Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[matildamouse]

After many trials and errors over the last 4 years with HRT I eventually settled on Estradot 50mcg, alternative nights of vaginal progesterone 100mg and twice a week Vagifem. After my scan was still OK on alternative nights of vaginal progesterone, I reduced my progesterone to only Mon, Wed and Friday nights. Had been doing the 3x a week progesterone regime for the last year. My scan's result showed my fibroids still the same size and a lining of 5mm, which is very similar to my annual scans of the last 4 years.

I have done this experiment with my Dr aware and an agreement for annual scans. I have no spotting so I am happy it worked well for me.

[SueLW]

Why didn't you want to continue with the every other night you were using?  I've just started on it this way.

[matildamouse]

It was just a matter of getting to a more practical regime which was easy to remember :  Mon, Wed and Friday are progesterone nights and Tues and Sat are Vagifem nights.

Since then I have read the recommendations of inserting the progesterone as high up as possible, and the Vagifem more to the anterior vagina near the urethra to assist with bladder issues as well. As I am contemplating increasing my estrogen to 75mcg patches to assist with waking up so early in the mornings, I might go back to alternative nights of progesterone. With the different areas of application ( as per the recommendations) I am aiming for, it wont be a problem if I have to insert both the progesterone and vagifem on the same night.

[SueLW]

With the different areas of application ( as per the recommendations) I am aiming for, it wont be a problem if I have to insert both the progesterone and vagifem on the same night.

Just consider inserting the Utrogestan as Vaginal Yoga!   . It's a bit of a contortionist move, but the sun definitely hasn't shone up where I'm getting it.  Any lower and I can feel it and that makes me uncomfortable.

[Traceylr]

Greetings matildamouse,
Glad the vag utro is working for you. I use it that way too ( every night though atm) . Sounds like you have a very understanding and progressive gp. Wish mine were the same. Ive booked to see my gp  to try to arrange a uterine scan as ive had a bit of spotting since i changed from oral to vag use utro. How did you mange to persuade the gp to get annual scans and ‘experiment' with your hrt? Any tips greatly appreciated .

[racjen]

Hi Matildamouse, I'm trying the alternate night regime with Utrogestan, as 100mg every night is way too much for me. Did you find it took your body a while to get used to this on/off dosing? I've only been doing it 4 days, but so far I just feel like I'm suffering from progesterone withdrawal, ie constant crying, feeling down and anxious etc., all the time.

[dangermouse]

Whenever progesterone is prescribed on its own it's either to take twice a day for creams or once a day for the minipill. If you are late taking the minipill then, for it's main use as contraception, it's deemed late and a risk. This shows how quickly progesterone leaves the system.

Apart from opening up the tiny capsules to have less on a daily basis, or twice a day, I think you're right about going through withdrawal taking it every other day.

[racjen]

I'm confused though, cos I thought progesterone had a relatively long half life compared with some other hormones, and that that's part of the reason withdrawal can last for several days. And I'm sure someone else on here said they'd been recommended this regime by a specialist.

I have the gel capsules - it doesn't really work to cut them in half, it'd be incredibly inaccurate and messy!

[Hurdity]

matildamouse - that's fab!

racjen - just to clarify re progesterone. Different progestogens have different half-lives in the body with progesterone being the quickest ie it breaks down very quickly in the body - which is why we have to take it in such large doses orally.

"As progesterone is rapidly metabolized in the intestinal tract, liver and many other tissues, its effectiveness is dependent on the galenic preparation, and – if administered orally or vaginally – on a high dosage. Therefore, most HRT preparations contain a synthetic progestogen (progestin) which can be used at relatively low doses because its inactivation is slowed down owing to structural peculiarities."

However systemic levels are sustained a little longer when progesterone is used vaginally. It seems that as it is absorbed directly to the uterus - it is thought to hang around there a bit longer.

"Compared with the oral route, the vaginal route of administration of progesterone results in higher serum levels of progesterone, which are sustained for a longer time than after oral treatment. The slow elimination of progesterone might be associated with a direct vagina-to-uterus transport by diffusion (uterine first pass) resulting in a high storage of progesterone in the uterus and a subsequent delayed release of the progestogen."

Both extracts from Kuhl  2005 Climacteric. Pharmacology of estrogens and progestogens:...

There has been research into alternate day administration of vaginal progesterone - I think I probably quoted the papers in several threads and the abstracts - can hunt them out if you like? This showed that alternate day dosing was effective in preventing endometrial hyperplasia at the prog and oestrogen doses used.

If you are changing from every day dosing then yes your body will have to adapt so you would go through a mini prog withdrawal phase but should then settle after that (hopefully!), with alternate day vaginal administration of 100 mg. How effective it is in preventing endometrial thickening will depend on your oestrogen dose.

In the past (2011!) I did alternate day dosage of Cyclogest pessaries with a low dose oestrogen (25 mcg) for about 7 months but this was after a two month gap from HRT so I built up from nothing. I didn't get any side effects nor spotting and feel I tolerated it well. (However I stopped this regime because flushes came back and I wanted to go back to my effective dose of 50 mcg but didn't want to increase the prog dose so went back to a cycle).

