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[LuLu71]

Hi Gracie and Ladybt,

Thank you for sharing that information about levels of estrogen needed to protect heart and bones. It's such a relief to know I won't be inducing cancer by increasing up one pump. Really, it helps so much with my sleep and sleep has an impact on everything in the body! For instance, last week my blood tests came back saying that I am prediabetic which I read can happen in menopause from lack of hormones and sleep...So glad for you that it has improved how your joints feel. I read somewhere that estrogen is involved in over 400 aspects of the body's functions...no wonder why so many of us feel so terrible through what is supposed to be "natural."

Ladybt, I think my gyno would take my gel away if I told her about 6 pumps a day lol. It's strange how I trust so much what this gyno tells me except for increasing gel - which is actually a huge thing. It's a shame I can't ask her more about why she is against using more because I am a bit afraid that she might stop being my doctor lol. She will never know that I am increasing the gel pumps! Thanks for sharing that both your GP and meno clinic concur on the dose. Sets me at ease.

Best of luck to you both with this "fun" journey!

[annedenmark]

Dotty's right: you can either take 100mg for 25 days or 200mg for 12 days depending on whether you are peri or post; although some post women still prefer to go with the sequi regimen. I'm following the same regimen as Ladybt28: 4 pumps daily and then 12 days of 200mg Utrogestan per month- which I am now taking vaginally; interesting you suggest Ladybt28 than 100 vaginally on a 12 day cycle is okay, Something to consider...(under supervision obvs.)
Anyway, 4 pumps is a prescribed amount (And my GP's a 'by the book' type). I think I read that some women have used up to 6 pumps; but I would guess too that this is under supervision.
Good luck,

[Ladybt28]

annedenmark - the theory goes that 100mg vaginally can be sufficient as it is absorbed immediately into the right area.  Obviously if it is taken orally then it is broken down by going through the stomach and the liver and so 100mg would be far too little orally.  I do 200mg because I use 4 pumps, but some ladies who have mega mega problems with progesterone only do the 100mg.

[annedenmark]

Ladybt28, given I'm on 4 pumps so I'll try 2 or 3 cycles of 200mg x 12 vaginally, to see whether that dissipates the prog symptoms I've been getting when I've taken in orally. Thanks for the info re absorption; I'd rather not drop to a lower amount of Utro without medical supervision.

[LuLu71]

Hi Ladybt and Annedenmark,

Thanks for pointing out that the progesterone is taken vaginally at 100 mg with the gel being >2 pumps. I only take 100 mg of progesterone orally a day, every day, no intermittent pauses in any type of cycle...I've started 10 mg of vagifem vaginally but this is estrogen....

So, orally taking progesterone at 100mg isn't enough to take more than 2 pumps of estrogel a day with? Or do you think that is okay?

Thanks so much in advance for answering.

[annedenmark]

I'm really no expert, but I would have thought that taking 100mg everyday of the month orally, would result in similar (if not greater) progesterone intake to the 12 days a month at 200mg that I've been prescribed to take orally, (alongside 4 pumps gel daily) -disregarding that I have changed to vaginal delivery. (I've done this to try to reduce uncomfortable prog symptoms, But I still take 200mg for 12 days).

As I said, I am new to this forum, (hence my newbie status) so I would strongly suggest you confirm this with your GP, and of course wait for an expert on this forum, too!
Sorry I can't be of more help,

[LuLu71]

Thanks annedenmark for responding. It is tricky eh? I wish all of this was written somewhere online by the pharmaceutical companies or professional articles. I wonder why it doesn't seem to be anywhere- that is, how much progesterone to take alongside the estrogen/estrogel.

If anyone out there is taking 100 mg of progesterone daily and more than two pumps of estrogel, I would love to hear about it! I'm thinking I can't really ask my GP because my gyno wrote him a letter explaining what I had been doing and why she feels this is wrong...I think he would side with her. Guess I could try for a second opinion from another gyno if I need to.

[Ladybt28]

Sorry if I have confused but there is some confusing information around dosages.
The prescribed dose on the leaflets and by GP's is either 100mg every day which is a continuous regime or 200mg for 12 days out of a 28 day cycle. The prescribed dose is also taken orally....this is what is written down and general prescribing but...

in Europe utrogestan can be used vaginally as I described because it gets absorbed direct to the right area and doesn't get broken down by the stomach...therefore some consultants will say you can use 100mg for the 12 days.

The difference in dose between the 100mg continuous or the 200mg 12 days is because the 100mg builds up in the system and is taken as it says "continuously".  the 200mg is the higher dose because it has to create a "hit" if you like over a shorter time to fool the body into a false period.  So the job of utro in 100mg dose continuously is to "stop" the womb lining building up and creating a balance so there is no bleed and the 200mg dose is to trick the lining into "shedding" what lining has built up.

I hope that clears it up...I don't know how else to explain it... it depends what regime you are doing continuous or cycle and how you are taking the utrogestan vaginally or orally (also how you get on with progesterone at all!) x

[LuLu71]

Thank you so much for sharing all of your knowledge Ladybt. Whew, I feel better now about going up to three pumps again. I know that I should also let my doctors know but honestly, as I said before, I'm scared my gyno may take the gel away from me lol. And it kind of freaked me out that she wrote to my GP about what I was doing, like she's covering her butt in case something goes wrong...

Thanks again for explaining. I understood what you wrote to clarify all of the differences in routes. Have a lovely night

[Hurdity]

The main thing is that the dose of utrogestan given as the licensed amount (ie 100 mg for conti or 200 mg for cyclical)  - is the given as the same whatever the dose of oestrogen - which may not be the case of some of the combi products that have higher progestogen amounts to correspond with the higher doses of oestrogen.

Notwithstanding the fact that you get more progesterone to where it's needed when used vaginally compared to orally - as Ladybt explained very clearly, there is a dose dependent effect of progesterone needed so that ON AVERAGE,  higher doses of progesterone are needed for higher doses of oestrogen.

BUT (and a very big but) - this is only an average and won't say how you will respond as it also depends how much oestrogen YOU absorb, what effect it has on YOUR womb and you won't know until you try!

The important thing is that variation from the licensed regime should be done under medical supervision - but with your knowledge and understanding - (so that if necessary you might need to educate them), and that any untoward bleeding should be reported to your GP.

Your gynae should not take your gel away from you!!!!

Hurdity x

[LuLu71]

Thanks Hurdity for all of the information. It sounds like what you're saying is if it is too much estrogen to progesterone ratio, then I would bleed? As I write on here and ask questions it does feel like I should, to be on the safe side, get actual medical supervision for this, going forward. I'm going to have a think on doing that or just trying this on my own for a bit...it's shaken my confidence a bit about health professionals who are supposed to specialize in this stuff when my gyno disagrees with something that is noted in the estrogel manufacturing instructions (some women need more than two pumps). Anyway, thanks so much for your knowledge. This stuff is tricky. xo

[sheila99]

Lulu, gynaes are specialists in pregnancy and childbirth, it doesn't mean they know much about meno. A meno clinic might be a better place to go.

[LuLu71]

Hi Sheila, Yes, you are right and somehow right about my gyno. What a strange coincidence for you to write that because I just finished a google search on her background/reviews, and yes, I think I was maybe giving her too much credit before (?) She's only been practising for a couple of years as well which is fine but for some reason I thought she'd been around for a lot longer...I'm in Canada and not sure if we have actual menopause clinics out here - that sounds wonderful!- I will look into this. Thanks x