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[linz57]

I am about to start a new hrt regime after being on a Conti patch for almost two years. I am going to use FemSeven 50 mg estradiol patch alongside 100 mg Utrogestan.
My dilemma is this, I have urogenital atrophy and digestive problems ( although both have been kept  under decent control with my conti patch) and I don't know which route would be preferable. If I take it orally for 25 days a month will it start up my acid/ hernia problems and if I use it vaginally will I get a recurrence of my bladder pain, VA  and urinary frequency etc etc?
I have been happy on my Conti patch and the only reason I have thought to change is that every 8 to 10 weeks I get a little brown spotting for about three days. I don't want to upset everything by changing and am now feeling unsure as to what to do.
Have any other ladies out there with the same problems as myself taken Utrogestan continually?

[Dancinggirl]

linz57
I can only share my experience with Utrogestan and I know I have been unlucky.  I tried it sequentially and got heavy bleeds and break through bleeding and spotting at other times.  I tried is continuously and continued to get erratic bleeding and spotting.  Most of the time I used it orally and on the higher dose felt very sedated, on the lower dose continuously I feel wonderfully spaced out and high!!!! There are issues round absorption of Utrogestan when used orally - one needs a good dose for it to be effective.  If you have digestive problems (I do) then I think absorption and gastric issues could arise - it has to be taken last thing at night on an empty stomach!!!!
I tried it vaginally and it really irritated by bladder and whole vaginal area - I was very uncomfortable.

Many, many women find Utrogestan really great and I'm sure some will be along soon with their advice.

If I were you I would have kept with the patches you were using as just the occasional spotting is quite tolerable.  A good alternative for you could be the Mirena with separate oestrogen - you tolerated the progesterone well with the patches and this is the same as in the Mirena and you are far less likely to have problems with bleeding and spotting with the Mirena.
If you are using Utro on a conti basis ( a non bleed version) then using it vaginally is generally thought not to be a good idea as it could irritate the bladder and VA.  Some use plenty of local oestrogen to counter the effects of using Utro vaginally. 
I hope this helps Dg x

[linz57]

Thank you Dancinggirl, your post has been very helpful to me.
The last thing I want to do is start up a whole host of problems just to alleviate the spotting and now I've read that Utrogestan  needs taking on an empty stomach I'm feeling less inclined to change from my Conti patch.
I know I won't find out how it might affect me unless I try , but it took me ages to stabilise the urogenital and stomach issues so I'm more than a little wary. Maybe in my case it's " better the devil you know"
Thank you once again

[Tinkerbell]

I found the utrogestan irritated my VA.

[linz57]

Did you use it vaginally or orally Tinkerbell?

[linz57]

One more question ladies, would the Mirena not aggravate my bladder and vaginal problems in the same way Utrogestan might?

[Nina]

I take utrogestan orally 1-25 and I have no problems - apart from the three days off when I feel rubbish!!

[Tinkerbell]

I used it vaginally, I went down the Mirena route in the end and I very happy with that so far.

[Dancinggirl]

I had the Mirena for 4 years in post meno and it was actually the best option at the time.  If I were to go back on HRT I would probably opt to have the Mirena again. It didn't seem to aggravate my bladder and the VA was taken care of by the oestrogen.  The Mirena simply delivers the progesterone more locally to where it is needed, so causes fewer problems over all.  I did get some mild sedation in the first few months but many do not get this - if you are used to a conti HRT then you would probably be fine as well.
The problems I had when using Utrogeston vaginally I think was because of the capsule coating dissolving and then irritating the whole vaginal area.
DG x

[linz57]

That's good to hear about the Mirena and it  has given me food for thought. I have heard quite a few horror stories about it but equally good things too. I always thought it would aggravate my bladder so I never gave it much consideration,  but after hearing you ladies say you were fine I now feel at least I have another option, thank you.

[Hurdity]

Hi linz57

I know I have already replied to your pm but just thought I would put my thoughts on here too.

