  from the very wise Hurdity et al I managed to persuade her to let me try Estradot patches 25 mcg and Ultrageston capsules 100 mg.. I was so relieved!
But..this is the lowest dose,which she insisted on,and I am worried it wont be enough..also on the pack it says I have to take the ultrogestan every day for 25 days of my cycle..but as i do not have a cycle does that mean continuously? - and should I expect some sort of bleed?...I am confused! I also mentioned to her that I thought you could administer the Ultrogestan as a pessary ( which i preferred the idea of)  but she said that is only in the 200mg..is this correct?
I have only been given a months supply of medication and have to go back and see her again to monitor things but I feel it was a bit like the blind leading the blind..any advice gratefully received!
 
 Diamond and pearls x

[Hurdity]

Hi Diamonds and Pearls

Great that your doc has prescribed this for you!

The standard advice is to re-start on the lowest dose to see if you are symptom free on that. This happened to me. I came off HRT when my doc changed me to Evorel conti 2-3 years ago, because the Cyclogest I had been using was giving me migraines. It didn't agree with me (the Evorel) so I stopped HRT completely. When my symptoms came back after 3 months she suggested 25 mcg which worked for a while but then not completely so I went back to 50 mcg. (I recently reduced to 37.5 mcg in the summer because of the bleeding but again have gone back to 50 mcg which works like magic for me!).

The standard dose for continuous Utrogestan - ie those who are post-meno - is to take it for 25 days out of 28. I'm not sure of the reasoning here but it could be just to ensure there is no lining build-up. If there was then reduction in progesterone (on the three days) would cause a small bleed. In practice many women are prescribed and use Utrogestan continuously. You are very unlikely to get any thickening on that dose of estrogen and Utrogestan.

Re the vaginal use. In the UK it is not licensed for vaginal use as part of HRT, but the 200 mg is used vaginally for fertility treatments. The company leaflet (translated from the French) though, states that vaginal use is an alternative to oral use for those who suffer side effects. However I can't imagine one would want to use it all the time like this if in a sexually active relationship! I have never taken it orally but it does seem to affect my bladder when I use it (11 days in 6 weeks now) so this would be annoying all the time - but we are all different of course. Many gynaes prescribe it vaginally in UK for women who suffer side effects from oral progesterone.

Also it is generally accepted by many gynaes ( due to some studies) that less is needed when used vaginally because it is absorbed straight to the uterus where it is needed, so for example it may well be that 100 mg used vaginally for 11-12 days per month would be sufficient to keep the lining thin - but you may well get a small bleed in this case.

I hope this explains and is helpful - and good luck and hope you feel better very soon!

Hurdity x

[Diamonds and pearls 53]

Hi Hurdity,
Thanks so much for your prompt reply and your invaluable information-I  now feel reassured that I am on the right track! I just hope it works for me as I have been feeling so miserable. Just one more thing though..I also mentioned Oestrogel to my G.P as a possibility instead of patches and she said she did not think she could prescribe it but gave me the name of a specialist consultant at our local NHS trust so that I could enquire whether it was in fact available. I was quite surprised when she said this as i know lots of ladies on here use it-do you think it's down to cost in my particular area?

Diamonds and pearls x

[ellie66]

Diamonds and Pearls I have worked in the NHS and General Practice for years yes Oestrogel is availble my Pharmacist always has it in stock. Its the Utogestan that is prescribed less.

I would persue the Oestrogel I can't see why it would an issue. I did speak to my Pharmacist today and ask him to get some Utogestan in as my GP has put a script in the post as its not something the Pharmacist ever has scripts for but he always has loads of Oestrogel in stock. Its a village Pharmacy and only one village Surgery my GP is a colleague elsewhere near my partner.

[Dancinggirl]

Just wanted to let you know that Oestrogel should definitely be available through your GP - I used it for many years.  It's great because you can adjust the dosage to your requirements very easily. Oestrogel is on the list under HRT preparations so, if you want to try it, print off the info on this site and take it to your GP.
Good luck  DG x

[Diamonds and pearls 53]

Hi Ellie and Dancing Girl. thank you so much for your replies-I did think it was strange that she 'wasn't able' to prescribe Oestrogel-I can't help thinking it may be down to cost.
 Ellie, I shall have a word with my pharmacist and see if they stock it-they had to order in the Utrogestan but it came the same day so no problem.
Dancing Girl,you were one of the ladies I was thinking of when I asked about it as I remembered you saying how great it had been for you. I have to go back to my G.P. for a progress report so will take the printed info with me  and show it to her..honestly why does it all have to be such a battle?!
Happy New Year to you both ..I am certainly hoping for a happier one!

