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[amy1235]

Hi all
I thought I'd start  new thread on this subject although I know there have been several discussions before on the use of utrogestan vaginally either continuously or on alternate days. ( I know Hurdity mentioned a study on this subject some time back)
I'm on Femseven 75 estradiol patch and up to now have been using utrogestan vaginally on a long cycle (6-8 weeks) and then getting a rather heavy withdrawal bleed. I'd like to transition to continuous use in order to eliminate bleeds and since I mostly don't feel too bad while on the utro. I waited until the end of my last withdrawal bleed and then started utrogestan 100mg vaginally on alternate days. However, one week in and I've started a bleed again, not just spotting but a full bleed. I don't know what to do now......do I stop the utro and wait until the bleed has finished and then start it again? Is it because I have a thickened lining? Is it because the alternate day dosing of the progesterone is not stable enough for me to prevent the endo lining from building up? Should I try it every night or 25 out of 28 ....Should I consider lowering my estrogen dose? ....I'm spending hours on the Internet trying to research this subject but still haven't come up with a suitable answer. BTW I'm 57 and have been on HRT for nearly 8 years.
Sorry to ramble on .......

[Sooze]

amy1235,
I'm assuming that you're post meno?  According to the info on HRT preparations on this site Femseven 75 is a high dose preparation so alternate days may not be enough for you.  I've never done a cycle, but my logic would to do utrogestan every day for a few months first (possibly up to 6) and see how the bleeding settles and then try dropping to alternate days. 

You may have to reduce to a lower patch though to balance the alternate days of utrogestan, which may or may not be adequate to alleviate symptoms.

I'm on Sandrena 1mg and it took 5 months for the spotting I was having to stop when I changed to alternate days (I'm 56 & post meno). But I've never been on a high dose oestrogen.
HTH,
S

[KiltedCupid]

amy1235,
I'm assuming that you're post meno?  According to the info on HRT preparations on this site Femseven 75 is a high dose preparation so alternate days may not be enough for you.  I've never done a cycle, but my logic would to do utrogestan every day for a few months first (possibly up to 6) and see how the bleeding settles and then try dropping to alternate days. 

You may have to reduce to a lower patch though to balance the alternate days of utrogestan, which may or may not be adequate to alleviate symptoms.

I'm on Sandrena 1mg and it took 5 months for the spotting I was having to stop when I changed to alternate days (I'm 56 & post meno). But I've never been on a high dose oestrogen.
HTH,
S

Sooze - I'm thinking of trying alt day with sandrena. I'm currently using 25mcg fem7 conti but need to find options as I think I'll run out before new batches are released. I was considering 0.5 sandrena as that's approx 25 patch and twice a week utro as I'm seriously averse to that stuff.  How have you got on with your regime?

[Hurdity]

Hi all
I thought I'd start  new thread on this subject although I know there have been several discussions before on the use of utrogestan vaginally either continuously or on alternate days. ( I know Hurdity mentioned a study on this subject some time back)
I'm on Femseven 75 estradiol patch and up to now have been using utrogestan vaginally on a long cycle (6-8 weeks) and then getting a rather heavy withdrawal bleed. I'd like to transition to continuous use in order to eliminate bleeds and since I mostly don't feel too bad while on the utro. I waited until the end of my last withdrawal bleed and then started utrogestan 100mg vaginally on alternate days. However, one week in and I've started a bleed again, not just spotting but a full bleed. I don't know what to do now......do I stop the utro and wait until the bleed has finished and then start it again? Is it because I have a thickened lining? Is it because the alternate day dosing of the progesterone is not stable enough for me to prevent the endo lining from building up? Should I try it every night or 25 out of 28 ....Should I consider lowering my estrogen dose? ....I'm spending hours on the Internet trying to research this subject but still haven't come up with a suitable answer. BTW I'm 57 and have been on HRT for nearly 8 years.
Sorry to ramble on .......

Hi there amy 1235

I've bumped the thread for your with all the studies and it's here too:

https://www.menopausematters.co.uk/forum/index.php?action=post;topic=43633.0;last_msg=732906

The relevant ones are:

Alternate day utrogestan:

Endometrial effects, bleeding control, and compliance with a new postmenopausal hormone therapy regimen based on transdermal estradiol gel and every-other-day vaginal progesterone in capsules: a 3-year pilot study
Cicinelli et al 2005

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90010354&pident_usuario=0&pcontactid=&pident_revista=605&ty=58&accion=L&origen=zonadelectura&web=www.elsevier.es&lan=en&fichero=605v83n06a90010354pdf001.pdf

"In a 3-year prospective study, 30 postmenopausal women received transdermal E2gel and every-other-day vaginal P in capsules. At study completion, endometrial thickness was significantly reduced as compared with baseline (2.7 0.5 vs. 3.4 0.9 mm), endometrial biopsy showed endometrial atrophy in all cases, and amenorrhea was achieved in 92.6% of cycles, while excellent patient satisfaction was achieved. (Fertil Steril 2005;83:1859–63. ©2005 by American Society for Reproductive Medicine.)"

