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[olisue]

Hello

I've been on estrogel/utrogestan since February.  I'm 46 and prior to starting HRT I hadn't had a period for 6 months and was experiencing hot flushes/night sweats.

The above combo took about 2 months to kick in, but was working well.  I was on 2 pumps of gel and 100mg of Utrogestan taken vaginally 12 days a month, and having a 5 days bleed each cycle.

I asked my GP if I could change to Cyclogest pessaries (this was purely because utrogestan contains gelatin) and she agreed and this month I've been using half a 200mg cyclogest pessary in place of the utrogestan.  But I've had no bleed this month and the hot flushes have come back.  I've increased the estrogel to 3 pumps about a week ago, so still waiting to see if that helps. 

Does anyone have any experience of using cyclogest?  If so, do you think the dose I've been prescribed is right?

Thanks for reading

[IZA]

Hi Olisue. I've only just registered in this site so this is my first post. I was taking 100mg Utrogestan vaginally too with no side affects but my menopause consultant said as it's not licensed to be taken that way, she's putting me on Cyclogest pessaries. I haven't started on them yet but as they come in 200mg, please can I ask you which way you cut them in half? I need to take 100mg every day (no break). Do they cut in half easily? Sorry I can't help with your question but I will come back and let you let you know how I'm getting on with them. If, like you, my hot flushes come back, then I?ll go back to Utrogestan orally. I only took them vaginally as I was getting bloating and that worked really well for me. I can't find any information about cutting the pessaries in half anywhere, so if you can help with that, I?ll be really grateful. 

[olisue]

Hi Iza, thanks for replying.  I peeled open the wrapper so that approx half of the pessary was showing and cut it in half with scissors.  Then put the wrapped half back in the box for the next day.  Probably not completely accurate but it balances out over 2 days. 

I didn't get any side effects from the cyclogest, but I've got a feeling 100mg isn't enough for me.


Please let me know how you get on xx

[IZA]

Thanks Olisue. That's really helpful. it's coincidental that you think 100mg might not be enough for you, as my specialist was happy for me to use the whole 200mg pessary daily. I said that as I've only been taking 100mg Utrogestan, I was worried that I would have progesterone overload on 200mg (not that I know what the affects would be!) She said that a lot of women take 200mg daily but it's still a big jump for me. Then again I had major issues with thickening of my womb two years ago so perhaps a higher dose would be better. Isn't it a nightmare, finding the right balance? I've increased my Oestrogel pumps to 3 now so if I do get hot flushes again or other side affects, I?ll try taking the full pessary for a while. Thanks again. I hope it goes well for you.

[Hurdity]

Hi olisue and also IZA

The most important thing to note is that utrogestan is manufactured on the continent to be used both vaginally or orally ie the same product. The 200 mg version is now used for fertility and the 100 mg version for hRT. However the 200 mg used to be packaged for HRT, so in that sense actually it has been licensed and I think the change was probably for commercial reasons, who knows? I did a post on this which I can find and bump for you which gives the French product info translated.

Cyclogest is not licensed in UK to be used for HRT at all (strangely) but like Utrogestan licensed to be used vaginally for fertility purposes. In practice some gynaes and enlightened GPs prescribe it also for HRT.

In terms of dose, the amounts of progesterone absorbed to the endometrium through the vagina are not exactly comparable between the two methods becase they are a completely different formulation with a completely different delivery method.

The way to work this out is either to look for studies that measure how far the endometrium is protected with the various doses, or look at the data on how much is abosrbed in the product info, or as a rule of thumb, how much is given for fertility with the different treatments.

When I was using Cyclogest my GP prescribed me 400 mg per day for 11 days per cycle. I felt this was a high dose but if you google the product ( and utrogestan) you will see that for luteal support Cyclogest is prescribed at 400 mg maximum twice a day vaginally (800 mg), and utrogestan at 200 mg three times a day (600 mg). I would suggest therefore because you are cutting the capsules you might not be getting enough (since more a higher dose of Cyclogest is needed to achieve the same effect compared with utrogestan) so probably just cutting off a quarter of it may well give you better protection?

If you don't have a bleed it generally means that the endometrium hasn't built up enough although if far too little progesterone this also could I think prevent the right changes to enable the womb lining to be shed.

Hope this helps

Hurdity x  IZA

[IZA]

Hurdity, you are so knowledgeable. Thank you for taking the time to send that message.
Im going to try to take the full 200mg Cyclogest and see how it goes. To be honest, I was quite happy taking the Utrogestan 100mg vaginally (it caused bloating when I took it orally) but I upset the apple cart by telling my specialist that I took it that way. She wasnt at all happy with that but as it's meant to be taken orally, I can understand her reluctance to leave me taking it that way.
I was on HRT for five years and I was happy and healthy but I suddenly had light occasional bleeding and investigations showed that my womb was way too thick. I had tests and biopsies but no cancer was found thank goodness. They told me to stop the HRT immediately and the effects were devastating. By the time I was finally put back on it two years later,  I was in such a dark place both physically and mentally and Im already feeling the benefits of taking it again. I cant afford to let my womb get thick again though (apparently the combi HRT I was taking before, only had a very small amount of progesterone in it), so its important that I get the dose of progesterone correct. I have no idea how I will know unless they scan me but I am 58, so Ill be taking it every night as I no longer have periods.
Its all trial and error isnt it but I am just grateful to be back on it Thank you so much for the information you provided. I will read up on it further. X

[Hurdity]

IZA: My pleasure. I've been doing it for a long time ie been on HRT for 13+ years so have had time to read up about it so want to share what I've gleaned along the way. At a critical point on my HRT journey I discovered this forum and the members at the time helped me enormously.

