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[Grizzler]

Sorry if this is an old one but would appreciate any comments/advice to help me decide.
Been on transdermal oestradiol and Medroxyprogesterone Acetate and found it absolutely fine for me, no progestone downsides and also never had a withdrawal bleed (had problems with progesterone only pill and Mirena coil though).
I was originally advised to go onto Utrogestan but then found out that it had peanut oil in it and as I'm allergic to nuts big-time I couldn't take the chance.
Reading the HRT risk research, it seems that maybe there's a reduced risk with the bio-identical progesterone in Utrogestan, so that seems to be the drug of choice over MPA, and now it seems that they've taken out the nut oil and put in sunflower oil, so I can take it now.
So - do I swap or not? (oh, and anyone found if it's upset their stomach at all - I have a bit issue with that at the moment...!)

Thanks.

[Hurdity]

Hi Grizzler

Firstly thanks for letting us know that the oil used in Utrogestan has now changed to sunflower oil rather than peanut oil - that's great news for those who have a nut allergy but want to take progesterone  . I don't think that has been commented on before ( but I might have missed it!).

It depends where you are in menopause, how old and how you take your HRT really. Yoy say you've never had a withdrawal bleed so that implies that you are on cyclical HRT because any bleeding on continuous combined HRT is usually some form of breakthrough bleeding. Also it depends how long you have been on it and how long you want to stay on it.

I was always nil-by-mouth for my HRT so used transdermal HRT from the start. After a 3 month trial with Evorel sequi when I discovered that norethisterone was not for me, I changed to progesterone and have been using it ever since. Nil by nouth means I don't take progesterone orally - but use it vaginally - although it is not licensed to be used this way for HRT in UK (but it is for fertility treatment). In France, this is recommended as the route of choice for those who have side effects from oral use. If you are using it continuously though - I wouldn't want to use it vaginally - for obvious reasons ie if you have an active sex life!

There can be problems with absorption of progesterone orally with some women, and also if you use it on a longer cycle this needs monitoring through regualr scans. Have you had a scan at all - in view of the lack of bleed? However it is usually bleeding rather than lack of it that is cause for concern.

Hope this helps and I am sure others will be along later to tell you their experiences - especially oral users of utrogestan.


Hurdity x

[Grizzler]

Thanks for the reply.

I take the Utrogest. oil (excipient) information from a Google search: Pharmaceutical Journal and Medicines Online - seems it changed around March/April 2015. BUT please check. I phoned Besins (the manufacturer) and they couldn't tell me!!  I would most definitely insist that the GP/pharmacy/dispensary double-checked the packs obtained as I suspect that there's still some older stock out there.

I'm not sure whether I want to use cyclical or continuous HRT at the moment, nor which is safest and best and most suitable for me (and my GP certainly doesn't know). I came off the pill nearly 2 years ago, just pre 50, and don't therefore know where I am or what's happening, cycle wise.
I had some spotting, discharge or mild bleeding last year (i.e. first year off pill and on HRT) , but that was a response to the progesterone only pill and since stopping that there's not really been a withdrawal bleed after taking 14 days of MPA each month (which there's meant to be) nor after a few months of not taking either that or the Oestrogel. I understand that a small % of women do react like this, and perhaps as I was on a fairly low Oestrogel dose it wasn't utterly unexpected.

I did go through the scan and internal investigations route last year because of the not-utterly-predictable-cycle issue (what a joyous experience  ) and all was OK bar a small polyp and fibroid, duly removed. No mention's ever been made of ongoing scans unless there is a 'suspicious' bleed situation again.

I think I've decided that I want to go back onto HRT after a test break without it, and I want to stay on the transdermal oestrogen (Oestrogel) as it seems to suit me and is 'safest' on many counts. I'm happy to stay on the MPA, either cyclical or continual, as it seems to suit me well enough: but I just wonder if the Utrogest. would be worth the trial/swap on 'safety' grounds given the bio-identical issue. It would be the oral route for me.

Not even sure if it's worth swapping, but I think that I'd be happiest knowing that I'd done what I can (on current thinking) to minimise HRT risks - I'm just interested, if available, in some feedback on whether others would stick with the known devil or take the chance with someting which might or might not cause several months of 'hassles'. Had a year of them already, between the hysteroscopy/polypectomy, Mirena coil and other new, ongoing, persistent health downers which might or might not be menopause related.

Cheers.

[Sunnydays]

Hi Grizzler
I was interested to read your post because this progestin is the one I've been given to use, but not tried it yet.
From posts I've read there are some ladies who, just like all the hrt variants,  tolerate Utrogestan  well and some who simply don't get on with it. I think if something works for you then it seems a shame to change as I wonder if there are any health differences between the two types. I think suiting you and alleviating meno symptoms is the priority.
I have a 25mg oestrogen  patch and I'd be really grateful if you could share the doses of both Estrogen and progestin you take and how long for etc.
Thank you

[Grizzler]

Sunnydays - the oestrogen which I'm on is the transdermal (skin) gel, called Oestrogel (17B Oestradiol). I really can't remember what the actual dose is but it's somewhere between 1 to 4 squirts a day (on the inner thigh in my case, first thing in morning). I started on needing 4 squirts, latterly was down to below 1 - but it can be varied according to symptoms. Let's say that 1-2 a day average was good for me.
The MPA was between 10 and 14 days a month at 10mg tablets (I recall - again, don't have them to hand).
I took the two of them for just under 2 years continually with nothing but good to say about it, and am pretty sure that I'm going to go back onto the same regime shortly. Just waiting to see if eiter I have any natural cycle left or if there's any change in my annoyed stomach (gastritis) issue which has annoyingly cropped up this summer.

I did initially get prescribed Utrogest. by the menopause clinic (the GP didn't know if progesterone was even necessary....) as their progesterone of choice but couldn't take it then because it had peanut oil in it, so they recommended MPA instead. However, they did not make me aware of any difference between either type of endometrial protection drug at all (risk or otherwise) and were only concerned with which one I tolerated best.

The reason I'm looking into changing is because there seems to be quite a feeling, possibly backed by some research which I've read, that indicates more natural progesterone preparations (e.g. Utrogest.) to be safer or to present less risk (especially as regards breast cancer risk) than the synthetic progestins (e.g. MPA).

[Grizzler]

Thanks.
Is there any signiicant risk/reason not to stay on the MPA for the time being and then try Utrogest. later? I think that I want to go back onto HRT again pretty much now, and the way that life and health's been lately - never mind Xmas and then winter holidays -  I just want it to settle down to acceptable/good again before messing around and potentilly having to cope wtih more changes and unpredictability, possible side effects etc. For various reasons, since coming off the pill and going onto HRT I've really only had about 6 months so far (in 2 years) of what I'd call stability of symptoms, cycle (or not, in my case) and it's just doing my head in, never mind all the other things going on with this time of life. If I can justify getting a bit of predictable stability then I think it's probably worth the small increased risk. It was a position which I was otherwise very happy with, so there is an arguement not to disturb that; but then again, if it's a more risky position... 

[Hurdity]

Hi Grizzler

I totally agree with Stellajane. You are not going to give yourself any risk in the short term - it is long term that the risks are thought to kick in. Like her I use utrogestan for long term safety reasons - I am in my 60's so go by the most natural route but if you are only using it for say 5 years and in your 50's then whatever suits you best.

Hurdity x