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[grumpyjane]

Hello all

After my Dr´s appt last week I´m home again. It´s a 900 mile round trip  And today, I´ve managed to find the last of the Estradiol I needed. So now I have everything how do I start??

Estrogel 60mg/100g - 2 pumps a day
Utrogestan 200mg - every other day, vaginally
Vagifem - one a week

This is how the Dr said I should take them but having read lots of what you lovely ladies have been writing, I think I should change a couple of things. ie Utrogestan - I need a break right, so I can bleed if necessary, even though I am post meno? and Vagifem, do I need to "load" it, ie. every day for 2 weeks then twice a week?

I appreciate that the doctor should be advising on this really but I´m abroad and it´s not quite NHS here 

Oh, and Vagifem in the morning cos it sticks to the vagina walls and won´t fall out  and Utrogestan at night??

J x aprehensive and hopeful aargh!

[grumpyjane]

Oh and one more thing.. how to get the Utrogestan far enough "up there"?  I´ve got one of those syringe type thingies you use to give pills to animals. Do you think that might work? 

[Cassie]

I dont think the Utrogestan is meant to be used every other day, you are bound to get a breakthrough bleed like that. I use the 100mg for 12 days of the month, if you want to have a bleed then you would use it like that. The gel is rubbed into your legs, I alternate legs, at night when I get into bed. To make things easier I usually use the Utrogestan from the 15th of each month for 12 days, then when one stops, a few days later you will get a withdrawal bleed.
Cannot assist with Vagifem but there are many ladies using it so someone will be along shortly to advise, All the best, am glad you are safely back, sounds like a huge mission to get your HRT....   Regarding getting it far up, no you dont need to, just put it in as far as it will go with your finger that will do the trick.

[Dancinggirl]

Cassie is right. How you use HRT generally depends on whether you are peri or post meno. If you are using 200mg Utrogestan then this should be every day for 12-14 days each month which should then result in a withdrawal bleed after the 12-14 days. You can use Utro continuously but this is usually 100mg daily for 25 days with a 3 day break before starting again and this conti version is usually used when in post meno.
I would start with just one pump of oestrogen daily and then increase to 2 pumps if you feel you need it.
Vagifem is usually used everyday for the first 14 days and twice weekly after that.
The leaflets that come with all these things should give directions.
DG x

[Mary G]

I use an applicator I got with some thrush treatment for placing the Utrogestan in the right place - it goes right up to the cervix. 

As for how often to use Utrogestan, that is a difficult one because it depends on how well you tolerate it and whether or not you are happy to have periods.  I was told that I could take 100mg vaginally every day with the Oestrogel (I now use two pumps every day) with no breaks for a continuous combined HRT which is more or less what your doctor has suggested - have you been given 200mg capsules? 

Alternatively, if you decide to have periods or the continuous regime does not suit you, you could take it for several days per month which will give you a withdrawal bleed.  I am severely intolerant to all types of artificial progesterone so I take the minimum which is 100mg vaginally for 7 days per month but you might want to do the same as Cassie and take 100mg for 12 days per month, just to be on the safe side.  It's important to try and take it vaginally, it works much better that way and you will have fewer side effects like breast pain.  If you take it orally, you will need a lot more to get the same effect. 

Hope that helps.

[grumpyjane]

Thanks for being so supportive!

After more homework today- and reading of leaflets, I've decided to start with Vagifem for 2-3 weeks and then if I  need it I'll add in a pump of gel too. I'll  take the Utrogestan 200mg for 12 days and allow for a bleed for 2 or 3 cycles, even though I'm  def post meno.

D day tomorrow!  I don't  know why, but I feel a bit like I'll be blasting off into space or something..  Like once I insert that first Vagifem there'll be no going back. Gulp.

J x

[Dancinggirl]

grumpyjane - If you just use Vagifem then you won't need to use the Utrogestan.  You only need to use Utro if you are using the systemic HRT -  i.e. Oestrogel.  Vagifem is very low dose so will not build up your womb lining.
I don't feel you should think of using hormones as a road of no return.  If you use Vagifem and find your vagina and bladder are improved then this is great.  If you then decide you need more oestrogen then adding some Oestrogel, then you will need to use Utro for 12 days per month to protect your womb lining.  At no stage is this something you have to continue if you don't like it.
As you are post meno then you will find you get some side effects as your body welcomes and adjusts to having hormones again.  Don't be frightened - you may be surprised how good you feel!!! Good luck  Dg x

[br350]

Piggybacking on this, I have read and heard that Utrogestin (Prometrium here in the U.S.) can be used -  the same oral capsule - by piercing the gel cap and then placing high up in cervix.  Is this really ok?  The outer gel coating of the Prometrium is designed to be digested by stomach acid. 

How can it properly leach out of the gel cap and get up into the cervix and uterus?   This does not make sense to me at all.  I have read about another specific vaginal form of progesterone that is designed for vaginal use only.   Can anyone comment on this?  I've read that many women use the pink or yellow gel caps (utrogestin/Prometrium) vaginally but don't get how this works.   Thanks for any info!

