Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Sarah2]

D&P
Sorry to butt in, but no that is not the case with vaginal use=long cycles only.

In the UK it isn't licensed for vaginal use except as part of fertility treatment I think ( though in France it can be used for HRT vaginally) but some women use it this way with the agreement of, or on the recommendation of their specialists.

I have been using Utrogestan for around 9 months as long-cycle progesterone, taking 200mgs x 10 days every 8 weeks- orally. My specialist was happy for me to use either route ( he is very familiar with the drug) but as I already have bladder sensitivity I prefer the oral route.

The reason some women prefer to use it vaginally is that the absorption is better sometimes.

I think I mentioned on this thread or another one that I started bleeding on day 10 rather than 2-3 days after stopping it ( each long cycle) which made me think the absorption was erratic. My dr did tell me that Utrogestan can give erratic bleeding- I was warned in advance!

I am now trying a different type of cycle due to bad period pains- won't bore you with the details- but a shorter cycle and 100mgs Utrogestan over more days.

[Diamonds and pearls 53]

Thanks Sarah, I am learning all the time! I guess a shorter cycle with Utrogestan being used vaginally (plus a bleed) might not be to everyone's taste each month..whereas 10 days every 2 months plus a bleed isn't so bad..I am not sure what to do- I have still got a bit of pinky discharge on and off,just like the beginning of a period,and I feel pre menstrual too.Will  hang on and see if things settle down,if the absorption is poor maybe that's the problem. On the website it says this type of regime can take up to 6 months to settle ..I really hope it hurries up!
Diamonds and pearls x

[Hurdity]

Hi Diamonds and pearls

That's exactly it - most would not want to use vaginally that often - for me 12 days in 7 weeks is more than enough!

Re the dosage - the licensed dose is 200 mg x 12 days per 4 weeks orally.  As I've said already, if not on this thread, then on another, any major deviation from the licensed dose needs to be done carefully and under medical supervision. I doubt whether any NHS doctor would agree to 200 mg x 10 days orally every two months, because this is more than 3 times the length of time on unopposed oestrogen than the licensed dose. Personally I wouldn't want to be on this dose - well I would, but wouldn't countenance it!

If you are under a private gynae then as I've said before you can have access to regular scans to check for endometrial hyperplasia - but of course once you've been prescribed the hormone you can do as you like - but with caution and vigilance if you are on NHS as many of us are on here.

Hopefully it will settle soon!

Hurdity x

[Sarah2]

Hurdity and D&P- just to clarify- the dose was 200 x 10 days on an 8-week cycle- so the bleed was after 8 weeks, not after 10 weeks. I suppose the correct way to describe this is a 6-week cycle. However, I am 'allowed' to take that amount every 6-8 weeks and I trust my gynae to know what he is doing - he's aware of the hyperplasia risks.

I think this is the same or similar to several women on the forum who are deviating from the licensed 12 days from days 15-26 as a  monthly regime?

John Studd recommends 100mgs x 7 days (700mgs in 4 weeks) over a 4 week cycle.   200mgs x 10-12 days ( 2000mgs) over 8 weeks ( bleed week 8 ) is more than double that amount.

I don't know how other people access repeat prescriptions because I have to contact my gynae for a prescription each time I need more. He will check my notes of what I had when. He prescribes 2 months at a time and does a review every 6 months, in person.  The Utrogestan are dispensed in a way that I am given pretty much the amount needed ( adding in a few extra sometimes depending on how they are packaged) because I have to pay for each tablet, rather than a pack, though sometimes a pack is needed.

[Diamonds and pearls 53]

Thanks Hurdity and Sarah..I really appreciate your patience in trying to help me..I do find it all rather daunting and confusing-it was so much easier to just pop a pill with my old regime but of course that's not an option now! just one more thing..as my dose of 25 mcg estradot is so low do you think 200mg prog taken orally over 10 days would be too much? Would love to try the 7 day 100 mg dose that John Studd recommends, and that Sarah mentions..but don't think my GP would agree somehow!
Ladies, thank goodness you are there to advise me,it makes me feel less alone in all this,thank you!-will doubtless be back with more questions!

