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[andius]

 INTERESTING!!   2016 article on micronized progesterone:

Climacteric. 2016 Aug;19(4):316-28. doi: 10.1080/13697137.2016.1187123. Epub 2016 Jun 9.
The impact of micronized progesterone on the endometrium: a systematic review.
Stute P1, Neulen J2, Wildt L3.
Author information
Abstract
Postmenopausal women with an intact uterus using estrogen therapy should receive a progestogen for endometrial protection. International guidelines on menopausal hormone therapy (MHT) do not specify on progestogen type, dosage, route of application and duration of safe use. At the same time, the debate on bioidentical hormones including micronized progesterone increases. Based on a systematic literature review on micronized progesterone for endometrial protection, an international expert panel's recommendations on MHT containing micronized progesterone are as follows: (1) oral micronized progesterone provides endometrial protection if applied sequentially for 12-14 days/month at 200 mg/day for up to 5 years; (2) vaginal micronized progesterone may provide endometrial protection if applied sequentially for at least 10 days/month at 4% (45 mg/day) or every other day at 100 mg/day for up to 3-5 years (off-label use); (3) transdermal micronized progesterone does not provide endometrial protection.

[Mary G]

Hurrah!  Thank you so much for that andius.  This is very interesting:

" (2) vaginal micronized progesterone may provide endometrial protection if applied sequentially for at least 10 days/month at 4% (45 mg/day)"

It would explain why I can get away with using so much less than the NHS licensed dose (i.e. 100mg Utrogestan vaginally for 7 days every 5 weeks)  and have a lining measurement of just 2mm.  It is obviously much stronger and more effective when used vaginally and this needs to be taken into account when it is being prescribed.  My gynae says it works better when placed right next to the cervix so it should really come with an applicator - I use an old one I got with some thrush cream. 

Time to change the NHS licensed dose/guidelines on using it vaginally?  How about manufacturing Utrogestan @ 45mg?

[dazned]

I think it won't be changed anytime soon when it says " may " 

[andius]

Well, I think the 45mg or 4% refers to the vaginal progesterone gel that is used for fertility treatments and tried for menopausal patients.

Also note that the 200mg progesterone was give ORALLY and not vaginally, suggesting that high of a dose may not be needed if used vaginally.

It will be interesting to see if this may spur a change in recommendations or formulations worldwide, or maybe even more studies will be done ( I hope so regarding studies).

[CLKD]

I HATE the expression 'experts'  - but thanks for the heads up!  If only the 'experts' would listen to those of us who really know ……….. because so many ladies suffer symptoms. 

[clare663]

Hi. Can I ask something? Im post meno (5 yrs) and want to start on the estrogel and micronized progesterone. Do I have to take the progesterone every day like in the combi patches or just for some of the days and will I get a bleed? Im finding this so confusing!!!

[Cassie]

Great then I can tone down from my 12 days of 100mg Utro and still have sufficient protection, I hope.... How wonderful if one could get a 50mg dose!

[dazned]

Hi Clare633 you need to use it everyday at 100mg to have a no bleed regime ,if youu use it for the last 14 days of a cycle then you can expect a bleed. Its when you stop progesterone that you get a bleed. Hope this helps

[clare663]

Hi Dazned. Yes I did think that but I have had such bad side effects with HRT that I would quite happily have a bleed if it eased the symptoms!!!

[Cassie]

I have been so so bad this month, have not taken the utrogestan for almost 8 weeks, keep expecting a bleed, need to start tonight, had a bad flu virus and the after effects hung around for simply ages, just could not face the Utrogestan side effects as well.....

[Sunnydays]

I don't know how I missed this original post. Thanks andius. Interesting that vaginally it suggests 3-5 years.
Stellajane will be interesting to see your scan results. How long ago was your last one.?

[Rhiner]

Hi All,

I have been getting my oestrogen sorted with a patch for last 2 months, before starting Ultro. I have now been on Ultro for 2 weeks and I have been taking 100mg every other day, orally!  Saw the gynae (private) yesterday and he is happy with this regime, as I have had no blood show.  I will have a scan in 6 months to check the lining (or earlier if I see any blood). I am really happy that, so far, I do not need to take every day! He stated that 'one size does not fit all' and each woman will require a different amount and that the French/Swiss prescribe this way or 3 days, with scans to check.