Really I was wondering about the spotting and whether you have had it investigated ( sorry I can't remember?).  If your lining is OK then it may not be a problem though what might be causing it would be difficult to ascertain....I did get this (not on conti HRT though) after sex - and in my case the gynae thought it might be due to a cervical ectropion as it didn't occur at other times. If it really only is a bit of pale brown streaking then as long as you have your lining checked regularly then it should be fine if you can tolerate it. Of course if it develops into something more then another option is to use a cyclical HRT as many women do for that reason - although they probably have more bleeding then spotting. I can see you would not want to go down this route at your age/stage!

Re the Utrogestan - I have only ever used it vaginally but would not want to use it continuously this way. Personal relations aside I do find it irritates the labia after a bit and get itchiness on the exterior. It also makes me pee more - especially at night although never more than twice (per night). I think progesterone anyway tends to have this effect. I don't know of anyone who is using it vaginally all the time and you may not want to use it cyclically although a long cycle is a possibility (with the consent of your doctor) if your lining has been checked and all OK. To me that is the best of all worlds and is possible on low to medium doses of oestrogen if lining responds OK ie not too thick. I minimise side effects from utrogestan by plumping up with local oestrogen (extra to maintenance dose) for the week before starting it - I have no evidence to back this up though apart from my own experience! Also vaginal progesterone gets more to the uterus and into the system than oral utrogestan so with doc's approval you can use it less often or lower dose - provided your lining is OK and is monitored.

I have never taken oral Utrogestan as I have taken all my HRT as nil-by-mouth as being the most natural and least disruptive way of getting hormones into the system - and if you have digestive issues I would say no to oral Utrogestan on a continuous basis. Re the empty stomach - although it says this I think this is to ensure as consistent dose as possible of the utrogestan - in fact the research shows that the bio-availability of the prog increases when taken with food - but if it sometimes was and sometimes wasn't taken on ampty stomach - could lead to fluctuations in your system and therefore to more spotting or bleeding, if you see what I mean.

I hope this helps and do let us know what you decide!

Hurdity x

[linz57]

I did have the spotting investigated in June of this year, had a hysteroscopy, D&C, biopsies etc and all was fine. My lining was 6.1mm and on my letter from the hospital it said "benign prolific endometrium". Now I'm no expert but I would have thought that 6.1 while on a Conti regime was ok. I was discharged back to my doctor and that was that.
After reading people's posts on here I think I'm going to stick with my Conti patch awhile longer as I really don't think it sounds as though   Utrogestan is goin to be a benefit to me. As you say Hurdity, a longer cycle might be the way to go so I shall discuss that the next time I visit my GP . Thank you again for your help.

[Hurdity]

Hi linz57

Although a lining of 6.1 mm is not especially thick, the thicker the lining becomes the greater the risk of endometrial cancer, and the risk is greater if there is vaginal bleeding as this implies some sort of problem or irregularity. In your case as you would expect nothing was found and that's brilliant!! However if the balance is slightly wrong in your case and the lining continues to thicken and you continue to experience spotting or bleeding then it could be a cause for concern - so I would say think about what the consultant and docs have said and the suggestions we have made and then decide what you want to do. If you stay with the conti patch and the situation gets worse then you might need to have another hysteroscopy etc. Alternatively the doc might just suggest you change to a regime that will ensure more adequate thinning and/or shedding of the lining to prevent it overgrowing - or possilby the longer cycle and putting up with a bleed.

I can see it is a dilemma - and I've strayed away from your original question!!

Hurdity x

[linz57]

It sure is a dilemma, nothing is ever simple is it? I'm just dismayed that I may have to stop using my patches, as apart from the spotting they worked well and I had no nasty side effects. Ah well, back to the doctors for yet another discussion .........

[Dancinggirl]

Linz57 - don't rule out the Mirena  - you are clearly not progesterone intolerant so the Mirena may give you exactly what you need with fewer problems re bleeding and spotting as it's more efficient as keeping the lining thin.  Dg x