Diamond and pearls x

[Diamonds and pearls 53]

Hurdity, another question..sorry..re the Utrogestan, although the prescription dose is for 25 out of 28 day, the advice on the patient information leaflet is to take it from day 15-26 and I see a lot of other ladies on this site seem to do this. Is this because I am post meno and the shorter time period is if you still have a cycle? I am a bit worried too because I took my first tablet last night and then was wide awake and buzzing for the next 2 hours or more..this is most unlike me and I never experienced it on the combi hrt tablets.. very disturbed sleep too.. any ideas?

Diamonds and Pearls x   

[ellie66]

Diamonds I am Perimenopausal so yes that is why I am on 15-26 day regime. I prefer a cycle anyway to know where I am at. So even if I was postmenopausal I would continue as I am. Your choice really Hurdity correct me if I am wrong? 

[Diamonds and pearls 53]

Thanks Ellie, my G.P didn't explain dosage to me at all..and I was so glad to get the prescription that once I had it in my hand I shot out of the surgery as fast as possible! Tbh I am not sure she knew anyway as she had to keep referring to her medical book. .but she is very young..sigh!

Diamonds and Pearls x   

[ellie66]

Diamonds I agree so good you got the prescription we are knowledgeable here. If you are concerned emailed Dr Curry for £15 to check dosage. I agree re your GP run out of the door and keep a low profile 

[Diamonds and pearls 53]

I  may do that Ellie..will just see what Hurdity says first, she usually knows, thank goodness! Yes, I felt it was touch and go re the prescription-the G.P actually  suggested anti depressants instead as they were'less dangerous' ( due to my age ) but I was determined and she reluctantly agreed..but have only got a months supply so am praying I do not have any bleeding or she will probably insist I come off again.

Diamonds and pearls x

[Hurdity]

Hi Diamonds and Pearls

Here is the information from the SPC (summary of product characteristics) for utrogestan 200 mg and 100 mg:

http://www.medicines.org.uk/emc/medicine/19896/spc
 
The recommended dose is 200 mg daily at bedtime, for twelve days in the last half of each therapeutic cycle (beginning on day 15 of the cycle and ending on day 26). Withdrawal bleeding may occur in the following week. Alternatively 100 mg can be given at bedtime from day 1 to day 25 of each therapeutic cycle, withdrawal bleeding being less with this treatment schedule.

If you look at the information on this site (ie MM) you will see the same information - with the 200 mg given days 15-26 ( or 12 days per month ) if you are peri-meno, and 100 mg for 25 days out of 28 if you are post-meno (ie half the dose for a longer time period)
http://www.menopausematters.co.uk/to_progestogens.php

In practice as I think I've said elsewhere, many women are prescribed it daily when post-meno without the 3 days break. It would probably be best to take as prescribed, and if it suits you after a few months to check whether you have any bleeding on this regime, you could try taking it continuously - but perhaps mention to you doc if you do.

RE ellie's point - I am the same, as are others on here. Post-menopausal but choose to continue with a cycle even though I am 60. In fact as I went onto HRT before I was post-meno but was almost 54 the doc never changed my prescription and I didn't know (by age 57) that I didn't need to have a cycle, as I hadn't bothered to read up on it until the regime I was on caused me problems!

Hopefully you won't get any bleeding but sometimes this does happen initially on conti HRT and especially changing to a new type!

Hurdity x

[Diamonds and pearls 53]

Hi Hurdity,
Thank you so much for your reply,that makes things much clearer..I shall follow the regime as prescribed and adjust accordingly if I have any bleeding. Out of interest,do you know why it is suggested you take the Utrogestan at night, if taken orally (can see why if taken vaginally) as I felt  wide awake when I first took it -unless that was my imagination!..but it took me ages to get to sleep!

Diamonds and pearls x

[ellie66]

Diamonds I am wide awake when I take it too  If I use it vaginally it gives me a sore fanny so this would not be any use hehehehe 

[Diamonds and pearls 53]

 Ellie !!!...Lol