Vaginal use of Utrogestan is recommended by the manufacturer if there are side effects from oral use - but this is in France, because vaginal use for HRT is not licensed here ( bizarrely).
Inserting them vaginally when bleeding - I guess it depends on the bleed and how heavy. I would worry about it getting washed out though if you use tampons maybe the tampon will help keep the capsule up there sufficiently long for some progesterone to diffuse into the uterus?
Some women do start to bleed towards the end of the progesterone course. You could try to tweak your cycle as sheila says but if it continues to happen then try to take the whole course otherwise you may not be getting sufficient and you may end up shortening your cycle too much?
Yes you would stop the Utro and start counting from Day 1 as first day of the bleed - but personally I wouldn't do this, except perhaps once to try to sync your own cycle ( but in peri the cycle doesn't remain the same!).
Using utro vaginally should avoid the digestive side effects. It's the same capsule, just push it up as far as you can before you go to bed. Besins and the NHS think it's the same dose, Newson thinks you can halve it. Take your pick who you believe (obviously less risky with a low oestrogen dose than a high one). Medical advice is to continue taking it if you bleed early. I stop and count again from day 1 so the cycles remain in step.
Just to clarify here - Besins always recommended taking the same dose vaginally as orally if there are side effects from oral use. There have been limited small-scale studies showing that half the vaginal compared with oral dose is effective in protecting the endometrium, but these studies were conducted using small to medium oestrogen doses - from memory, 25 mcg and 50 mcg patches (though don't quote me on that!). The Newson clinic policy was to extrapolate that as recommended dosage for all women, irrespective of their oestrogen dose (ie halving the vginal dosage compared with oral), because so many women have some degree of progesterone sensitivity, which can be a sticking point when it comes to HRT.
The British Menopause Society recently gave guidance on Progestogens and Endometrial Protection in their Tools for Clinicians series in which they conclude: "Based on current evidence if progesterone was considered for vaginal administration (out of license use) in women who experience side effects with oral intake, this should ordinarily be given in similar doses and durations as suggested for oral progesterone intake with HRT."
Hurdity x