Diamonds and pearls x

[Sarah2]

My honest answer is- I don't know! It does sound a lot but then I am using around 1mg or less of Oestrogel daily which is a low dose too- equivalent to a 37mg ( mcg?) patch.

How are you planning to do this- are you going to go to your dr and ask or are you going to adjust the dose yourself?

[Diamonds and pearls 53]

Sarah, I don't think I had better self medicate-I shall persevere for a bit with the conti regime and hope things settle. If not,and the bleeding /discharge continues I shall have to go back to my G.P and ask her about adjusting the dose. I may also consult Dr Currie ( as Hurdity suggested in an earlier post) and see what she recommends.  I just want to find a way of staying on hrt, if I possibly can!
Diamonds and pearls x

[Hurdity]

Sarah - if you are taking 200 mg progestogen for 10 days in 8 weeks then it is an 8 week cycle.  Regarding how much you are prescribed, as you are under a private gynae so yes you can be closely monitored. It is still less in 8 weeks (2000 mg) than the licensed amount for 4 weeks (2400mg), I agree this might be excessive for some doses but it needs to be done under medical supervision as you do.

Also I have to re-iterate that John Studd recommends 7 days of 100 mg progestogen (Utrogestan) in his discussion about progesterone intolerance. I repeat that anyone who is seeing him will have the benefit of regular private scans for which they will pay, to check the womb lining. I would not suggest any woman just decides to do this without medical supervision and if she cannot afford regular (annual) scans.  Also since the amount of progesterone to oppose the oestrogen building up the womb lining, is dose dependent - this 7 day  x 100 mg dose can't possibly apply to all doses of oestrogen! Nor does he distinguish (well on the section of his website I was looking at!) between oral and vaginal use which will make a considerable difference to absorption and action on the womb lining.

Having said all of this Diamonds and pearls, you are on a low dose of oestrogen compared to most women on HRT, and therefore will need less progesterone - other things being equal, so it may be sufficient.

I think you will find Dr Currie will recommend continuous combined HRT, but perhaps if you consult her, give her your reasons for wanting to be on a cycle and see what she says. Hope it is all successful!

Hurdity x

[Diamonds and pearls 53]

Thanks again Hurdity, I am more than happy to stay on the continuous combined hrt but just want to eliminate the bleeding..if Dr Currie were to advocate that I continue with this do you think she would advise an increase in the oestrogen or slightly less progesterone?
Diamonds and pearls x

[Sarah2]

Hurdity- I'm confused! if you yourself take 2400mgs for a 6-7 week cycle then is that not less than the licensed amount  because you are not having a 4-week cycle where it's taken from day 15-26 every 4 weeks? Apologies if I've misunderstood what you have said.

If I take 200mgs x 10 days after 6 weeks ( bleed follows roughly 12 days later) than that surely is a 6-week cycle the same as you are doing?

I don't think my dr prescribes on the basis of always having scans. obviously they are available as required, but not as routine if there is no need, he's very aware of the risks of hyperplasia and we discuss the best balance to try to achieve. Would you be unhappy on the dose that I am on?

[Hurdity]

Aaaaagh!

The cycle is the total number of days of oestrogen added to the total number of days of progesterone! If you take 6 weeks of oestrogen + 10 days progesterone = cycle of 52 days which is about 7 1/2  weeks. In the menstrual cycle Day 1 is the start of bleeding, Day 29 the start of the next bleed and within that 4 weeks you have had the oestrogen and then the O and P....

If you look down at my post to Diamonds and Pearls about 12 below this one I explain the difference between the vaginal dose vs oral. There is no licensed vag dose in UK for HRT as you yourself pointed out. I explained how I arrived at what I take and is based on research I've read re absorption. I don't have the refs to hand. I've read about this over the last 3 years.

During the discussions with Diamonds and pearls we have been very careful to distinguish between oral and vaginal doses, and I have explained my dosage and the reasoning carefully. Please don't confuse the issue Sarah!

