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[matildamouse]

I recently increased  my Estradot patch from 37.5mcg to 50mcg with continuous vaginal progesterone 100mg and twice a week Vagifem. I am 53 and 2 years post menopausal. I tried once in the past to do the cyclical regime but felt terrible on the increased progesterone(200mg) and also did not get any bleed after the progesterone withdrawal, so decided to rather continue with the conti regime. I never felt on top of the world (will I ever again  ) but felt OK-ish as my hot flushes were nearly gone which is my main menopausal symptom. I always(months on end) had low grade stomach and backache as though I am going to have a bleed as well as bloatedness but just lived with that. Also struggled with constipation since on progesterone. Despite all the negatives of the regime I decided I can cope with all of that as anything is better than hot flushes! My last scan in April showed a 4mm lining and multiple fibroids.

With the increase in Estrogen I had a low grade unilateral headache for days on end and just did not feel myself but pushed through as my Dr thinks I should be at 50mcg Estradot at my age for the other health benefits as well.

We went on holiday last week and I just grabbed my box of progesterone to only realise on arrival I only had 4 left in there and not enough for the 8 nights we are away. I then decided to spread it out and use it on alternative nights and will continue with daily on return home. After a week of that I suddenly realised (lightbulb moment) my periodlike pains are bloatedness are GONE and constipation is so much better. My headache also disappeared!!!

I now wonder whether the increased estrogen helped with the negative effects of the progesterone or is it because of the only every other day progesterone or may be a combo of both. All in all I actually just feel so much better, infact the best since I started HRT a year ago. I am so tempted to continue like this and ask my Dr for a scan when she is back from holidays in Nov to see whether alternative days of vaginal progesterone 100mg is adequate to keep my lining thin on Estradot 50mcg.

Any ideas, experiences or opinions will be welcome please. Thanks.

[Jenna]

Hi matildamouse - have a look at Smarlo's posts on the utrogestan/estrogel support group thread. Here is one:


"Hello All

Chipping in with my experience - a good one.

I was put on Oestrogen + Utrogestan in 2012 by a Swiss gynaecologist: one pump and a bit per day of gel and twice a week of Utro vaginally. I am intolerant of progesterone; blow up like a balloon and get breast pain. But spreading out the Utro the way I'm doing is working wonderfully well - no more insomnia, no more vaginal atrophy, no brain fog. I feel I'm getting the benefits of the oestrogen without the progesterone downside.

I take the utro on Monday and Thursday nights after climbing into bed, having applied the gel on alternating thighs during my last trip to the loo before bedtime.

I get regular lining scans and they always range from 2.5mm to 3mm. And this Swiss way, which the doctor said is a normal regime throughout France, Switzerland and Italy, produces no bleed - it keeps the lining thin on its own.

I don't think I would want to subject myself to the raging PMT-style symptoms I would have by taking it for seven consecutive days, as advised by Prof Studd. This Swiss doctor was adamant that this regime would be best for me and, four years later, I'm feeling great with no postmenopausal symptoms."

Hope this helps!

[Rhiner]

Hi,

I am a similar age to you and am on estrodot patches.  I had 2 months on oestrogen alone to sort out the dose and then introduced Utrogestan 100mg after this time. I thought I would start gradually after all the side effects I had heard about this prog, so for 2 weeks had 1 tablet on alternate days. I then had an appointment with the specialist and I suggested I keep to alternate days and he agreed.I mentioned the Swiss and French Clinical studies, which he was very aware of.
I have now been on the regime for 6 weeks and initially had a little period pain and was a little tired and dizzy, but now feel fine ( just a little itchy over this last couple of days which I hope is transient).  I am having a scan in March to check thickness. I am also taking orally at the mo, not vaginally.
Rhiner

[matildamouse]

Thanks ladies you are all very helpful. Jenna, so interesting re Smarlo's regime and other countries.

I am in Australia and my very pro-HRT GP  who specialises in women's health is happy with vaginal Prometrium, in fact she takes it herself.

Rhiner on what dosage of Estradot are you? I am also not sure how the gel and the patch compare when it comes to dosage.

[Rhiner]

Hi Matilda, I am on 75ug, but I had my ovaries removed in March and that deprived me of all oestrogen, so may be need a little more because of this. That is when I started needing HRT.  I tried 50ug initially but it wasn't quite enough, was still feeling quite faint.

If I get any spotting the scan will be brought forward, but OK so far.
R

[Menomale]

Hi matildamouse - have a look at Smarlo's posts on the utrogestan/estrogel support group thread. Here is one:


Hello All

Chipping in with my experience - a good one.