If you're in UK and were seeing a menopause specialist doctor or gynaecologist then they should know that utrogestan is manufactured to be used vaginally or orally and that many specialists in UK prescribe it for vaginal use for women who have side effects from oral use ( which is what the manufacturing instructions say in French. Hope you saw the other thread I bumped which details this? In case not here it is: https://www.menopausematters.co.uk/forum/index.php/topic,45782.0.html ). It is completely wrong of them to say it is (only) meant to be taken orally. Vaginal route is given as an alternative for those who suffer sdie effects as you will see. Like I said in my previous post and above it can be used either way and just by some quirk of UK licensing (compared with other parts of EU) is now not packaged for vaginal use ie the same product. They should also know that in fact research shows that MORE progesterone gets to where it is needed for the same dose used vaginally compared with oral use. This stands to reason as vaginally it is absorbed stright through the cervix to the uterus where it acts on the lining.  It avoids both the vagaries of the digestive process and the liver "first pass" effect whereby the progesterone that gets through the digestive process has to be metabolised by the liver and then transported to the uterus that way. You can imagine that is much less efficient.

Therefore if you were happy to use Utrogestan and it was protecting your womb I would go back to it, although Cyclogest can be just as effective like I said, even though not licensed for HRT at all in UK. You could educate your specialist! Are you paying for this advice? Otherwise you don't need to tell him/her (that you are taking it vaginally) although this is less helpful when you want to work with them over your treatment.

The advantage with Cyclogest is that it can be used as a suppository ie anally as well as a vaginal pessary so that this can overcome some issues with continuous use if in an "active" (!) relationship for example. I did use it like this (ie suppository) when I used it cyclically although I must say I did not like the effects of this ( won't go into details!!!), but just thought I would mention. If course used as suppository it still has to be absorbed into the blood stream (through the bowel) and transported to uterus  though doesn't have to go through the liver) so vaginally is the best way for utrogestan or Cyclogest in this respect (in terms of how much gets to the lining where you want it).

What HRT were you on that caused the womb thickening?

Anyway I hope this helps

Hurdity x

[olisue]

Thanks so much Hurdity for your thoughtful and detailed reply.  I'm almost convinced now that half a 200mg pessary is not enough progesterone for me, so I will ask my GP if I can increase it.
xx

[IZA]

Hi Hurdity
When I had my complete meltdown at the doctors and was finally referred to a specialist, the lady was amazing and explained that my 100mg Utrogestan was an oral tablet but could be taken vaginally if I had an side affects (which I did...bloating). She was fully aware that a lot of women took it this way. However in my review, a different specialist dealt with my treatment (NHS by the way...I am in the UK) and appeared to have no knowledge of it being taken this way, hence the change to pessaries.  I did want to argue the point and say no....that I was happy taking the Utrogestan vaginally...but it would just make things awkward and I am still trying to get myself sorted again so for now I will leave it. She's lovely...don't get me wrong...but I too am shocked that she thinks it cannot be taken vaginally, full stop.
Anyway, I will try the pessaries and see how it goes and if I have any issues, I will ask to go back to taking Utrogestan but orally ( wink).
Considering that I had to stop the HRT suddenly because my womb was too thick, I have never been given a scan or anything since so how do I know that it has even gone back to a normal size before I started taking HRT again. Does it instantly shrink without the HRT?  I am still so shocked at how badly my body reacted to stopping the Oestrogen. Some women seem to stop taking HRT and they manage perfectly well. I even stopped working because of the aching and exhaustion and eventually stopped seeing friends, as I kept bursting into tears and my hot flushes were so bad that my face just kept falling off in front of people (or that is how it felt). It was so embarrassing and made me very depressed. I went back to doctors many times, asking to be put back on it and I tried lots of alternatives but I just became a shadow of my former self and in the end I had a bit of a breakdown. Luckily it was a female who saw me this time and she had me referred as an urgent case.
I do worry because if I can't stop it at my age, when will I be ok without it? How late can women stay on it? That is a question that I am scared to ask incase they say I can only take it until I am 60 or something. I have had tests and I am fine in every way so it is definitely just the lack of Oestrogen that caused my downward spiral. Now that my hot flushes have stopped, I have started to socialise with people again (via the internet as it's lockdown sadly) and that's been wonderful. I feel so much happier already.
Thank you again for the latest message you posted. You've been very helpful again and I am waiting to see how Olisue gets on with increasing her dose too. X

[Hurdity]

Hi again IZA

No the womb lining doesn't instantly shrink. In fact I don't know what happenes to a thickened lining if you stop HRT for ever and are post-menopause. I do know (from what I read) that it is thought that the endometrium generally eventually atrophies after some time post-menopause, so that it (the oestrogen receptors) no longer responds to oestrogen and stays thin, otherwise, since we continue to produce oestrogen even when post-menopause but at a low level, our womb lining would continue to thicken. It seems that in some women it does and this is what can lead to cancer. In your case it will depend on how thick the lining was and the bleeding you had. It may well have thinned down?? You will soon find out because if still thick you will start to get bleeding when you take the progesterone (although this may be expected anyway in the first 6 months of continuous combined HRT).

