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[Hurdity]

As this comes up frequently I thought I would do an information post on this topic. I thought I had done a separate thread about it but can't find it so maybe not - here it is now:

Utrogestan (micronised progesterone) is manufactured by Besins, Belgium to be taken orally or vaginally (see below) - it is only in the UK that it is licensed just for oral use as part of HRT.

Previously both 100 mg and 200 mg capsules were available and packaged for HRT in UK. Some while ago the packaging of the 200 mg HRT capsules ceased (no idea why!) so only the 100 mg capsules are now available for HRT (but without applicators as they are not officially used vaginally in UK).

However the identical 200 mg capsules have always been available in UK for fertility purposes which in the UK are indicated for vaginal use. These are provided with an applicator. https://www.medicines.org.uk/emc/product/3244/smpc

Anyone who would prefer to have the 200 mg capsules - even if you want to take them orally - should ask for these. If the doc says Utrogestan 200 mg is not licensed for vaginal use for HRT  – they are the same capsule. You can mention that they were just withdrawn -  not for any medical reason since the cyclical dose of utrogestan  as part of HRT remains at 200 mg.

In the French database of medicines (the "base de donnees publique des medicaments") this product is listed as: "UTROGESTAN 100 mg, capsule molle orale ou vaginale " (soft oral or vaginal capsule) - similarly for 200 mg.  In the info it gives the indication for vaginal route, amongst other uses, if side effects are experienced with oral use:

"Dans toutes les autres indications de la progestérone, la voie vaginale représente une alternative à la voie orale en cas:

• d'effets secondaires dus à la progestérone (somnolence après absorption par voie orale)."

Translation: In all other indications of progesterone, the vaginal route respresents an alternative to the oral route in the case:
.. of  side effects due to the progesterone (sleepiness after absorption by the oral route).

A post giving summaries of the studies looking at the use of vaginal progesterone in protecting the endometrium (womb lining) as part of HRT is here:

https://www.menopausematters.co.uk/forum/index.php/topic,43633.15.html

Hope this information is helpful . I'll bump it from time to time when there are Qs about it.

Hurdity x

[Turkish delight]

Hurdity 

Not sure if I imagined this but, I think I remember reading in another of your post saying that a paper outlined/recommended halving the dose from 200mg to l00mg if you are taking it vaginally and not orally as your doc prescribe the 200mg for? Is that a thing or am I making it up lol!

Just so I'm being clear(bcz I don't think I am )Is 100mg vaginally equivalent to 200mg orally? Please confirm or correct.

TD

[MicheleMaBelle]

Hi TD- it's not a different dose. You take 200mcg for 12-14 days if you're on a cyclical basis regardless of  method of dosage. 100mcg regardless of method if you take it daily ( no bleed )
Anything less should be done under medical supervision x

[KiltedCupid]

Hi TD- it's not a different dose. You take 200mcg for 12-14 days if you're on a cyclical basis regardless of  method of dosage. 100mcg regardless of method if you take it daily ( no bleed )
Anything less should be done under medical supervision x

That was always my understanding MicheleMaBelle, I've posted prescribing spec from C&W as, for new members this could become really confusing. Old hands at hrt know there's room for manoeuvre with doc approval but newbies shouldn't be confused.

https://www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause-and-pms-clinics/links/ProgestogenandProgesteroneRegimensinHRT130518AGREED.pdf

[Turkish delight]

Wow thanks girls for clearing that up.

Since I've upped to 2 pumps I haven't had a bleed on 100mg x12.
I saw the specialist only once and was cut loose to find my own way. My GP is good but admits when he is clueless.

Now I'm on 2 pumps I should up my utro to 200mg, to fall in line with the guide. Could have sworn I read that 200mg orally is 100mg vaginally.

Thanks again, my brain fog is hindering all my thinking faculties atm.

TD

[Hurdity]

Hurdity 

Not sure if I imagined this but, I think I remember reading in another of your post saying that a paper outlined/recommended halving the dose from 200mg to l00mg if you are taking it vaginally and not orally as your doc prescribe the 200mg for? Is that a thing or am I making it up lol!

Just so I'm being clear(bcz I don't think I am )Is 100mg vaginally equivalent to 200mg orally? Please confirm or correct.

