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[claude66]

Currently taking the estrogel/Utrogestan combination but am getting lots of break through flushes and night sweats. That coupled with the fact my surgery cannot ever seem to get my repeat prescription right means I want to change.

Have a GP appointment this week but no idea what to change to? For ease I want something in pill form.

[Keepgoing]

I don't know much but maybe another pump of the gel may sort out the problem, I'm on this also and when I'm taking the utrogestan I do get hot so I take another pump go gel when taking utro and that is working for me so far then I just go back to 2 pumps when not taking utro xx

[Dancinggirl]

claude66 - whilst transdermal is usually the best option I can understand your wish to change. If you want to try pills, I would suggest you try Femoston 2/10 - in the sequi version first to try and stabilise your bleeding pattern and then change to conti if need be. Sadly the conti version of Femoston only comes in a lowish dose. The progesterone in Femoston is the closest to the natural progesterone in Utrogestan. Many of us prefer the sequi regime, even long into post meno, as erratic, problematic bleeding and spotting can be a nuisance. I think the gel/Utro on a conti basis doesn't always work that well because Utro is not as stable and powerful as other progesterones.
If you are happy with the OEstrogel (you maybe need to use a slightly higher dose if you are still getting flushes) you could try Provera MPA (instead of Utro) as this is a more powerful progesterone to help prevent the problematic bleeding.
I was getting the problems with spotting etc. when on Gel+Utro and decided to take a break for 2 months to let my womb shed properly and allow my body to clear out all hormones; I then started again with a sequi regime of just one pump per day and am now doing 12 days of 200mg Utro to see if this low dose of oestrogen yet higher dose of Utro keeps my womb lining thin and prevent site spotting/bleeding issues.   DG x

[claude66]

Thanks all. I have tried another pump of the gel and while it keeps the daytime flushes at bay it's doing nothing for the killer night sweats.

I had IVF for years and my body is used to being pumped with hormones so I don't have any adverse reaction to progesterone.  I also haven't had a bleed on the gel/ultro combo for about 3 months now. Not that I mind in the least but it's probably proof it's not working.

Maybe Femoston is the way to go.

[Dancinggirl]

If you aren't getting a bleed, then this will be because you are not getting enough oestrogen so upping the number of pumps (so from one to 2 or 2-3 each day) is the way to go - this should also help reduce the flushes. Try splitting the doses to some in the morning and some at night. I assume you are using Utro sequentially? The gel/Utro combo is really good and does allow some flexibility.  Do tell us exactly how many pumps of gel per day you use and what dose of Utro and for how many days each month.  Transdermal is generally better as one needs a higher dose of oestrogen in pill form as so much is lost going through the liver etc. 
If your GP doesn't get the prescription right, then I would suggest you 'spoon feed' them each time - write a letter stating exactly what you require - their computer system may not be bringing things up properly.  DG x

[Taz2]

I don't really know too much about how the different hormones work but could it be that there isn't enough progesterone being used so that withdrawal doesn't induce a bleed?

Taz x

[Dancinggirl]

Taz2 - it is apparently to do with the balance of oestrogen to progesterone.  If you aren't using enough progesterone then the lining can build so erratic and problematic bleeding is likely to result. If you are using a low dose of oestrogen, or not absorbing it well, then the lining won't build up so much and if one is using a good amount of progesterone then little or no bleeding may be the result. Sometimes too much progesterone can give problem bleeding because it is atrophying the womb lining too much but I think this is rare.  There are some on MM who are worried about the effect of too much progesterone on the womb but the risks are usually linked with thickening of the womb lining because of too little progesterone. 

claude66 - I think you can probably increase your gel to a level that controls your flushes well as I suspect you are not absorbing oestrogen that well - you may then start getting a bleed after the Utro phase - it's about the benefits versus the side effects - there are always compromises. Keep us posted.  Dg x

[claude66]

I have increased gel to 3 x pumps a day. I take 200mg of Utrogestan for 12 days.

Another issue I have, which is making me want to change protocol, is the nightmare I have when putting in for a repeat prescription. Dr will only give me one gel at a time and 30 utros at a time (the message that 200mg is no longer available and therefore 100mg needs to be doubled up hasn't got through)

The prescription charges are crippling

[Mary G]

claude66 if you are still having symptoms then it suggests you are not getting enough oestrogen.  You might be like me and need shed loads to feel completely back to normal.  How many pumps are you taking at the moment?  Perhaps you need 3 or 4 pumps everyday, it is no unknown.  If you do go up to 4 pumps, it would be worth splitting the dose to two pumps every 12 hours to keep your levels up.

If you are not getting enough oestrogen from the gel I doubt you will do any better on the oral variety.  I found them to be very ineffectual and much of it gets lost in your digestive system.

How much Utrogestan are you taking?  I was wondering if you are drowning the oestrogen out by taking too much Utrogestan which would explain why you are not getting much traction from the gel.

I would suggest you increase and split your gel dose before changing to a different regime.

[claude66]

is it worth going down to 100mg of progesterone rather than 200?

If I go to four pumps a day then one pump would only last about a fortnight.

How many pumps do your Drs prescribe in one go? I always request two and prescription always comes back for one

[Dancinggirl]

I wouldn't reduce the amount of Progesterone - this won't make any difference at this stage but may unbalance things.
Have you had this regime on the advice of a gyane or specialist?  I think you need to make an appointment with your GP to discuss your issues around the prescriptions and how they given out - HRT is usually given out for 3 months supply at once. The £8-£9 prescription charge is not actually that much when compared with the cost of the HRT given - if you can't afford the charges then you probably need to be on some benefits??? So perhaps look into this.
I get 3 canisters of Oestrogel plus enough Utro for 3 months.  It may depend on what your health authority advises regarding prescriptions for HRT.
Also it may be worth having your thyroid checked as well in case this is playing up and causing the sweats. A blood test to look at your oestrogen levels could also be a good idea to se what you are absorbing - I get a level of between 475 -600 on 2 pumps of gel.!!!! Some ladies get far less - we are all different. Do check you are applying the gel correctly - so look at the leaflet again.
DG x

[claude66]

No I don't need to be on benefits - but £32 a month is a lot I think. I just resent it a bit because my bloody Dr won't give me more than what amounts to less than a month's supply in one go.

I'm definitely applying the gel correctly.  How can you apply it incorrectly?! (unless you put it in your hair or something?)

I'll see what GP says. I just find most of them pretty useless on the subject of HRT. Hardly inspires you with confidence when they Google as you're sitting there.

[Mary G]

claude66, I can really sympathise with you and know how you feel, my GP was completely useless on the menopause and HRT and refused to help me meaning I was forced to seek help privately and pay for it of course. 

I think £32 is far too much to be shelling out on HRT each month and it's far more than I am paying even though I don't use the NHS.  I buy my HRT without prescription and over the counter in Spain.  I pay €4.00 for a tube of Oestrogel (Spanish branded version) and about the same for a box of 100mg Utrogestan but it lasts me ages because I take much less than you do.

My advice is to make a formal complaint to the surgery and I would definitely reduce your Utrogestan dose down to 100mg and see if that makes a difference.   

[claude66]

thanks all. I have an appointment for tomorrow. One good thing about my surgery - appointments are easy to come by 

[Dancinggirl]

claude66 - I do think it is perfectly reasonable to get at least 2 months supply at a time - so this would be 2 prescription charges. Definitely discuss with GP - mention that most women seem to get 3 month supply at a time.
Dg x