Re the 7 days - this is what the British Menopause Society and Women's Health Concern Paper says and it relates to progesterone intolerance:


One of the main factors for reduced compliance with HRT is that of progestogen intolerance........

The dose can be halved and duration of progestogen can be reduced to seven to 10 days to minimise progestogenic side effects.

This may result in bleeding problems and hyperplasia, so there should be a low threshold for ultrasound scanning and endometrial sampling if clinically indicated.

Re your Q Diamonds and pearls - I appreciate your asking me and I try to help based on my limited knowledge, reading and experience, but Dr Currie is a top gynaecologist and I would not remotely begin to presume what she would advise! I said what I did because I had a consultation with her last year and this is what she advised me - based on my circumstances.  Let's just hope for your sake that the bleeding stops !

Hurdity x

[Diamonds and pearls 53]

Hurdity, I really do appreciate all of the help and advice that you have given me.I should have realised that my question was an impossible one for you to answer-sorry! I will wait a little longer and as I said earlier, I won't adjust the dose without medical advice but will probably have to go back to my G.P if things don't settle down soon.I have my 3 day break from prog starting tomorrow so it will be interesting to observe whether anything changes...we will see!

[Diamonds and pearls 53]

Am feeling really despondent today, still got bleeding on and off and its now a week since this started..not sure how long I should leave it before going back to my GP. I feel sure she will just follow the guidelines of sending me for tests again, and will not be open to adjusting the hrt. Don't know what to do for the best.

Diamonds and pearls x

[Night_Owl]

Hi D&Ps 53 - Not sure if this will be of any interest/relevance but thought I'd let you know anyway, if anything by way of comparison of another type of long cycle regime.

I'm highly progesterone intolerant and have attended a London hospital meno clinic since 2009 trying different types of HRT - and have been searching for a bearable long cycle regime.

As we know, we're all different (I'm 51, 7 years post meno, suffer with migraine too since meno which complicates things further) and have been on this regime for a while now: 

* HALF Estraderm patch 25 x twice weekly.
* Vagifem 10 x twice weekly.
* Utrogestan 100 x 12 every six weeks, vag route.

(I also take a range of supplements including fish oil and magnesium.)

I usually have no withdrawal bleed or just something slight.  I can't bear to have bleeds and did when I was on higher estrogen and didn't feel any better with the increased dose.

My symptoms are not too bad on this low dose trickle of estrogen however I do suffer when on the dreaded Utrogestan.  For me it's the Least Bad Option (often discussed on here for those of us who are prog intolerant).

On this very low dose of estrogen, the clinic still insist on TWICE yearly scans. 

I hope you manage to find a suitable regime.

Night_Owl
x

[Diamonds and pearls 53]

Hi Night Owl, thank you for your message, and for details of your regime.I am actually on a conti regime at the moment of 25 mcg estradot patch 2x weekly and 100 mg Utrogestan daily for 25 out of 28 days. This is  a new regime for me after having to stop my tablet hrt due to investigations for bleeding issues (3 times in the last year and which stopped each time I came off hrt) All proved normal  but the consultant wanted me to stop hrt due to my age (60) However he agreed to refer me back to my GP'S care and I persuaded her to let me try the separate oestrogen and prog hrt as this was recommended on here.However 10 weeks on and the bleeding has started again.
I am not sure whether a long cycle regime would be better..I was just looking at options.To be honest I suspect my GP will strongly suggest that I come off hrt altogether this time.
Your dose of oestrogen is very low,do you find that is enough to control meno symptoms-hot flushes etc, also how does the Utrogestan affect you in the prog phase-does it make you feel very premenstrual?
 Do you mind saying which London meno clinic you attend and do you find them sympathetic? They are obviously very thorough if they insist on twice yearly scans on such a low dose of estrogen! I was wondering about asking my Gp  for a referral and am in SE London myself so your clinic might be one i could consider.
Many thanks for the information,it is interesting to see how different everyone is!
Diamonds and pearls x