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[Peripurple]

Hi there, just wondered if anyone has any advice/thoughts on my regime.  After seeing a specialist I was prescribed 3 pumps Oestrogel daily and 12 days per month utrogestan.  I also have Vagifem every other day.  I found I just could not tolerate the 3 pumps after battling daily headaches and migraines and reduced to 2 pumps, the headaches have stopped and I get on with the utrogestan really well.

The problem I am having now is I am having a bleed on day 6 of the progesterone and carry on spotting for a good 2 weeks.  The impact this has had is my vaginal burning and itching, and bladder problems are back with a vengeance. I am presuming this is to do with the prolonged bleeding messing up my ph/flora.  I am using Actigel and Vagifem which are not really working.  Should I increase back to 3 pumps? Has anyone experienced headaches which have passed after a while? I am 42 and peri and any advice/experience with this is really appreciated

[CLKD]

Can U explain why the vagifem isn't working?

[Dancinggirl]

I would have a Mirena fitted instead if using Utrogestan. Utrogestan can be a less effective at protecting the womb lining, especially when used orally and if atrophy is apribkemthen using Utrogestan isn't an option.
I had a Mirena with Oestrogel for 4 years and it was the best hrt regime I ever tried  - the bonus was that it stoppped all bleeding after the first few weeks.  Between 30-60% of women are bleed free with a Mirena.
DG x

[Peripurple]

Hi CLKD, I suppose what I mean is Vagifem isn,t preventing this flare up, or helping it at the moment.

Thankyou dancing girl, I am seeing the specialist in 3 weeks so will discuss the mirena with her.  Could you explain why utrogestan shouldn't be taken when you have urogenital atrophy?

[Dancinggirl]

Sorry, I probably wasn't clear in my explanation. Utrogestan can be used vaginally as well as orally. It isn't licensed to be used this way in the UK but it is in most other countries. Many women on this forum do use it vaginally and find it more effective (the progesterone is going more directly to where it is needed) - when used orally more is lost through the digestive system.
However, if you struggle with urogenital atrophy, then using Utrogestan vaginally can be an irritant. I couldn't use it vaginally for this reason and when I used it orally I got erratic bleeding and felt quite spaced out as well.
The Mirena delivers a small continuous amount of a synthetic progesterone directly into the womb (less is absorbed systemically so fewer side effects) and it is better at maintaining a thinner womb lining and this can reduce bleeding significantly for most women.  DG x

[Hurdity]

Emmapurple - Are you peri-menopausal? If so this can cause bleeds at odd times when your own hormones kick in. Utrogestan is very effective at protecting the womb lining when used vaginally, and depending on the oestrogen dose (sometimes less so at the licensed dose when taken orally) but as Dancinggirl says this can cause irritation to some women.

I also find that Vagifem itself causes irritation to bladder (and increased frequency) on the day/night I take it - so annoying that the 25 mcg dose is no longer available....

Have you thought of the Estring - which delivers the equivalent of the 25 mcg Vagifem directly to the vagina through a removable ring. There are a few users on here.

If you get on well with the progesterone then you could take it for longer than 12 days per month if you continue taking it orally - to try to protect your lining? This may well regulate the bleed a bit better after a few cycles?

Hurdity x

[Peripurple]

Thanks dancing girl, yes I would like to avoid taking it vaginally as I'm really sensitive, I always have some level of irritation even with the Vagifem.

Hurdity I didn't realise I could take the utrogestan for longer, is that OK to do?  Yes I am peri menopausal.

[Hurdity]

As I said if you are peri then the bleeding might not be to do with the progesterone effectiveness but more to do with your natural hormonal cycle kicking in and ovulation.

The British Menopause Society recommendation (paper in 2016 https://journals.sagepub.com/doi/full/10.1177/2053369116680501) said that "if bleeding is heavy or erratic on a sequential regime, the dose of progestogen can be doubled or duration increased to 21 days". Many women can't tolerate this but if you are OK on it then go for it if the erratic bleeding persists ( and mention to your doc quoting the BMS recs if necessary!).

Hurdity x