I was put on Oestrogen + Utrogestan in 2012 by a Swiss gynaecologist: one pump and a bit per day of gel and twice a week of Utro vaginally. I am intolerant of progesterone; blow up like a balloon and get breast pain. But spreading out the Utro the way I'm doing is working wonderfully well - no more insomnia, no more vaginal atrophy, no brain fog. I feel I'm getting the benefits of the oestrogen without the progesterone downside.

I take the utro on Monday and Thursday nights after climbing into bed, having applied the gel on alternating thighs during my last trip to the loo before bedtime.

I get regular lining scans and they always range from 2.5mm to 3mm. And this Swiss way, which the doctor said is a normal regime throughout France, Switzerland and Italy, produces no bleed - it keeps the lining thin on its own.

I don't think I would want to subject myself to the raging PMT-style symptoms I would have by taking it for seven consecutive days, as advised by Prof Studd. This Swiss doctor was adamant that this regime would be best for me and, four years later, I'm feeling great with no postmenopausal symptoms.

Hope this helps!

Hi Jenna,

Do you know if she is still on this regime? I am keen on trying Utrogestan twice a week. I'm already changing the oestrogen patch twice a week so that would be easy for a menobrain to remember 

[Jenna]

Hi Menomale,

I'm sorry but I don't know whether Smarlo is still on this regime as she hasn't posted lately. I would send her a PM - I'm sure she will be happy to reply.

Have you seen this thread about using progesterone on alternate days:

http://www.menopausematters.co.uk/forum/index.php/topic,34355.msg548742.html#msg548742

Hope this is of interest to you!

[Menomale]

Thanks Jenna, this is one of the many strategies I want to consider when it comes to utrogestan. In my opinion, the less amount necessary to keep a thin endometrium is the best choice as I have already felt some awful effects.

[matildamouse]

Menomale, see my recent post regards this regime where I had good results. On phone and in car now, so not able to expand atm.

[Menomale]

I will certainly do, matildamouse. Thanks!

[Hurdity]

Thanks Jenna, this is one of the many strategies I want to consider when it comes to utrogestan. In my opinion, the less amount necessary to keep a thin endometrium is the best choice as I have already felt some awful effects.

I think many of us feel this way about progesterone! However it is important to have enough to balance the amount of oestrogen you are taking in order to protect the womb - so on a low dose of oestrogen, with perhaps twice a week progesterone vaginally - might be sufficient for some women - but I would not advocate most women on here experimenting with this unless they are seeing a menopause specialist!

Jennas mentioned the thread about alternate day utrogestan - and somewhere in the Utrogestan/Estrogel support thread I posted ( several times I think) the abstracts to papers about this. Not sure if I can find them though - will try!

Hurdity x

[Hurdity]

Hi there - have found the post with all the abstracts!

Menomale you will see the first one reports the alternate day dosing - but with a low dose of oestrogen ( 25 mcg patch) and vaginal progesterone - so that is promising. I'd forgotten about that study actually - my memory is not as good as it was! Looks like there can be some spotting/bleeding with this regime ( as you might expect) - and suggests further studies are needed.....

Hurdity x

Sunnydays I have just copied and pasted some notes I made some time ago from various papers. I haven't re-read them before posting. I'm sure there are others too:

http://www.ncbi.nlm.nih.gov/pubmed/22321028'

Endometrial response to concurrent treatment with vaginal progesterone and transdermal estradiol.
Fernández-Murga L1, Hermenegildo C, Tarín JJ, García-Pérez MÁ, Cano A.
Author information
Abstract
ABSTRACT Objective To describe the effect of the intermittent administration of vaginal progesterone and a low-dose estradiol patch on endometrial stability, as assessed by the rate of amenorrhea and endometrial stimulation. Methods This was an open study in which 64 moderately symptomatic, postmenopausal women were treated in the outpatient clinic of our University Hospital for different intervals up to 1 year. The treatment consisted of a combination of patches delivering 25 µg/day estradiol and intravaginal pills containing 100 mg of micronized progesterone. Patches and pills were administered concomitantly in a twice-a-week protocol. The endometrial response was assessed by endovaginal ultrasound completed with suction biopsy when required. Results Both cumulative amenorrhea and no-bleeding rates increased progressively and reached 88.9% and 100.0%, respectively, by the 12th month. Isolated or repetitive episodes of bleeding, bleeding and spotting, or only spotting were reported by three, four, and 12 women, respectively. Endometrial thickness remained unaltered. Endometrium was atrophic in the seven women in whom a biopsy was performed. Conclusion The substantially reduced progestogen load determined by this combination achieved an acceptable incidence of spotting or bleeding when associated with a low estrogenic dose. There was no apparent endometrial stimulation. Additional studies are required to confirm this observation.