[grumpyjane]

Hi dancinggirl.
Oh really I didn't know that. Is it because it's  a relatively low dose and just used vaginally? (obviously doh) Mine are 25mcg.
I don't  feel it's an irreversible step, I think I'm still slightly brainwashed  by all the bad publicity. Hence why I'm  rather late starting. I'm  quite prepared to use Oestrogel - which I have ready on standby - I just think I want to start slowly.
So, I'm going to start Vagifem for a couple of weeks, see how it goes and if I feel I need gel I can start that, and the next day (15 of the cycle) start on my 12 days of Utro. Does that make sense?  I really appreciate your advice!
J x

[Pollie]

Grumpyjane - Vagifem will only treat your vaginal symptoms. If you want to relieve yourself of nightsweats etc you will need systemic HRT. Good idea to start them separately so that you can easily identify any side effects. If you are definitely wanting to treat your hot flushes I would be inclined to start with the gel and utro as you may find after a few weeks that solves your vaginal symptoms too and you won't need Vagifem

Pollie

[Cassie]

Depends what you wanting to use it for.....Tovahfell. The Utrogestan has a white rubbery outer layer which dissolves, not necessary to prick it open it dissolves vaginally and is fine to use that way many women do so.

[Dancinggirl]

Hi grumpyjane
You won't need to start the Utrogestan until you have used Oestrogel for 14 days.  If you just use Vagifem - and you could stick with Vagifem for a month or so to see if that is all you need - then you won't need to use progesterone at all. Vagifem is very low dose ( even 25mg ) so progesterone is not needed when using this alone. Are you UK based?
How you use what you have been prescribed depends on what symptoms you are trying to control.
If it is mainly vaginal discomfort that is the problem then if I were you I'd do 2 weeks of daily Vagifem then twice a week for 2-4 weeks. If you vaginal area is better with this and you don't feel you need to reduce other meno symptoms like flushes or nights sweats, then you could simply stick with the vagifem.
However, if you are need to reduce flushes and nights sweats then I would start both the Vagifem and the Oestrogel (just one pump Oestrogel per day to start with) and use 12 days of Utrogestan on a sequential basis to see how you feel over the next 2-3 of months. If flushes and night sweats are not under control then increase to 2 pumps of Oestrogel per day. You can take Utro either vaginally or orally - I take Utro orally last thing at night and it helps me sleep better which I find great.  Many prefer to use it vaginally but it can irritate the bladder. Using Vagifem and Utro vaginally together could be difficult(though possibly fine) and ideally they should both be used at night.

If you do take both Vagifem and Oestrogel with sequential Utrogestan and find you feel good on the Utrogestan (I feel great when taking Utro!!!) then you could change to using 100mg of Utrogestan daily for 25 days out of 28 (just leaving a 3 day break each month) and this would possibly result in little or no bleeding. Don't rule out taking Utro orally - if you need to sleep better then it does have a lovely sedative effect that I find has worn off well by morning.
You may find you get Utrogestan in 100mg pills so if you use it sequentially (12 days per month) you will need to use 2 at a time. If you do have 200mg pills then if you change to the 25 out of 28 day Utro regime then you will need to ask for the 100mg Utro pills.


TovahFell - I really wouldn't pierce the coating before inserting the Utrogestan/Prometrium pill - it apparently breaks done fine in the vagina and you might loose some of the contents and therefore not get the appropriate dose. In other parts of the world it is licensed to used vaginally.

I hope that is helpful ladies.   DG xxx

[grumpyjane]

Pollie and dancinggirl, you´re so right, I do have many other symptoms I want to control. VA is just one of them, and varies from cope-able to razor blades. Otherwise I have hot flushes, insomnia, tearfulness, irritability, clumsiness, brain fog and occasional severe fatigue.

So on second thoughts I´m going to start with one pump of Oestrogel a day and also continue with the Vagifem which I started this morning. Then on day 15 start the Utro 200mg for 12 days.

Interesting about the slight sedative effect of Utro dancinggirl - another thing I didn´t know. Going to try vaginally first and keep a check on any side effects. I´m not in the UK - Venezuela - but am due back for a visit in Feb so I´ll make a GP appt for then to get checked out.

Such good advice girls 

J x

[Hurdity]

Great information and posts here!

Just to add that I use utrogestan vaginally on a cycle (every two months) and when I do I put the Vagifem in in the morining and the utro at night. I wouldn't put them in together. My reasoning is that the utro could easily slip down and fall out (have had 4 children) so best at night. The Vagifem is designed to stick to the vaginal walls where it slowly releases the oestrogen so fine in the morning (unless you're going to do an energetic workout of course!).

Also the Utrogestan available in Europe is exactly the same product for oral use (for HRT) and vaginal use (in UK for fertility). Well the 200 mg dose was and I assume the 100 mg is manufactured in the same way also ie with the same coating.

As we have discussed before it dissolves fine - I always get a good bleed when I use it and my womb lining has been scanned a couple of times since starting utrogetsan and is normal.

Hurdity x

[Mary G]

grumpyjane, I would suggest you start using the gel straightaway.  If I remember rightly, it was a bit of a struggle for you to get hold of it so why not try one pump per day to begin with and see how you get on?  If it doesn't go well, you can always up the dose to two pumps or stop taking it altogether if you prefer. 

If you have vasomotor type symptoms, the Oestrogel is the only thing that will help, the vagifem is only for the localised vaginal problems. 

Good luck and don't be scared off by unfounded media scare stories!