Hurdity x

[racjen]

Thanks Hurdity, still not really sure what to think. I just looked it up on Wikipedia and it said that vaginally administered progesterone has a half life of 25-50 hours, which seems long enough even at the minimum for it not to cause continuous withdrawal if taken every other day. I'm not changing from every day though - I've done 2 months of 10 days on 100mg and found that even that long on 100mg makes me horribly depressed, plus the withdrawal is awful. So am starting again post bleed to see if having a continuous lower dose is better. It's a shot in the dark - otherwise I'm still stuck in a day-to-day struggle situation with no hope of improvement on the horizon.

[SueLW]

Thanks Hurdity, still not really sure what to think. I just looked it up on Wikipedia and it said that vaginally administered progesterone has a half life of 25-50 hours, which seems long enough even at the minimum for it not to cause continuous withdrawal if taken every other day. I'm not changing from every day though - I've done 2 months of 10 days on 100mg and found that even that long on 100mg makes me horribly depressed, plus the withdrawal is awful. So am starting again post bleed to see if having a continuous lower dose is better. It's a shot in the dark - otherwise I'm still stuck in a day-to-day struggle situation with no hope of improvement on the horizon.

It's me that told you my hormone specialist had said I would be fine taking Utrogestan vaginally every other night.  So far I'm just over 2 weeks into the programme and I feel OK.  I'm only on one pump of estrogel, which I don't think is enough, but it's hard to tell as the weather has made me feel unwell. 

The thing I am noticing is that's my water retention is worse, feet are swelling and I feel sloshy, and my stomach is very bloated.  I'm not sure if it is the progesterone doing that, or the Estrogel or my hypothyroid State.  But years ago I had a Mirena coil fitted and I remember going back to the doctor after 2 months complaining about being tired, bloated, miserable.  She told me to stick with it and I did.  And I recovered and all those symptoms went away.

[matildamouse]

Greetings matildamouse,
Glad the vag utro is working for you. I use it that way too ( every night though atm) . Sounds like you have a very understanding and progressive gp. Wish mine were the same. Ive booked to see my gp  to try to arrange a uterine scan as ive had a bit of spotting since i changed from oral to vag use utro. How did you mange to persuade the gp to get annual scans and ‘experiment' with your hrt? Any tips greatly appreciated .

HI Tracey. Yes my Doctor is a GP specialising in women's health issues. She is also a guest speaker at menopause conferences all over the globe, so I was really lucky to discover her. I had to do a lot of research to find her, so it might be worthwhile depending on where you are, to google and ask around for GP's who are pro-HRT in your area. I am not sure how to convince your Dr...maybe referring to this website about various regimes. If you can afford the costs, maybe suggest you will go for a private scan at your own costs. Good luck, it is hard enough as it is!

[matildamouse]

Hi Matildamouse, I'm trying the alternate night regime with Utrogestan, as 100mg every night is way too much for me. Did you find it took your body a while to get used to this on/off dosing? I've only been doing it 4 days, but so far I just feel like I'm suffering from progesterone withdrawal, ie constant crying, feeling down and anxious etc., all the time.

Hi racjen, it is so interesting how we all differ. No I do not get any withdrawal symptoms at all. If I take it every night, I get side effects like feeling spaced out, cramping and feeling constantly hot. Can it be that your symptoms are just the normal side effects of progesterone some women experience and maybe not withdrawal symptoms?

I really wish they want to consider a 50mg progesterone!!!

[matildamouse]

The thing I am noticing is that's my water retention is worse, feet are swelling and I feel sloshy, and my stomach is very bloated.  I'm not sure if it is the progesterone doing that, or the Estrogel or my hypothyroid State.  But years ago I had a Mirena coil fitted and I remember going back to the doctor after 2 months complaining about being tired, bloated, miserable.  She told me to stick with it and I did.  And I recovered and all those symptoms went away.

Hi Sue, I also get VERY bloated on continuous vaginal progesterone, so I am sure it is progesterone related. I also just feel weird.... can not really describe it. When I tried it orally every night, I tolerated it better than vaginally every night.

[racjen]

Hi MatildaMouse

no this isn't normal side effects for me - I usually get a limited amount of stomach upset, which settles quickly, and progessively worse and worse depression from continuous utrogestan at 100mg daily (vaginally). After about a week of alternate days I'm feeling really ill - constant stomachache, nausea and backache, plus bleeding all the time. So kind of like having a really horrible period all the time. I suspect the problem in my case is that I'm on a higher dose of oestrogen than you (Evorel 100) so this amount of progesterone just isn't enough, but the annoying thing is it is helping with the anxiety, which is the main problem for me. Seems like I just can't get the balance right - if I drop the oestrogen dose I get depressed, if I take progesterone for too long I get depressed, but without it I get horrible anxiety. Aaaaaaargh, what to do next?