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[Dancinggirl]

I think most women find Utrogeston makes them drowsy and dizzy so it's best to take at night - however there are some exceptions - everyone is different!  DG x

[Diamonds and pearls 53]

So ladies, especially Hurdity if you are around.. apart from the wakeful bedtimes,how long before I should feel a positive difference re my hot flushes and low mood? I have been on and off the low dose tablet hrt in the past and used to feel a difference within a few days whenever I restarted. This time, so far, nothing..in fact hot  flushes especially as bad as ever. As I haven't used this combination before I wasn't sure what to expect.. I know it's only been a few days but just longing to feel  better..

Diamonds and pearls x
 

[Dancinggirl]

I'm sure Hurdity will be along soon to advice but you have been given a very low dose of oestrogen and I think this will take a little longer to build up in your system to relieve symptoms.  DG x

[Diamonds and pearls 53]

Thank you Dancinggirl, That is what I am hoping

Diamonds and pearls x

[ellie66]

Dancing Girl I would say if you are still having hot flushes you are not having enough oestrogen. You may need to up the oestrogen. I found my hot flushes creeping back on 2/10 Femston but gone with 3 or 4 pumps of Oestrogel.

[Hurdity]

Hi there diamonds and pearls - there are lots of other women on here who know about this too! Dancing girl has answered your question - it's the side effect of drowsiness which means Utrogestan is recommended to be taken at night.  So if it wakes you up and that's the only symptom then maybe take it in the morning! Bizarre effect though - since it has a sedative effect - but maybe 200 mg is a bit too high for your metabolism or something ( really have no idea here...). Perhaps the metabolic byproducts (after going through the liver) are keeping you awake? I know it wakes me more in the night but that's because it affects my bladder, - I still wake feeling more tired than otherwise when I have the utrogestan, and that's even when taking it vaginally.

I think you only started on 31st which is Tues - it is a low dose of oestrogen but it is early days to notice a difference. You can't say the dose is too low yet I would have thought. After stopping HRT for 3 months I went back onto 25 mcg patch which did eventually stop flushes - I began to notice after a few days), but then they started to return ( over a longer time - several months) so went back to 50 mcg.

As you are the same age as me and well post-meno, you have almost no oestrogen of your own so as Dancinggirl says it may well take longer, so personally I would stay on the 25 mcg patch for a while longer and see how you feel - I really would expect you to notice some difference soon - but we are all different!

Hurdity x

[Diamonds and pearls 53]

 Thank you Hurdity for your advice..and Dancinggirl and Ellie too. Hurdity, it is just that as you are on the same regime you were the first person I thought of to turn to for help!
 In the pack instructions it says to change the patch at night time and to take the Utrogestan at the same time but perhaps I will swap to mornings If I continue to feel so wide awake..I am only on 100 mg of Utrogestan at the moment so goodness knows how awake I will feel if the amount is increased! ( as I imagine would be the case if I were to be  given the next strength patch?)
Hopefully the flushes will begin to abate once I have a bit more oestrogen in my system,as has been suggested. I guess things calmed down more quickly with the pill hrt as the dose was higher ( even though it was classed as low dose) Fingers crossed!

Diamonds and pearls x
 
   

[Dana]

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

Hi Hurdity

You actually covered some questions I was about to ask.... you must have been reading my mind...lol...

I'm currently following the same routine that (I think) you are still following which is 200mg x 12 days x vaginally every 2 months, but frankly I'm getting tired of having a period even if it's only every 2 months. My period isn't that dramatic. It's heavy-ish maybe on day 2, but it's then pretty light for maybe a total of about 4-5 days.

As you may remember, I am also tapering my diazepam dose (now down to about 0.6mg, but still got a few months to go. It's a slow process....), and I now find that I'm less frightened of taking the Utrogestan because it doesn't seem to be giving me any problems, even taking the 200mg. Prog can be a benzo agonist (or vice versa), so I think that is why I had trouble with it when my diazepam dose was higher.

My problem is that Utrogestan STILL isn't available on prescription in Australia, so I have to obtain my supplies by other means (shhhhh). So, even though my doctor knows I'm using it, I can't ask her any questions because she's not experienced with it at all. So I need to rely on you (and the other ladies here) to give me the latest thinking on Utro dosing.

I have been toying with the idea of taking Utro continuously (to avoid a period), but I wasn't really certain what would happen during those 3 days when you stop taking the 100mg. So two questions..

