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[Hurdity]

Thanks for the update SusieJ - glad your consultant is suggesting this flexibilty. Women like you reporting on what their consultants have said, are very helpful to the rest of us who haven't (yet) seen a specialist so that's brilliant and reassuring (re the longer cycles). Of course all our bodies react differently and some of us may have more uterine problems (eg small fibroids) meaning a long cycle may end up leading to heavier bleeds - but it's great to have feedback from what all the different gynaes are saying.

Hurdity    x

[Sunnydays]

Hi I was googling effects of taking Utrogestan vaginally (didn't know if it might have a negative effect in the vagina walls after a while) and whilst I didn't find the answer I came across this post that I found really interesting and I wondered if Susie J was still out here and how getting on with the cycle? And Kittyjay you mentioned that you sometimes take it orally during a cycle and I wondered if that still works for you? 

[SusieJ]

Hi Sunnydays!

I am still here but only occassionally remember to look at posts so I'm really pleased I found yours so quickly!

There isn't any evidence that taking utrogestan vaginally has any harmful effects to the skin or vaginal walls, but the reason it isn't licensed here for that route is that there isn't enough research to show that it works for it to meet the standards of drug licencing. It's also curious to me that the recommended dose doesn't change if you have a smaller dose of oestrogen (as other progestins reduce with smaller oestrogen dosage) and having discussed this with my specialist doctor she said this was for the same reason: there isn't evidence yet of what a safe reduced dose would be. There's also no evidence yet on whether peri-menopausal women (like me) have enough of their own hormones for a lower dose to be safe. So, this means that she's relatively relaxed about me being flexible with route and dose, as long as i go back for annual scans.

At the moment things seem to be working really well for me, but it has taken some adjusting. I tried the 200mg cycle that I mentioned here, trying the vaginal and oral routes, and tried extending the cycle too. However, I found the fatigue side effects to be absolutely overwhelming in every variant and had to stop. I wondered if the problem was a culmulative build up with daily use, and after discussion with the specialist, I decided to try taking 100mg every other day. This is a conti regime, but it is obviously only just over half the recommended dose (I don't take a three day break). However, even here I found myself getting increasingly exhausted. My Dr was confused about this as it is such an extreme reaction, and I seemed to be tolerating it less well rather than getting used to it as I went on. She suggested I got tested for everything else just in case the fatigue wasn't drug related: I did this for a belt and braces approach though it was clear to me the fatigue coincided with utrogestan and stopped a few days after I stopped taking it. The obvious answer to me is that I am metabolising the drug slowly and it is producing culmulative effects even with a day off in between. My GP and the specialist both thought this was possible as women do metabolise drugs differently, and this could also be that i have some of my own hormones knocking about producing a progesterone overload. So: the upshot is that I am still taking it, and have been given permission to play around with the dosage as I go. At the moment I am having no issues at all taking it every two days for two doses, then at three days for one dose, then at two days for two doses, and so on. I've also reduced my oestrogen dose a little to 0.75mg (again, in discussion with the doctors) as I thought it might reduce the risks a little further, and am having no issues there either.

I haven't had any bleeds in four months which suggests that it is doing its job, though of course the extent of side effects and bleeds aren't a reliable indication of whether it is actually protecting the endometrium, and I'll only get a better sense of this when I go back for my scan in November. And the positive side is I feel absolutely fantastic: sex drive back, energy and all that - i feel like myself again, only with better skin! 

I'm not in a relationship just now so I haven't had to negotiate the partner/drugs issue I initially wrote about, but as I've found a way to manage utrogestan orally I hope this won't be an issue. I'll keep you all posted though...

Does this help? How are you getting on?
All best wishes
Susie

[Sunnydays]

Thanks for taking the time for such a full reply Susiej and I'm so glad things have turned round for you - great!
I'm taking Utrogestan vaginally and I don't seem to get a negative effect - not even the sleepiness - which I could do with a bit of as my sleep is so poor.  I had a blip a couple of days ago as I discovered that alcohol (even small amounts) don't work with Utro  for me and I thought I was having a massive side effect, but this has now passed.
Keep us updated on how things go for you.

[foreign body]

yes, unfortunately utrogestan and alcohol don't mix well. When i am taking it one small glass of wine is my limit, two glasses result in a hangover. Meno is no fun!

[Night_Owl]

Hi SusieJ - just to says thanks for the update and useful information - it's always good to hear how others cope with taking Utrogestan.  Interested to read that you've found a manage-able and creative way to take Utro in a way that your biochemistry can cope with it, mini-breaks in between usage.

"... However, even here I found myself getting increasingly exhausted. My Dr was confused about this as it is such an extreme reaction, and I seemed to be tolerating it less well rather than getting used to it as I went on".

That's the thing with progesterone - for some women there is no 'getting used to it' - and the cumulative effect kicks in after continual use of a a few or longer days.  Exhaustion and tiredness, almost like sedation, is a definite side effect of Utro and it's surprising that GPs have not heard of this.

"... The obvious answer to me is that I am metabolising the drug slowly and it is producing culmulative effects even with a day off in between. My GP and the specialist both thought this was possible as women do metabolise drugs differently ..."

This is such a good point about how we all metabolise drugs differently and maybe goes some way to answer why some people can tolerate certain drugs (and foods, alcohol) and others not.

This is quite interesting:

The Liver and Drug Metabolism

http://www.nottingham.ac.uk/nmp/sonet/rlos/bioproc/liverdrug/6.html

Many factors can affect liver metabolism. In aging the numbers of hepatocytes and enzyme activity declines. Diseases that reduce hepatic blood flow like heart failure or shock can also reduce the metabolic potential of the liver.

Metabolism can also be altered due to a genetic deficiency of a particular enzyme. Also the use of other drugs as well as dietary and environmental factors can influence liver metabolic function.

The liver hepatocytes contain all the necessary enzymes for the metabolism of drugs. The main enzymes involved in metabolism belong to the cytochrome P450 group.

For example, Grapefruit juice and the herb St John's Wort inhibit Cytochrome P450 activity. On the other hand, cigarette smoke and brussel sprouts increases p450 activity. In fact, there are tables available that list numerous drug, dietary and environmental factors that can interfere with these processes.

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The fact that you haven't had a bleed would indicate that the Utro is working well.

Hope the current regime continues to work for you.

J x

[orchid]

I used to get away with 2.5mg of Northesterone for 5 days a month to give me a bleed when I was on Oestrogel. I'm postmenopausal though.