TD

Apologies if I confused you Turkish Delight. The licensed dose  is as Michelemabelle said. However some gynaes and menopause specialists (and some GPs) do prescribe lower doses for vaginal rather than oral use (notably Louise Newson). This is why I posted the studies on the other thread - firstly to show that it can be used vaginally, and secondly the preliminary studies which show that half the vaginal dose is sometimes effective (in protecting the endometrium) compared to when used orally. I think someone once linked to something that Louise Newson wrote about this - but she prescribes privately and therefore supervised.

Interestingly the French instructions still give the same dose for vaginal as for oral use in their prescribing instructions.

No brain fog at all! Unless under medical supervision then go by the licensed dose....

Hurdity x

[Hurdity]

PS in fact there is information in the main thread where I have quoted all the studies - about variation from the licensed regime. The last study in the list was published in Climacteric - the Journal of the International Menopause Society:

"P. Stute, L. Wildt & J. Neulen (2018)
Climacteric, 21:2, 111-122,
https://www.tandfonline.com/doi/full/10.1080/13697137.2017.1421925

Abstract
Postmenopausal women with an intact uterus using estrogen therapy should receive a progestogen for endometrial protection. International guidelines on menopausal hormone therapy (MHT) do not specify on progestogen type, dosage, route of application and duration of safe use. At the same time, the debate on bioidentical hormones including micronized progesterone increases. Based on a systematic literature review on micronized progesterone for endometrial protection, an international expert panel's recommendations on MHT containing micronized progesterone are as follows: (1) oral micronized progesterone provides endometrial protection if applied sequentially for 12-14 days/month at 200 mg/day for up to 5 years; (2) vaginal micronized progesterone may provide endometrial protection if applied sequentially for at least 10 days/month at 4% (45 mg/day) or every other day at 100 mg/day for up to 3-5 years (off-label use); (3) transdermal micronized progesterone does not provide endometrial protection"

One of the other studies compares 100 mg with 200 mg used vaginally - so this is what gynaes and menopause specialists are basing their recommendations on.

Hurdity x

[Turkish delight]

That's brill thanks Hurdity for replying


I'm confused a lot in mono, sometimes it feels like my brain is just toying with me like a cat with a ball of string.

I feel so much better for knowing the extra info, and have peace of mind knowing that I haven't been doing it all wrong by taking 100mg for the 2 months I've been on 2 pumps, and that nothing bads gonna happen to me bcz of it. I'm not under any supervision whatsoever, not even an initial first 6-month check, so I will go with the standard 200mg from now on instead. Phew, one less thing to worry about is a good start to my Sunday lemme tell you.

I'll probably start another thread on what tests I am supposed to be having to avoid any of the hrt pitfalls, like scans I've read about others having etc.
I'll have to go and petition for them as I mentioned I'm in this alone, no one is looking out for me except you girls of course.


TD

[Hurdity]

Bumpity bump... for Macca65

This one do you mean Macca?

Hurdity x

[Hurdity]

Bump for Kittykats and others new to utrogestan and vaginal use especially if their GP or specialist has not heard of it being used like this.

Hurdity x

[Hurdity]

Bump for friend of lhasa ipso and Emm225.

Hurdity x

[Hurdity]

Bump (again!) for Emm225 - I see I've already bumped it for you a couple of weeks ago!

The posts fall off the page so quickly though so easily lost!

Hurdity x

[Hillbilly]

This is great info thank you 

I started Utro on 1st of May and have been using it vaginally (2x100mg) despite the pharmacist at my surgery telling me it wasn't licensed for use that way.

It's very odd 

[Emm225]

Thank you for this.  I spoke to a doctor on the phone...one from the practice I haven't seen before but she was the only one available... the other day as had a few side effects taking orally...just v tired etc.  She categorically told me they shouldn't be taken orally and weren't licensed for it.  She suggested I had either a Mirena fitted (I had one taken out before xmas because of bleeding...had Mirena for a good 15 years, no problems and no periods until recently...I would have thought the reason I didn't have another in was because of bleeding?!) Womb lining is thin as had every scan and test under the sun when had bleeding as they were worried was cancer or something. Thankfully once the Mirena was removed bleeding stopped...but has started again this week after 3 or 4 weeks of HRT patch and pill.
I just don't seem to get answers from my doctors...husband said they seem to be treating it as art rather than science.  When it's my body and it involves medication I would rather it was science!

[Hurdity]

Bumpity bump for IZA

Hurdity x