You haven't said what HRT you were using which caused the womb lining to thicken, and how ignorant of the docs then to suggest that you needed to come off HRT if all was otherwise well and no pathology etc, when what is needed is the correct balance of oestrogen and progesterone for your particular body. The fixed dose combi products available are not necessarily right for all women! Also do I get the impression you were taking it cyclically before? if so then the womb lining thickens and thins as part of the cycle so depends when in the cycle the scan etc was carried out.

It does sound like you are one of the women for whom continued oestrogen is so imortant for physical and mental health. I have never tried to come off it for longer than 3 months so I've no idea how I would feel now. I'm in mid 60s btw and you can now take hRt for as long as you want provided there is no compelling medical reason not to. This should be an informed decision between you and your doctor after discussion of the risks of continuing. They should not force anyone to stop HRT. Check out the British Menopause Society statement: https://thebms.org.uk/publications/consensus-statements/hormone-replacement-therapy/ . As long as you keep yourself healthy in other ways ie body weight, diet, exercise, lifestyle, alcohol etc then you are minimising cancer risk from these sources.

From what I gather you have started taking the oestrogen, and are now feeling better, but have yet to start the progesterone (Cyclogest)? From what you've said already I would not cut the pessary in half but use it all. In fact if you did need a lower dose ( which I don't think is the case with Cyclogest for reasons given before but might be for lower oestrogen doses) it would be better to take it alternate days than to cut it.

I had a brief few months of trying continuous combined hRT when I went back on it after stopping ( 2011) and at the time the doc suggested going for a lower dose so I went onto 25 mcg patches instead of 50 mcg. Along with another woman on the forum on the same combo we worked out that we could take the Cyclogest every 2 or 3 days based on our oestrogen dose and other regimes. For me this worked fine but I was on a very low dose of oestrogen. My gynae specialist gP was happy with this. As it turned out my flushes returned after initially stopping so I had to increase the oestrogen dose, and that being the case I didn't want to take a higher dose of progesterone all the time so sent back to cyclical and changed to utrogestan ( discovered through this forum, as it was quite a new preparation for menopause).

Hope this helps,  good luck and hope you continue to feel better

Hurdity x

[IZA]

Hi Hurdity
One of the many issues I had when I was forced to stop HRT, was fog brain. I developed a second language (could even say a sentence backwards perfectly....hugely embarrassing in public!) and my memory was terrible. Well quite clearly the dippiness has not improved yet as I have finally collected my new Progesterone pessaries and they are not Cyclogest. They are Utrogestan 200mg vaginal capsules. I had read that for HRT, women are given either Utrogestan 100mg tablets or Cyclogest 200mg pessaries that can be cut in half so I presumed that they would be Cyclogest as I have not read about Utrogestan 200mg capsules being prescribed...only for pregnancy. I feel so silly! I have searched the internet and I cannot find anyone who takes them for HRT...not continuously every day, like me. It is good in the sense that I was taking Utrogestan 100mg already (Vaginally) so I know that I am absolutely fine taking that brand with no side affects but doubling the dose is still concerning me. I took my first one last night and slept like a log which is a bonus (I normally wake at around 3am for some reason but I go back off after an hour or so) and it was very easy to take. I did ask my specialist if I could take it every other day but she said that I would be at more risk of a bleed taking it that way. I notice that you did that when taking your Cyclogest though. With you experience of taking progesterone...as the 200mg builds up in my body from taking it every day (or does it not build up? I am not sure how it works in the body), can it cause any ill affects?
 I have now increased my Oestrogel to three pumps as I am still struggling with severe fatigue and aching joints, so I guess I need more progesterone to combat the extra Oestrogen?
In answer to your questions...I was on Kliovance combined HRT. My womb was found to be 16mm thick. I had a fibroid removed which I now understand could have been caused by the excess Oestrogen? My initial bleed that sparked off all the tests, was extremely light, so it is many years since I had a proper bleed. The last thing I want is to have bleeding now. As the days pass, I can feel myself slowly getting better. I am not expecting miracles as I had so many problems after having to stop it but I am getting there.
I am just worried about taking double the dose of progesterone. If it has no ill affects on the body though, then perhaps it is a good thing to take, as my womb was so thick. Have you any experience/knowledge  of taking Utrogestan 200mg vaginal capsules?
Thank you for the link you added by the way. You are an asset to this forum. X