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[pepperminty]

Hi Ladies,

if you are on a conti combined HRT, I was wondering why there would be 2 doses of PROVERA Medroxyprogesterone 2.5 or 5 mgs daily. Why are there 2 ? How would you know which one?

Also when on Utrogestan daily how important is not taking it with food etc- say if you had a late meal and want to go to bed early?

PMX

[Dotty]

I think the guidance is to take 2.5mg but if it doesn’t control bleeding to go up to 5mg.

If you take Utrogestan with food or on a full stomach it increases the absorption . I’m not quite sure why that matters though! X

[pepperminty]

Thanks Dotty, It is all soo complicated !

PMX

[Hurdity]

I think the guidance is to take 2.5mg but if it doesn't control bleeding to go up to 5mg.

If you take Utrogestan with food or on a full stomach it increases the absorption . I'm not quite sure why that matters though! X

Yes it's weird that women are advised not to take on a full stomach and I can only conclude that the measurements of absorption and amounts needed to thin the lining were recorded and gave more consistent results ( ie less variable amongst women) in terms of dosage for efficacy maybe? I did read the paper about absorption and maybe there were even more side effects with greater absorption (can't remember offhand) but recall that following this study the advice was take take at least 2 hours (I think?) after food.

If women are having trouble obtaining full control of endometrium on say 100 mg utrogestan then if they don't fancy taking it vaginally then maybe trying taking it with food would be the next step? It could also be that absorption was more variable when taken with food and therefore if levels fluctuate more then more erratic bleeding could occur. Sorry thinking aloud and I should really try to find that paper!!!

Hurdity x

[pepperminty]

Hi Hurdity,

It seems such a faff to take it 2 hours after food if one is on a continous combined regime - every day  . It would mean no eating after 8 pm for me as I am asleep around 10pm- , I wonder if it has to be 2 hours?  I wonder why this happens with Utro and not the others? 

PMx

[Hurdity]

Utrogestan is very unstable and breaks down quickly in the body which is why it has to be taken at far higher doses than the other progestogens. Natural progsteorne is produce consinuously in pulses by the ovary (after ovulation) but of course we can't mimic that. if there was a ring that could hold it that would be fab but it breaks down too quickly in the body - I'm not sure if a progesterone ring has been tried (to be made)?

I can't remember exactly whether it was two hours - just off out so no time to check - but it was just to ensure stomach wasn't full of food as it increased absorption - it really won't do any harm but if you vary the time or state of your stomach when you take it then your systemic prog levels may fluctuate a bit more.

Hurdity x

[KiltedCupid]

Utrogestan is very unstable and breaks down quickly in the body which is why it has to be taken at far higher doses than the other progestogens. Natural progsteorne is produce consinuously in pulses by the ovary (after ovulation) but of course we can't mimic that. if there was a ring that could hold it that would be fab but it breaks down too quickly in the body - I'm not sure if a progesterone ring has been tried (to be made)?

I can't remember exactly whether it was two hours - just off out so no time to check - but it was just to ensure stomach wasn't full of food as it increased absorption - it really won't do any harm but if you vary the time or state of your stomach when you take it then your systemic prog levels may fluctuate a bit more.

Hurdity x

There is a progesterone vaginal ring. No idea why it's nit more widely available.

https://path.azureedge.net/media/documents/RHSC_progesterone_br.pdf

[pepperminty]

I wonder if the unstable element is part of  why some have trouble with Utro? It is a shame that there are not more progestogens available in tablet form in the uk .

PMX

[Hurdity]

There is a progesterone vaginal ring. No idea why it's nit more widely available.

https://path.azureedge.net/media/documents/RHSC_progesterone_br.pdf

That's interesting. It looks like it has limited use though - as an additional contraceptive ring for breastfeeding mothers in whom ovulation is fairly well suppressed anyway, and available mainly in some of the developing countries of Latin America where this is a need for woman controlled method of contraception which can be used without medical intervention especially in the first year post-partum, (so I read). A very low amount of progesterone is released per day (10 mg) - but I am interested to know why it is able to remain stable for 3 months - presumably because the environment is inert rather than in vivo ie the living cells of the human body - but also must be stable at body temperature.  Would be good if more research could be done - although we already have a vaginal gel - but which is very little used, as well as other vaginal progesterone caspules used for fertility which could also be used for HRT - but I suppose with these you get the high peaks of progesterone which is what causes the side effects.

Hurdity x

[KiltedCupid]

I just assumed if it prevents pregnancy, and the success rates seem to back that up, then it's stopping the endo from growing and maturing which is the whole point of an efficient prog. Even removing the breastfeeding efficacy, if 10mg from a ring can do this then why are we using 100mg vag route on a conti basis?

