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[Dolly]

Hello everyone,
I'm new but have been reading this wonderful site for a while.

I was prescribed 3 weeks ago Estrogel 1-2 pumps per day then Utrogestan 200mg daily for 12 days for 3 months to try which I have not had dispensed yet.  I tried the mirena coil at the suggestion of a private consultant for approx. 16 months for irregular periods sometimes heavy/peri menopause symptoms and had a nightmare of symptoms (sever breast tenderness, morning sickness type feeling, being hungry all the time, fatigue etc etc) it then migrated and had to be removed via hysteroscopy. 

Due to my experience with mirena I feel that I don't tolerate progesterone well as many other people don't that I have read about on here and I would like to take the lowest possible effective doses of both hormones.  All the research I have done so far leans towards lowering the dose of utrogestan and taking vaginally but this is not licensed in UK for HRT.  I took the private prescription to my doctors but could only get to see young male doctor who was actually quite interested in the subject and pointed me towards this site  .  He suggested patches which I don't want to use as they are not bio.
 
I am a 48 year old exhausted single mum of an energetic 9 year old boy, I have him 90% of the time, am working part time mainly due to symptoms with no family support, my symptoms have been bad for about 4+ years and I am at breaking point, my very low mood, low energy and feelings of rage are beginning to affect him.  I just don't think I could cope with any more extreme symptoms so am reluctant to take so much utrogestan orally.   So my question is.

Is it reasonable to ask the GP for a new prescription for Estrogel 1 pump and 100mg of utrogestan vaginal capsule? for 7 days as per Prof Studd to try for 3 months given my history?
I would be very grateful for any advice or suggestions.
Dolly x

[Hurdity]

Hi Dolly

 

Sorry don't have time to reply in detail at the moment - lovely evening here so going down to the coast in a minute....

However - there is no danger in using utrogestan vaginally even though it is not licensed because at least as much, if not more, normally gets to the uterus where it is needed to protect it. Some limited research suggests that a lower dose can be used when taken vaginally but this would be off licence and under supervision - but better to take cyclically if used this way. It is the same product ie capsules taken orally as vaginally, although the 200 mg capsule is no longer available for oral use so 2 x 100 mg must be used orally and vaginally.

The metabolic by-products from Utrogestan taken orally are  what causes some of the worst side effects - the French instructions for example recommend vaginal use if side effects are experienced from oral use.

I would start with the recommended dose but used vaginally and see how you feel and then take it from there. Then if you find the side effects too bad then yes do go to your doc and ask if you can reduce the dose under supervision - and by that I mean for the doc to eg refer you for regular scan at least until you know how your uterus responds.

You haven't said your age nor where in menopause. Sometimes gynaes prescribe lower dose progesterone when women are still having regular periods and ovulating - therefore still producing their own.

Prof Studd's regimes are lower than the licensed dose and Dr Currie said this recently:

Just to confirm, while Professor Studd is very experienced and extremely knowledgeable, his regimens are not always in line with current recommendations, particularly around use of progesterone.
As always with providing menopause advice, this should be individualised and flexibility should be applied, as long as there is a clear understanding of national and international recommendations. Some women are intolerant of progestogen and progesterone and so it is appropriate to adjust the regimens, as long as it has been fully explained and discussed.
Best wishes
Heather

Hope this helps and good luck - sorry this is rushed and a bit disjointed!

Hurdity x

[Freckles]

Hi Dolly
There's no vaginal version of Utrogestan prescribed in the UK at the moment (bizarrely as it is elsewhere) , so I use the oral version with a pessary dispenser and get it up there internally as high possible last thing at night.
 I found it more effective that way, minimal side effects (compared to taking it orally).
So I'd suggest doing the same.
I'd suggest no point in seeing your GP if the issue is the Utrogestan.
Stay with your current dose of Oestrogel as it sounds like progesterone  issues re mood?
They can't prescribe vaginal Utrogestan as it's not available in that format in the UK
GP's can be hard of thinking  re HRT and in my negative experience of them re HRT. 
I see Studd once a year and get a fairly standard Studd prescription:  2/3 pumps of Oestrogel daily, tiny bit of Testim gel daily and Ulstragestan 100 mg for 7 days each month- less than the over prescribed (IMO)  NHS "guidelines".
I am really progesterone sensitive but find I get the necessary bleed each month, with minimal side effects compared with oral administration.
Of course medical professionals may disagree with Studd's (and others) clinical views  and some  may adhere more rigidly to NHS guidelines than others.
All I can say is that Studd's regime re Utrogestan works well for me and numerous  other women, with far less side effects  than the oral version  which is twice the dose and twice the time as recommended by the NHS.
I couldn't cope with that NHS regime
I think many  women give up HRT primarily due the excessive amount of Utrogestan or other forms and the horrible side effects.
I think the NHS "suggest" such large dose for so each so women don't sue them for breach of care, don't ask for uterine scans and basically don't give a damn.  It's cheaper for NHS.
Just remember that NHS "recommendations" for HRT are just that: "recommendations".  And not fully endorsed internationally.
"One size does not fit all"