The lowest amount for the body, the better!
Rhiner

[Rhiner]

Hi Menomale, Its certainly worth a try. I had gone against what the consultant originally wanted me to do, i.e. 100mg per day, so was worried that I would be 'told off', but no, he absolutely agreed with me. Even if a bleed occurs he said that it does not necessarily mean lining thickening, but to have a scan a bit sooner to check if alls well.

Also, was on oestrogen alone for 8 weeks to get the dose sorted, before bringing in the prog part. 3 months is apparently the limit for oestrogen alone with uterus, that may be worth knowing for some folks.  This time really enabled me to ensure no side effects from oestrogen and also get the right dose (after the bad headaches I had on femoston), before embarking on the dreaded prog!

Rhiner

[Hurdity]

Thanks for posting this andius. I have a feeling someone else also posted it a few weeks ago. As you say the 45 mg per day was referring to Crinone 4 % gel - so all of you who are rushing to reduce your dose - this is not comparable to the utrogestan formulation - just as utrogestan is not comparable either to Cyclogest where generally double the dose is prescribed ( again off licence for HRT).

So PLEASE do not think this gives you license to experiment as you please - but discuss any change in regime with your doctor and make sure you have regular scans for anything less than the licensed dose.

I'm not sure actually that the article reports any new studies but as it is a systematic review - brings together all the published information on vaginal progesterone - but as I said you cannot compare Crinone gel with utrogestan/Prometrium. Unfortunately as often the case with these papers - only the abstract is published and you have to pay quite a lot of money to view one article ( approx $35 - which is a bit steep for something that ought to be publically available!).

I reproduced some of the abstracts and some research preivously on the Utrogestan/Estrogel thread - maybe I should start a separate thread so it can be easily found?

Here is the information about Crinone:

Vaginal progesterone in menopause: Crinone® 4% in cyclical and constant combined regimens
D.de Ziegler124, R.Ferriani3 , L.A.M.Moraes3 , and C.Bulletti4

Human Reproduction, Vol. 15, (Suppl. 1), pp. 149-158, 2000

https://humrep.oxfordjournals.org/content/15/suppl_1/149.full.pdf

Compliance with hormone replacement therapy (HRT) is notoriously low despite ample documentation of clinical efficacy. The two major reasons given by women who discontinue HRT are uterine bleeding and side-effects. The recent development of a controlled and sustained vaginal progesterone gel allowed single daily application and made prolonged use such as for menopause possible. Here we report our clinical experience with two therapeutic options for HRT using natural progesterone administered vaginally. A first group of 69 menopausal women received the sustained release vaginal progesterone gel, Crinone® 4% (45 mg daily) from days 1-10 of each calendar month with oestrogens taken continuously. A second group of 67 women received Crinone 4% twice weekly in conjunction with continuous oestrogen therapy. Endometrial thickness was evaluated before and after 6 months of treatment. Histological verification was obtained in all cases of abnormal bleeding. At 6 months, 63 out of 69 (91.9%) women receiving progesterone cyclically experienced predictable withdrawal bleeding. The vast majority, 54 (80.6%) of 67 women receiving Crinone in constant combined association with oestrogen therapy, remained amenorrhoeic throughout 6 months of therapy. AH cases of abnormal bleeding were biopsied and no hyperplasia was seen. Our results indicate that both regimens using the sustained release vaginal progesterone gel controlled bleeding in HRT. Combined with the lower incidence of side-effects characteristic of vaginal progesterone, both vaginal progesterone regimens have the potential of improving HRT compliance.

I don't know of anyone currently using it but I know someone on here has tried it - who is extremely prog intolerant, but the side effects were too severe for her to continue.

It's great that recommendations are appearing but of course there are a lot of ifs and buts..... perhaps women should ask for Crinone to have a go - but of course being unlicensed, probably more difficult to get than utrogestan.

Hurdity x

[andius]

I posted this back in July....maybe some new articles are out now??

I only read the abstract...haven't read the article.

A