1. Would it be acceptable, do you think, to just keep taking 100mg everyday without taking a break at all? (You did mention that above, but I just wanted your expert opinion).

2. Doing the vaginal thing isn't too much of a drama, but when it's everyday I'm wondering if I would get pretty fed up with that too. I've never taken Utrogestan orally, but I'm wondering how successful others have been taking it this way.

[Hurdity]

Hi Dana

Sorry I missed your post - when I am not on the forum for a couple of days sometimes I don't catch up as it's always the most recent ones that come up! When you've done a few more posts you'll be able to send me a pm if you want to get in touch!!

I used to be on a 2 monthly cycle but when I had the bleeding (actually found to be due to an ectropion) and they found a thickened lining after a scan I reduced to a 6 weeks cycle. Now that really is a pain, taking Utrogestan that often and then the bleed week. I didn't mind the 2 months, so tentatively thinking of going back to that - maybe a week at a time and see how the bleeding goes.

Glad to hear Utrogestan seems to be suiting you though - many women are finding this even after problems with other synthetic progestogens. How frustrating that this product nor anything similar is not available in Aus - is there no-one putting pressure on the authorities (whoiever decides this is Aus?) to introduce it? I am sure buying it is cheaper than paying to go to a private practitioner and being prescribed compounded progesterone which I presume is what many have to do in your position?

Re taking Utrogestan continuously without the 3 day break, I don't think my opinion is especially expert and I haven't taken it like that. However there are definitely some members on here that do - hopefully they will come forward, and are prescribed it like this by their GP - or perhaps it is just the specialist gynaes, private or otherwise.

However there is a paper about a small study in 2005 of a group of 30 women using gel (1.5 mg Sandrena) and vaginal progesterone 100 mg alternate days which showed this was effective in preventing endometrial thickening. Although it was a very small study and can't say how you would react, it is a promising result.(unfortunately can't attach it)

I would suggest you try the 100 mg daily vaginally and see how you go when you stop for the three days maybe? Personally given the above I would imagine in most post-menopausal women without other problems ( eg fiibroids) and especially if not very overweight, there is more than enough progesterone when used vaginally. If oral use requires 100 mg daily then I can see that alternate days for vaginal use could give the same dose to the uterus if not more.

Re daily vaginally use - I wouldn't do this - it's certainly no good for sexually active relationships anyway! Also it does affect my bladder so have to get up a couple of times in the night.

Re oral use - I think that question got lost at the bottom of your post as it was probably directed to others - but if you do a search there will be lots of threads about utrogestan. If you want some thoughts from current members why not start a new thread on this specifically?

There is also another recent thread I think with utrogestan in it - something like Estrogel and Utrogestan support group so do have a look at that one too.

Hope this helps and good to have you on board with the utrogestan/bio-identical HRT crew - there are more and more of us I'm glad to say!

Hurdity x

[Dana]

Thanks for the reply.

The latest I've heard about Utro's availability in Australia is from the Aust Meno Society, but they said "There are sometimes mixed messages so we have not heard yet if there are any developments on this issue". I have no idea what that means, but they have given me a contact for a pharma company that has a particular interest in hormones, so I'm going to contact them to see what they have to say. I think it all just becomes a bit political TBH. I don't mind getting it from my sources, but I just feel sorry for other Aust women who don't even know that a non-synthetic, non-compounded prog is even available.

I did try the alternate day routine quite a while ago, but never had much luck with it because I was still getting some break through bleeding even after a few months. Maybe I needed to give it more time though, but patience is not my best virtue..lol....

With my current cycle of Utro, I've now done 7 days x 200mg with no ill effects, so I may just stick with this routine for the foreseeable future. If I was to go to the continuous routine I don't think I would like to use it vaginally because it can get a bit messy after a while.

OTH, I'm not sure how I feel about taking it orally either. An American friend of mine is taking 100mg Prometrium orally every day and seems to be doing okay. I guess I'll just have to try it to see how it works. Once this cycle is finished, it might be a good time to try some experiments.