http://www.ncbi.nlm.nih.gov/pubmed/15222511

Efficacy of oral micronized progesterone when applied via vaginal route.
Choavaratana R1, Manoch D.
Author information
Abstract
The aim of the study was to compare the efficacy of oral micronized progesterone when applied by the vaginal route. The comparative study of serum progesterone levels between oral and vaginal micronized progesterone administration was conducted in sixty female volunteers. The subjects were equally divided into two groups to receive the drug either via the oral or vaginal route. The subjects' profiles showed that there was no significant difference in general characteristics between these two groups. The blood tests for estrogen and progesterone levels were performed on all volunteers before and after the drug administration. The data collected from the experiment revealed that the serum progesterone levels achieved by oral administration (5.06 +/- 2.95 ng/ml) differed significantly (p < 0.001) from those achieved by vaginal administration (8.26 +/- 4.09 ng/ml). The data also revealed that the serum progesterone levels of the oral administration group (4.23 +/- 2.68 ng/ml) did not differ significantly (p = 0.925) from the other group (4.15 +/- 3.40 ng/ml) when the serum estrogen level was less than 30 pg/ml. On the contrary, when the serum estrogen level was at least 30 pg/ml, there was a significant (p < 0.005) difference in the serum progesterone levels between these two groups (6.32 +/- 2.99 ng/ml for the oral route and 9.76 +/- 3.23 ng/ml for the vaginal route).

http://www.ncbi.nlm.nih.gov/pubmed/20575654

Transdermal estradiol and oral or vaginal natural progesterone: bleeding patterns.
Di Carlo C1, Tommaselli GA, Gargano V, Savoia F, Bifulco G, Nappi C.
Author information
Abstract
OBJECTIVE:
To evaluate the effects on bleeding pattern of two different doses of natural progesterone (NP) administered per os or per vagina in association with transdermal estradiol in a continuous, sequential estrogen-progestin therapy.
METHODS:
A prospective, randomized trial was conducted on 100 patients randomized into four groups. Each group received transdermal 17beta-estradiol treatment at the dose of 50 microg/day. Groups A and B received NP per os at the dose of 100 mg/day and 200 mg/day, respectively. Groups C and D received NP per vagina at the dose of 100 mg/day and 200 mg/day, respectively.
RESULTS:
After 12 cycles of treatment, no significant differences were observed in endometrial thickness between groups, suggesting that all treatments are effective in balancing the effects of estradiol on endometrium. Regarding bleeding control, patients in Groups C and D showed a higher number of episodes of regular bleeding than patients in Groups A and B and fewer episodes of spotting. The better control of bleeding was associated with a higher treatment compliance in patients who received vaginal NP, with a larger percentage of women completing the study.
CONCLUSION:
Transdermal estrogen replacement therapy combined with 100 mg of micronized NP administered per vagina from the 14th day to the 25th day of each 28-day cycle leads to good cycle control and provides excellent patient satisfaction without serious side-effects. This therapy could be a treatment of first choice in early postmenopausal patients.


E-mail from information manager at Ferring ( previous manufacturer of Utrogestan)

The product monograph talks of two trials of vaginal use as part of HRT – they're small patient populations – 20 and 30 patients in each.

One study used 100mg once daily vaginally for 21 days of 28 day cycle – the study lasted a year and was undertaken in 20 patients. Symptoms were significantly reduced, bone density remained and no adverse effects were seen. The endometrium was safely protected from the estrogenic effect of 1.5mg transdermal Oestrogel.

Another of 30 patients over 36 months studied the use of 100mg vaginal Utrogestan every other day. For most patients there was absence of bleeding and good patient satisfaction. There was a reduction in mean endometrial thickness and at the end of the study endometrial atrophy was seen in all cases. Five of the 30 women dropped out due to vaginal bleeding.

The references are:

Spritzer et al Exp Clin Endocrinol Diabetes 2003; 111 (5) 267-273

Vilodre et al Gynecol Endocrinol 2003; 17 (4) 323-328.

Hope this helps

Hurdity x

[Menomale]

I`m on a low (25 µg) dose of oestrogen.

[Hurdity]

Yes I know which is why I pointed it out! Also if you are peri-menopausal and still ovulating then you will still be producing plenty of your own progesterone (when you ovulate) so provided women are still monitored regularly it could be less of an issue than with post-meno women who rely only on exogenous sources (ie added from outside) of progesterone to clear the lining.

Hurdity x

[murphydurf]

Hi Menomale - would you keep us posted on your alt day prog as I'm interested in that regime. I currently have a mirena and allowed the doc to talk me into keeping it for another month which I'm somewhat regretting. I'm trying to reduce E also so would be interested in any info you have. Mx