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[Faf]

Hi ladies. I'm new to this site although I've been reading it since September! I'm 46 and peri (apparently - I've been on prog only contraception injection and now implant so no periods for over 10 yrs). My GP prescribed FemSeven but they did stick. I read on here about oestrogel and Utrogestan so this is what I now have. I'm going to start on 1st December so it's easier to count the days (15 to 26 for the tablets). I am NOT going to take them orally so I think 100mg via the V route should suffice. The GP said 200mg orally (she told me not to us them as a pessary) but even the leaflet with the tablets says 100mg a day and "do not take a double dose to make up for a forgotten one" so I'd be overdosing if I took 200mg!! Does that sound right? Also the gel says "2 to 4 pumps daily as advised by your GP" except my GP didn't advise me!! I actually had a telephone appointment as she was too busy to see me until AFTER CHRISTMAS ! Anyway, my query for those of you in the know is this: 2 pumps per day of gel and 1 x 100mg tablet via the V route on days 15 to 26 of each month. Does that sound about right? I know all this has been covered before so I apologise for going over old ground, but I am just trying to get this correct before I start HRT on Monday. Any replies and advice/guidance will be greatfully received! Thank you in advance. 

[Joyce]

Don't know about ultrogestan as on oestrogen only. But I used oestrogel & starting point was 2 pumps per day. It can then be increased or decreased as necessary.

[CLKD]

Don't ever worry about asking the same questions, sometimes points can be missed or forgotten    ……. you could have a chat with a Pharmacist, those in Lloyds have private room these days.  Sounds complicated to me 

Have a read, menus left of screen; we have a funny room too, have you found us there?  Let us know how you get on!

[Briony]

Hi and welcome Faf! 

I am in a similar situation to you in that I too am in my 40s (42), peri and just starting HRT (a few weeks ahead of you so I am due to start the Ultrogestan this weekend). 

I have been prescribed Evorel 50 patches with 200mg Ultrogestan to be taken orally. Like you, I intend to take them from the other end, despite my GP saying they could only be taken orally. My concern is how much to take vaginally? Do I take the 200mg as prescribed? Or do I just take 100mg since it's going in via a more direct route? I already know I do not tolerate progesterone well, so the less the better as far as I am concerned. However, I want to know that I am taking enough to be covered and balance the Evorel 50.

Any advice much appreciated. Thank you 
 

[Hurdity]

Hi Faf

  from me too.

Well it is an old conundrum this utrogestan lark - but the truth is it will vary from woman to woman and where you are in menopause too.

I think a few weeks ago we discovered that the patient information leaflet is incorrect and someone contacted the manufacturers.  The mistake may have been made when Besins took over from Ferring, former UK distributor.

The Summary of Product Characteristics is correct:
https://www.medicines.org.uk/emc/medicine/19895

This is what it says:
Posology

In women receiving estrogen replacement therapy there is an increased risk of endometrial cancer which can be countered by progesterone administration. 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.

Your doctor is correct.

The translation of the french leaflet also says to use 200 mg vaginally if used this way (ie when side effects from oral use) but many women take less because of the "uterus first pass effect" ie goes straight to the uterus where it is needed, and research papers show that a lower dose can be effective in preventing endometrial hyperplasia.

Vaginal use is thought to have fewer side effects, but my view is that the vagina needs to be well plumped up and not atrophied, to minimise absorption in the rest of the body - but I have no evidence for this!

Personally, if you are starting with vaginal use I would take the full dose, to ensure it is effective and then maybe tweak the dose after a few months and see how your body reacts and how your bleeds are.

Sorry this is in haste as working tonight! 

Hurdity x

[Briony]

Really helpful, Hurdity. Appreciated, as always x

[Faf]

Thank you all for your replies and advice. I will do 200mg as my Dr told me..... although at a different entry point  ! So lovely to have the chance of good communication and ideas back and forth without it being crammed into a 10 minute appointment which you leave realising you'd forgotten to ask other questions. I'll be back.....!! I know I've got to give it at least 3 months so will update you as I go. Good luck to you Briony. Hope the Ultrogestan works for you. Faf

[Briony]

You too Faf xx