[Diamonds and pearls 53]

Am feeling anxious..have been doing well on 25 mcg Estrodot patches with 100mg Utrogeston and my symptoms have been much reduced (I started this on Jan 1st after an enforced break from my tablet hrt whilst bleeding issues were investigated)As scans etc proved clear my GP reluctantly  allowed me to resume hrt  and I chose to follow the patches plus Utrogeston regime, largely on the advice from ladies on here.
So far so good, until tonight when I noticed a slight pinky discharge...just like before...and my heart sank.
I take the Utrogestan for 25 out of 28 days but am only on day 20 so don't understand why this might have occurred,especially as the oestrogen dose is so low.. any thoughts anyone? Am feeling so down- I really don't want to have to come off hrt and I am scared my G.P will insist I do ,especially in view of my age.(60)
Diamonds and pearls x

[Sarah2]

I think you have mild breakthrough bleeding caused by the Utrogestan.I wouldn't worry because all your scans etc have been fine and since then you have only been on a very low dose of HRT.

My experience of Utrogestan is that I start bleeding before I've finished the 10 days per long cycle ( usually on day 9) This is I think due to the poor absorption- it's not well absorbed orally so you can get some dips in the levels in the blood stream which could initiate a bleed.
When I took Norethisterone ( for 5 years) I didn't bleed until 3 days after the last tablet, each cycle.

I am now trying another regime with Utrogestan because I had severe period pain with the last couple of long cycles. My gynae has suggested taking 100mgs  21 days per month, or 15 days if I have side effects. He did suggest I could take it every day to prevent any bleeding but I prefer to have some sort of period - as long as it's predictable and this is yet an unknown for me with the new regime!

 I hope that I may be able to tinker with this a bit and maybe go back to 5 or 6 week cycles rather than monthly.  Like you I am wondering if this will bring on any breakthrough bleeding.

What you have is, I'm sure, just some breakthrough bleeding due to the absorption .

Re. your previous query over the prescribing of Oestrogel- if you ever wanted this and your dr refuses, you could try asking them for a private prescription. (NHS drs can give these.) You could then buy the Oestrogel and the cost may not be much more than the prescription fee. I pay for all my own HRT as it's a private prescription and the gel is about £9. This includes the pharmacist mark-up and dispensing charge.

[Dancinggirl]

Hi D&P53 -when on continuous HRT, as you are, it is very common to get some spotting of even a bit of breakthrough bleeding, so I really wouldn't worry.  If you get prolonged bleeding then this needs to be investigated. As your GP is so against HRT in the first place I wouldn't rock the boat by rushing in with the slightest worry - just adds fuel to their opinions.
I had a Mirena and Oestrogel for over 4 years - I had tried various other conti HRTs.  All the conti HRTs I tried gave some break through bleeding for the first few weeks or months and with the Mirena I had breakthrough bleeding and then spotting for about 5 months before it settled down. I always got the occasional spotting, as you are describing, at various times.
If you taking the 25 of 28 day regime of Utrogestan I believe it is not unusual to get a bit of a bleed after the break of Utrogestan - but as suggested by other, the absorption of the Utrogestan can sometimes vary so could cause some spotting.
Don't worry.  DG x

[Diamonds and pearls 53]

Hi Sarah,thank you for your reply, I sincerely hope that it is just breakthrough bleeding-it is just the teeniest bit of pink,not even enough to stain a pad but it is there when I wipe. I will see how I go after the 3 day break from Utrogestan which is in 4 days time. I am not going to rush back to the GP as I feel sure she will insist I stop hrt (due to the dreaded age 60 cut off) and I have only just started to feel relatively normal again...
Interesting to hear about your experience-I had thought about long cycle but when I mentioned this to the GP I was met with a blank look..sigh..I do hope your new regime works well for you,I would like to take less Utrogestan but it does not look likely now if I am having signs of a bleed on such a low dose of oestrogen.To be honest I shall be grateful to be able to continue  in any form as i was an emotional wreck without it!
Thanks for your advice re Oestrogel-I did enquire further and my GP sought advice and confirmed I would be able to have it prescribed if I wished.I hadn't pursued it as I'd been doing well on the patches-until now! It may be another avenue to consider though.
Diamonds and pearls x 

[Diamonds and pearls 53]

Hi Dancinggirl, Thanks so much for reassuring your advice-I  am just paranoid about being told to come off hrt and as you say, any excuse where most GP's are concerned, especially for the over 60's!
I shall wait it out a bit and hope it settles down. I have only been on this regime for 10 weeks so I guess it is early days.It just seemed odd that it happened 4 days before the 3 day break instead of during or after.Oh well,I shall try to stop worrying and hopefully things will settle down.
Thank you again for your reassurance.
Diamonds and pearlsx