As I've always suspected with Utro, it's a sledgehammer to crack a nut.

[Hurdity]

I just assumed if it prevents pregnancy, and the success rates seem to back that up, then it's stopping the endo from growing and maturing which is the whole point of an efficient prog. Even removing the breastfeeding efficacy, if 10mg from a ring can do this then why are we using 100mg vag route on a conti basis?

As I've always suspected with Utro, it's a sledgehammer to crack a nut.

The mechanism by which this ring prevents pregnancy has nothing to do with the endometrium and a whole different lot of research would need to be done in order to investigate its effects when used as part of HRT.

Since you highlighted this interesting method I had a look at the detailed info on the web and the aim is to prolong "lactational amenorrhea" (lack of periods while breastfeeding) in women who are breastfeeding at least 4 times a day and in whom ovulation is already suppressed to some extent.
http://origin.who.int/selection_medicines/committees/expert/20/applications/ProgesteroneVaginalRing.pdf

From the link you gave - the mechanism of action is twofold - firstly through hormonal inhibiton of ovulation (through systemic absoprtion and presumably contributing to disruption of the endocrine control of the whole process including the brain's involvement - what is known as the hypothalamic–pituitary–gonadal axis), and secondly by causing thickening of the cervical mucus and thereby inhibiting sperm penetration.

I totally agree that more research is needed into alternative methods of delivering progesterone and something like a vaginal ring would be amazing! If only this were being carried out as well as more research into eg 50 mg capsules and different doses of progesterone corresponding with different oestrogen doses.

Yes taking progesterone the way we do once a day is like a sledgehammer and we are doing it because of the instability of the compound in the body so we have to take these ridiculously high doses just to get the right amount to protect the uterus consistently. If only something else like this could be produced a lot of us would be very happy

Incidentally those who take 200 mg orally presumably can split their doses to take 100 mg twice a day 12 hours apart for the same effect? Vaginally may not work due to gravity.

And - we are back to the question of dydrogesterone again. I would love to be able to try this to see how I felt compared with Utrogestan...

Hurdity x

[Mary G]

I've found a brilliant alternative to Utrogestan, bespoke 50mg progesterone.   I also take oestrogen and testosterone every day.

It's not available on the NHS and it's fairly expensive but it's worth every single penny to me.  I was staring down the barrel of a hysterectomy.

I don't have any side effects, feel as good as I did on the oestrogen only part of HRT and it's bleed free!   

It also works extremely well on the uterine lining.   My last scan was 3.3mm.

I've been on this regime for a year now and still can't believe I've found a continuous combined regime that works without nasty side effects.

So there is hope out there.

[Sammiejane]

Hi ladies

Could any one advise what effect if any micronised progesterone utrogestan has on the hair does it help hair growth or cause hairloss ?

I'm shedding hair exessively on estradiol well using estrogel and trying to establish if I should use progesterone even though I have no womb as my ratio of estrogen to progesterone is now high which maybe causing my hair shedding !

All blood work fine

[KiltedCupid]

I've found a brilliant alternative to Utrogestan, bespoke 50mg progesterone.   I also take oestrogen and testosterone every day.

It's not available on the NHS and it's fairly expensive but it's worth every single penny to me.  I was staring down the barrel of a hysterectomy.

I don't have any side effects, feel as good as I did on the oestrogen only part of HRT and it's bleed free!   

It also works extremely well on the uterine lining.   My last scan was 3.3mm.

I've been on this regime for a year now and still can't believe I've found a continuous combined regime that works without nasty side effects.

So there is hope out there.

MaryG - your prog sounds wonderful. I've earmarked this as a possible for me but I've reduced my E to such a low dose now that I need very little prog and have a thin endo measurement using small amounts of levo on a long cycle. But, I don't feel as well as you sound!

I will definitely keep it on file as a possible.

[bear]

Hi girls,

Actually there is a progesterone ring available for hormonal supplementation and pregnancy maintenance. It's being marketed by the same South American laboratory (Grünenthal Group) that manufacturers Progering. It's called Fertiring.

Remember that Utrogestan was also initially developed for pregnancy maintenance.

https://www.rhsupplies.org/fileadmin/uploads/rhsc/General_Membership_Meetings/Brussels_2018/Presentations/Day_1/NURHT/Meeting_user_needs_with_a_new_product_category_Considerations_for_the_future_of_vaginal_rings_-_Saumya_RamaRao__Heather_Clark_and_Naomi_Rijo_.pdf

https://www.sciencedirect.com/science/article/pii/S016836591930077X

BeaR.