This was carried out with 1.5 mg day of Sandrena gel, and alternate day 100 mg utrogestan vaginally. (not sure if the link works any more...)

and this one:

Twice weekly progesterone and estradiol

Endometrial response to concurrent treatment with vaginal progesterone and transdermal estradiol. 2012
Fernández-Murga L1, Hermenegildo C, Tarín JJ, García-Pérez MÁ, Cano A.

http://www.ncbi.nlm.nih.gov/pubmed/22321028'


"ABSTRACT Objective To describe the effect of the intermittent administration of vaginal progesterone and a low-dose estradiol patch on endometrial stability, as assessed by the rate of amenorrhea and endometrial stimulation. Methods This was an open study in which 64 moderately symptomatic, postmenopausal women were treated in the outpatient clinic of our University Hospital for different intervals up to 1 year. The treatment consisted of a combination of patches delivering 25 µg/day estradiol and intravaginal pills containing 100 mg of micronized progesterone. Patches and pills were administered concomitantly in a twice-a-week protocol. The endometrial response was assessed by endovaginal ultrasound completed with suction biopsy when required. Results Both cumulative amenorrhea and no-bleeding rates increased progressively and reached 88.9% and 100.0%, respectively, by the 12th month. Isolated or repetitive episodes of bleeding, bleeding and spotting, or only spotting were reported by three, four, and 12 women, respectively. Endometrial thickness remained unaltered. Endometrium was atrophic in the seven women in whom a biopsy was performed. Conclusion The substantially reduced progestogen load determined by this combination achieved an acceptable incidence of spotting or bleeding when associated with a low estrogenic dose. There was no apparent endometrial stimulation. Additional studies are required to confirm this observation."

This was using a 25 mcg patch and simultaneous vaginal utrogestan 100 mg both twice weekly.

From these preliminary studies you will see that alternate day 100 mg vag utro may well be insufficient to protect endometrial stimulation ( womb lining thickening) from 75 mcg oestrogen patch.
What does your doc suggest?

In your position I would do a short (normal) cycle and 200 mg for 14 days, have a good bleed and then start your new regime on about Day 5 of your bleed provided the heavy part is over. This should ensure your lining has mostly shed if it's not too thick and you can start on a new regime maybe without so much spotting. 25 days out of 28 sounds like a good compomise.

Obviously be guided by your doc but just my thoughts....

Hope this helps

Hurdity x

[Sooze]

KiltedCupid,
I'm doing quite well on the regime. I switched to Sandrena & Utrogestan  last Dec after a couple of years on Tibolone. Tried Utrogestan orally daily and then vaginally daily for 1st 2 months, but changed to alternate days as I felt that the dose was too much for me. Had some spotting during the change over, and when I switched to alternate days Utrogestan vaginally from Feb.  Spotting continued but did not increase, and stopped the middle of May, with nothing since.

Had a scan in August and everything was fine, with another scheduled for next Feb.  I have almost no flushes, less than 1 per week, and I get occasional whacky dreams on the Utrogestan nights.  I've had the odd fluttery panic feeling late evening - maybe 2 episodes in the last 3 months, otherwise very good.  Don't think I could get a better result with something else.
HTH,
S

[KiltedCupid]

Thanks Sooze, that's really helpful. I'm pretty much the same, very occasional heat and the fluttery thing. All considered, I'm ok with that as everything else seems ticketyboo. I'm going to give it a whirl next week, interesting to know it took a wee while for your spotting to stop. Forearmed and all that... I have twice yearly scans at ultrasound direct anyway so already keeping an eye on things.

Thanks for posting your experiences and hope it keeps working for you.

Oh, also, there's a lady who has just started tib, Padine I think, she's on the anyone taking tib thread. She might be interested to hear your report as you lasted quite a while on it. I knew I recognised your name as I was reading your tib posts when I was on it. You had more success than me!

[amy1235]

Thanks to everyone for such quick responses and Hurdity for attaching the studies......I'm going to try another short cycle and try and get a good bleed and then start continuous utro 25/28.... I might also start snipping a little piece of my 75 patch too and see how I go. My doctor doesn't really have much idea about things and tends to take his lead from me so I want to be really clear what I'm doing- I trust the opinions on here ...I think my lining is probably thicker than it should be which is why I seem to get quite heavy bleeds.

[sprocket]

Having heard that one of the uk’s main Meno consultants promotes alternate days for Utrogestan, have we heard whether the BMS ( british menopause society ) is in agreement with this as a potential progesterone regime?
Im very interested in using less Utrogestan if possible.