Sure, some GP's and other medics may disagree with Studd and numerous other leading world experts in gynaecology, as they agree the NHS guidelines re Ulstragestan/progesterone  are clinically unnecessary and excessive .
.
It's a tough choice, I know, but personally I think I prefer to accept the advice, extensive clinical research and experience  of an expert Professor  in Gynaecology and HRT than that of some GP's sticking to NHS "guidelines" without any flexibility.

Of course GP's vary considerably given the posts on MM.

See your GP if you want, but I don't he/she will be that flexible or helpful.

I'd stick to the 2 pumps of Oestrogel daily ( as prescribed)n and try 100mg tablet vaginally for 7 days at the beginning of the month and see how that goes for a couple of months. Then review if necessary with your GP
I know digressing from the received wisdom of a GP may cause a few fainting fits for some on MM , but trying it as suggested above for a couple of months won't be life threatening and may actually work for you? 
Nothing to lose by trying a variation in your applications of Utrogestan for a couple of months?
Good luck in whatever you decide!
Freckles XX

[Dolly]

Thanks so much for your replies Hurdity & Freckles. 

I am 48 with peri menopause symptoms and irregular periods.
I am keen to go with the 100mg over 7 days option as I have regular scans due to an ovarian dermoid cyst and am seeing the consultant again in 3 month.  I have emailed her secretary to let her know my plans.  The GP did look at me in horror when I said I had read on forums that women were taking the capsules vaginally.

I just have a couple more questions please is there a lot of mess in the morning/do you need to clean any residue out or does it all come out naturally? 

The prescription does not say when in the month to start my HRT? Do I start both gel and capsules together or use capsule for just the last week? Do I use the gel for a month then at beginning of the next month use the capsules? Does it matter what date I start.  I'm confused.   My periods are very irregular so I have no idea where about I am in my natural cycle.

Many Thanks
Dolly x   

[Hurdity]

Hi Dolly - that's great if you are already having regular scans and have told the consultant your proposed regime. I presume the scans include the uterus - because it is over-thickening of the womb lining that you need to be checking. However if your periods are still fairly frequent you may well shed the extra lining due to your own progesterone produced after ovulation. Either way you will get an answer from your consultant.

Although I haven't used oestrogen gel, the same principle applies re when to start. If cycles are infrequent you can start on any day - if they are approximately 3-6 weeks still then with some other HRT types it is usual to wait until the bleed comes and start the oestrogen on the first day of the bleed which counts as Day 1.  Depending on how long since your last period then either start the oestrogen straight away or wait a week or two and see if it comes. What does your doc say about when to start?

It is usual to start the oestrogen only part and then introduce the progestogen for the second part of the cycle - so in your case if you start the oestrogen on Day 1 then if you are doing the 7 day regime, you would take the progesterone to end on Day 26 so this would mean starting on Day 18. Hopefully you would then bleed approx Day 1 - although if your cycle kicks in this may not happen exactly then. If you are doing the 7 day regime then best to do the 4 week cycle rather than calendar month as it is so much less prog than licensed  - but check this when you visit your specialist in 3 months time.

In practice if you note the day of the week you start the Utrogestan then you would take the next course in 4 weeks time and needn't then count Days of your cycle - unless it all goes out of sync!

I hope that's clear about the cycle - ie the total cycle length including the 7 days progesterone phase is 4 weeks.

The other thing that might happen is you could get quite a heavy bleed initially depending how strong your cycle is - especially if you haven't had a bleed for while, and provided the progesterone does its job properly.

