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[Stella2]

Hi ladies,

I would be grateful for advice. I had a breakthrough bleeding (postmeno, 1 year on HRT) and attended a hospital appointment. So glad it's all fine, it seems that the bleeding happened due to Estradot 75 being prescribed without raising Utrogestan from 100mg. I have now been taking Estradot 50 for couple of months and I haven't noticed bleeding but the gynaecologist advised to take 200mg Utrogestan for a month and perhaps to carry on like that in the future to keep my lining healthy.
I took 2 Utrogestans last night and thought it will make me feel more sleepy but actually I felt wired and could not sleep for half a night. Would anyone know if this is normal and if it will get better with time? Also, is it safe and recommended to take high dose of Utrogestan in postmeno when on medium estrogen dose?

[Ellie O]

Hi Stella. I don’t think you need to take double progesterone just in case. If you are on 50 mcg oestrogen, and have no bleeding, it’s perfectly safe to remain on 100 mg Utrogestan.

[Ellie O]

Regarding sleep, Utrogestan sorted my sleep only in the first few months. From 8 months on, I keep waking up at 3 am and cannot go back to sleep for 2 hours. I don’t know how to stop this 3am awaikening!

[Stella2]

Thank you Ellie, not sure why she said so, she said the lining looks ok but that she would recommend doubling it for a month at least, but in the future too to keep the lining thin...
I'm sorry that you are struggling with sleep, I normally fall asleep easily but wake up around 5, not as early as you but still too early. Then I am so  tired in the evening because I can't get back to sleep.
I hope that this will resolve for you, sometimes we get into a pattern and then it changes again. Maybe someone will have an advice.

[Stella2]

I was thinking maybe I should try taking it vaginally, i think that 100mg would have the same effect as 200 orally, is that correct ?

[Ellie O]

Oral progesterone has more benefits, than vaginal. Also women say that vaginal use is messy.

[Stella2]

Thank you Ellie! I have just read something by British Menopause society, there was a confirmation that, if on Estradot 50, you should actually use 200mg Untrogestan. I didn't know that, maybe that's why many of us get breakthrough bleeding as we normally only take 100 mg.
I have been sleeping better now, maybe that was just for first few days.

[Dotty]

Hi Stella2 can you post the link for the info from the British Menopause Society ? x

As far as I’m aware it’s 200mg if you take it sequentially, but 100mg if you take it continually. This is up to a 100 patch or 4 pumps of Oestrogel .

[Stella2]

Hello Dotty, I must have been very tired when I read it, I looked at the article again and that might have been about sequential HRT. Apologies for misinformation 100 should be enough.
It seems that I needed a bit more on Estrodot 75
as the bleeding was caused due to this according to the gynecologist. She said there's no harm in doubling up on Utrogestan.

[Ellie O]

BMS recommends to double progesteron for doses 75 mcg and higher.

https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

[Dotty]

Ellie O thank you for the link x

[Dotty]

Hi please can you tell me what page the info is that states that you need double progesterone if you’re using a 75 patch?

I’m interested in this as I use 4 pumps of Oestrogel.

Thanks x

[Stella2]

This is very strange, I was sure that I found a BMS breakdown of various estrogen preparation s and amounts of Utrogestan that should be used but I can't find it anymore. I see that Ellie has provided the link but I also can't see it there.

[Dotty]

Hi Stella2. I can’t find any reference to needing double the amount of progesterone in this document.

As far as I’m aware, the licensed dose of Utrogestan is 100mg continuously up to 4 pumps of Oestrogel / or a 100 patch. That’s what this document says. You can double up on the progesterone if there is bleeding on this amount  or if you are taking an unlicensed dose of oestrogen which would be over 4 pumps of Oestrogel or more than 100 patch. x

[Ellie O]

Hi Dotty. This is extract from page 3:

The dose of the progestogen should be proportionate to the dose of estrogen. While no data is currently available on the endometrial effects of high doses of estrogen and the optimal dose of oral or vaginal progestogen in this context, women who require high dose estrogen intake should consider having their progestogen dose increased to ensure adequate endometrial protection (e.g. micronised progesterone 300 mg for 12 days a month instead of 200 mg in cyclical HRT regimens or 200 mg daily on a continuous basis instead of 100 mg in continuous combined HRT regimens).

75 mcg and 3 to 4 pumps are considered high doses.