The main purpose of taking any progestogen as part of HRT is either to ensure the womb lining is shed after it is stopped each cycle, or to keep the womb lining thin so that it doesn't shed or need to be shed. The difference and problem with Utrogestan (a possible con) – which we have discussed before - compared to synthetic progestogens - is that the dose given is a one-size-fits-all amount, which means that it doesn't work so well at the licensed doses for high doses of oestrogen.
In addition to that, progesterone as a compound is very unstable so only a small amount of what is taken in orally actually gets into the system – much being lost through digestion and the liver, so that larger doses than are comfortable for some women need to be taken to ensure enough gets through.
Those who take higher doses of oestrogen or who absorb oestrogen very well , or who have digestive problems – seem to find that unwanted irregular bleeding or spotting can occur, but taking higher doses of progesterone (Utrogestan) will produce more side effects. Of course there is flexibility with the dose - it is sure to work at higher doses but not everyone can tolerate these.
In terms of side effects – as well as keeping the lining thin (the main function) – we all want to take something that does the job with fewest side effects. Just reading women's experiences on this forum, for some women any progestogens are horrible, for others only the synthetic progestogens produce adverse effects and for others the Utrogestan can be too sedating compared to the synthetic ones.
However in my view it's not just about short term side effects. Those of us (and the gynaes/medical profession of course) who advocate using progesterone ie Utrogestan – is because this is bio-identical with our own progesterone and so far research has shown this to be associated with fewer long-term risks than the synthetic ones. The synthetic ones have negative effects elsewhere in the body than the uterus and can even (so I understand and have read) negate the positive effects of oestrogen in some respects (don't ask me to quote anything here though as the info is not at my fingertips so would have to search. Soz!).
This to me is a far more important reason to choose Utrogestan/progesterone than short term side effects – provided these can be tolerated and why several of us put up with it - see Mary G and Stellajane as the last two to comment. Several of us choose to use progesterone/Utrogestan cyclically and have a withdrawal bleed so that we use the most "natural" method we can and at the same time to minimise any adverse side effects, rather than use a synthetic progestogen like norethisterone or levonorgestrel continuously – just to avoid a bleed or prevent any spotting.
Personally I have compromised on my oestrogen dose (inadvertently) - ie it is lower than it probably could have been - by having a longer cycle and a medium bleed with minimal pain. Judging by the comments and levels quoted on here I probably could have had a much higher dose – but mine is sufficient to eliminate flushes and sweats.
I reduce the side effects by using it vaginally – which means I can take less – so I have 200 mg for 12 days per two months, and this sheds all the lining with no spotting or bleeding in between.
However I only started on a long cycle once I became post-menopausal – so at age 58 (I was likely post a couple of years or so earlier).
It's tricky but all in all Utrogestan is worth pursuing if you are in it for the long term – and in particular to late 50's and beyond. If you only plan to take it for 5 years – then go with anything that makes you feel best in the short term I would say.
Dancinggirl - yes it must be worth trying - just one pump - as you know you absorb the gel very well and would probably needs a higher dose to prevent the spotting - which takes me back to our usual moan - that there is no 50 mg dose!!!
As for bread – I hardly ever eat it these days and when I do I always like to slice my own.
Hurdity x