Re vaginal discharge - I wear a panty-liner at night (just one of those micro discreet ultra thin ones)  the days I do the vag Utro - and I wear one (the same) in the day anyway so it doesn't bother me. There really is very little - you might see some white specks in the loo - but in my case anyway it doesn't seem to come rushing out so most of it must find its way into my uterus through the cervix! You don't have to clean anything out other than your usual hygiene routine. You can reassure your GP that it's not just forum hearsay re the vaginal use - these are the explicit instructions on the French Patient Information Leaflet ( your doc will know what these are!) - that in the case of side effects from oral use (eg excessive sleepiness or dizziness), vaginal use is recommended. Also many gynaecologists/menopause specialists recommend this too. In fact there is a utrogestan product for vaginal use ( 200 mg capsules) but this is for fertility treatment - but it's the same stuff - how ridiculous is that?!

Hope this helps and so let us know how you get on as your treatment progresses.

Hurdity x

[MicheleMaBelle]

Hello Dolly- it's so nice to have you back where you belong!

The progesterone in the Mirena doesn't agree with everyone as it's a synthetic even although side effects are lessened
Utrogestan is bio identical and you've been prescribed the recommended dose- you might get on better taking 100mg daily for 25 days. You should try it to start with.
You can take it vaginally- most gynaecologist's agree with this as side effects are lessened.
You can get bio identical oestrogen patches- look at the HRT preps on this site
I've been prescribed both oestrogel and utrogestan. I haven't got on with either so it's not always the magic bullet that some women hope for.
Prof Studd has many fans on this site but not all his patients find his regime life changing. Great if it works- not so great if it doesn't.
See Dr Curries comments on his treatment regime. Caveat Emptor- there may be additional risks if you go off road.
Some gynaecologist private or otherwise are not keen on going off road but accept that progesterone intolerance can cause issues - in which case they will prescribe less but only under medical supervision.
This supervision will include annual scans of your womb lining- you may have to pay for these but might be lucky and get them on the NHS. So, it's not just ignorance and a reluctance of just GP's when it comes to treatment options- some of the specialists, equally as eminent as Prof Studd and his like are cautious but are prepared to tweak as necessary- under medical supervision.
Do not self medicate- get some medical advice beforehand or you are doing yourself a great disservice.
Tread carefully- listen to your body and safeguard it as much as you can. What works for some women doesn't work for others.
I was where you are- the " gold standard" regime hasn't worked for me. I still think that HRT when it does work, can do great things- all I would say is to proceed with caution and whatever you do, please do it under proper medical supervision, regardless of what views and opinions you might encounter on here.
I wish you well in your journey and hope you settle soon x

[Freckles]

Hi Dolly
In answer to your request for info:
I'm prescribed three pumps of estrogel daily which I take continuously, i.e every day.
The ultrogestan I take on the 1st of each month vaginally for 7 days.
It's the oral version but it dissolves well  internally if you use a pessary dispenser (e.g. similar  for thrush pessaries) and last thing at night and after using the toilet. Basically aim the dispenser as high as  you can to your cervix (neck of your womb/upper side internally).

No, you don't get any residue as it's absorbed easily, any possible excess you pee away first thing in the morning.  I don't need panty pads or similar.  It's all sorted itself out over night. 
Your GP needs re-educating! For some bizarre reason the UK doesn't license vaginal use of Ultrogestan,though plenty of other first world  countries do. 
But using it this way as I am progesterone intolerant/sensitive, I found less negative side effects, effective monthly bleed as required.
There is no way I could adhere to the NHS "guidelines" of double that dose for twice the length of time. 
Not unless I had a overwhelming desire to stay free of charge at a local psychiatric unit for an unspecified amount of time, as progesterone for me is some type of cosmic nasty joke.
I don't fancy going loppier earlier than necessary, so for me, this regime really works, as it seems to for many women on MM.
Obviously not for some.
*shrugs* Read around on here and elsewhere.  Make an informed decision. 
GP's for sure are not necessarily fountains of all received wisdom!
In other words medics are subjective and it's about what works for you. 
Good luck but do read around and don't just take my view (or any one else's for that matter on MM)  as gospel advice.

Only stating my subjective experiences.
Good luck!
Freckles xx

[Dolly]

Many Thanks for the advice all.
Very informative.
I will visit the GP this week, brace myself for a difficult conversation and let you know how I get on with everything.
Thanks
Dolly x

[Hurdity]

Glad to be of help and look forward to hearing the outcome and how you fare on whatever regime you decide to use

Hurdity x

[Dolly]

Hello All,
So I visited the GP (a different one as you can never get to see the same one twice) and she was very unsure but understood that I wanted some​ input\control over the HRT.  She has emailed the consultant and is still awaiting​ a reply, as am I.  So she has given me the estradiol to start (just waiting to see if period puts in an appearance). 

I have just read the info leaflet that comes in the box and most of it is detailing all the ways it can kill you.....blimey it's enough to make you throw it in the bin...I am actually quite nervous about rubbing the first pump in now!

Dolly x

[Dmt]

When I told my GP that I was inserting the oral 100mg Utrogestan vaginally to reduce side effects, she said not to do that and prescribed me the vaginal 200mg on the NHS. Perhaps I just got extremely lucky with my GP. The only thing she said she couldn't prescribe for me was testosterone. Seems different GP's tend to have their own rules.

[Freckles]

200mg is a hefty dosage!! With possible horrible side effects
I don't understand the concern with the *method* of using Ultrogestan. 
Agree with StellaJane- there is no logical difference in using 100mg vaginally c.f. 200mg, other than the dosage
There isn't one.
Vaginally Ultrogestan  works just as well orally, if not better as it bypasses your stomach, liver etc. before being effective.
So 100mg works better vaginally than orally.
Why on earth would you need double the dose?
That's why the oral prescription tells you take it on an empty stomach or two hours after eating.
100mgs for seven days each month seems to work for many women as well as being clinically prescribed by many private experts like Studd.
Tough decision I guess- rely on your GP's "expertise" or an expert in HRT who is more flexible in prescriptions for your needs?
One size doesn't fit all!
Especially if you or your GP rigidly adhere to NHS guidelines
An excessive amount of Ultrogestan can result in horrible side effects, similar to PMS symptoms .
Read around and read up so you are informed  about the treatment options.
GPs (and for that matter NHS and private Consultants) aren't always that well informed  about HRT so helps if you feel confident about the options.
I'd suggest you don't take their views as being written in stone and do some reading.
It's your health and future after all.
Good luck
Freckles x

[Dolly]

Thank you ladies,  your advice is much needed.
I have read and digested more and am leaning towards 10 days 100mg taken as a pessary and 1 pump of gel....I can add more gel if needed as the prescription did say 1 to 2 pumps per day.

Would I go with a 28 day cycle with the 10 day Utragestan option? So Gel only day 1i to 17 then both on days 18 to 28?  Can I start at anytime in my cycle does it matter if I started mid period or not as I have never taken hormones before? I wasn't given any guidance on when to start it by either.

Many Thanks
Dolly x

[Freckles]

I'm prescribed continual daily Estrogel (I'm on two to three pumps daily due to osteopenia) and take the Utrogestan on the first day of each month vaginally, for 7 days.
So basically on-going Estrogel with a 7 Ultrogestan day phase  at the beginning of each month.
Doesn't matter when you start the HRT.  Start the Estrogel now and just keep to the same start time each month re the Ultrogestan phase.
Think 100mgs for 10 days you might find too much after a few months (it builds up in your body) but see how you go!
Freckles x

[Hurdity]

Hi Dolly

Are you asking when to start oestrogen or Utrogestan? If you are still peri-menopausal - then you should tie in the utrogestan with your periods so count Day 1 as the start of your bleed and if your consultant has agreed to 10 day cycle of 100 mg vaginally ( or will monitor you?) then you would start the utro on Day 17 and take for 10 days. You should then expect to bleed again on Day 1 of the next cycle - but depends where you are in menopause. You can start the oestrogen at any time - and count from there if you know what day you are in your cycle.

If you periods are few and far between - eg you have gone 4 months without a period then just start with Day 1 as the gel and see what happens ( re the bleed).

You should start with as near the licensed dose as you can with supervision of your GP/consultant and see how you get on - and then you might be able to reduce it further under supervision if necessary. I am post-menopausal and take mine approx every 6-8 weeks - I do 200 mg vaginally for 12 days - and my GP is happy with this.

Hurdity x