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[Kai_63]

I was trialling Utrogestan 100mcg 25 day regime (oral) and although my symptoms (migraine, nausea etc plus loose bowels but she didn't think was related) have all but disappeared, I've been getting irregular spotting.

My gynaecologist has said it would be best to move back to 12 day 200mcg as it's possible I'm still perimenopausal.

She said I could try rectally (I'd prefer not to go vaginal route as I'm already using Vagifem 4x a week plus vaginal moisturiser daily and it's a faff).

What exactly is the best way to do this, how far does it need to go etc and are there any likely side effects?

Also on Oestrogel 2.5 pumps and Levothyroxine for thyroid.

[sheila99]

That's interesting. I've been using it rectally the last few cycles but thought it was very much off licence. It should avoid any digestive issues but it still gives me fatigue. No idea if my insides are normal but I have a shelf an inch or two up. If I push them onto it I don't feel them, if I leave them in the main passage my body wants to expel them. And use lube.

[Banjo1973]

I also use it rectally as some IVF practitioners recommend it. (My meno specialist says even says Cyclogest is not evidenced for endometrial protection taken rectally).

Despite this I still use it rectally as I get least side effects this way.

I wash a bit of the white coating off, squat, then push it up with my finger (a couple of inches).

Undignified but works for me!!!

[bombsh3ll]

Let me get this right, you're thinking about using it rectally not due to any tolerability issues but just because of a bit of spotting?!!!

Which was probably due to the 25 day regime, that you have now switched to cyclical at a higher dose?

Why not just try the regime suggested by your gynaecologist orally for a few cycles and see?

Personally I would rather have the spotting than sticking it up my bum!

[sheila99]

I actually find it better rectally than vaginally as there's no mess when the remains come out. Also I've bled every cycle rectally but didn't vaginally so it appears to be more effective for me so far.

[Kai_63]

Thanks you for the advice, this is really helpful. I think I'll give it a try at least.

[Kai_63]

Let me get this right, you're thinking about using it rectally not due to any tolerability issues but just because of a bit of spotting?!!!

Which was probably due to the 25 day regime, that you have now switched to cyclical at a higher dose?

Why not just try the regime suggested by your gynaecologist orally for a few cycles and see?

Personally I would rather have the spotting than sticking it up my bum!

The spotting is considered a concern because it's irregular which could suggest more serious issues. In theory the 25 day dose shouldbhave led to one monthly bleed but because I'm probably still peri it wasn't. And I do have intolerability issues with taking it orally. I already have vaginal atrophy so really not interested in taking it vaginally as it can cause irritation plus I have to fit it in around Vagifem and vaginal moisturiser.

No option is ideal and I don't really think your tone is helpful to be honest. I've spent two years trying to find a regime that works for me and still not settled. It's very stressful.

[Banjo1973]

I have also found thar taking it rectally produces a heavier bleed and I've finally got the benefits of the sedative effect.

Taking orally made me wired, vaginally was messy and was causing itching and irritation.

It was desperation that lead me to try it rectally, but for me it is by miles the best option and the only regime I've stuck with.

Good luck with it... it may seem yukky to some, but it's been a great solution for me x

[Hurdity]

I also use it rectally as some IVF practitioners recommend it. (My meno specialist says even says Cyclogest is not evidenced for endometrial protection taken rectally).

Despite this I still use it rectally as I get least side effects this way.

I wash a bit of the white coating off, squat, then push it up with my finger (a couple of inches).

Undignified but works for me!!!

The point is that Utrogestan is not designed to be used rectally AT ALL. There are no studies to indicate that it will be absorbed this way, notwithstanding that some gynaecologists are recommending it through ANECDOTAL rather than clinical evidence (though I am not up to date with studies - so may be there are trials using it for IVF?). However the manufacturers as far as I know have not tested its use this way. The structure of the capsule itself is not designed to facilitate rectal insertion.

re the comment about Cyclogest. The point is that Cyclogest is designed either for rectal or vaginal use even though there are no trials for its use in endometrial protection as part of HRT. Its shape and formulation enable it to be absorbed either route. Before utrogestan was available it was prescribed by specialists off licence as part of HRT eg the late famous John Studd....

I'm just sounding this note of caution to anyone who wants to try it without supervision, not to say it definitely won't work.

When I used Cyclogest as part of my HRT I was prescribed 400 mg for 11 days per month so I used to put one up the front and one up the back. Re the latter - this was absolutely horrible and had remarkable effects the next morning that I won't go into (far TMI!).

Kai - I suggest you ask your gynaecologist how you should insert it - and as you are being monitored then hopefully you will know whether or not it works. It's a soft capsule!

Hurdity x

[bombsh3ll]

Dysfunctional uterine bleeding is extremely common in perimenopause and not a clinical concern assuming you have had pathological causes ruled out.

I did not mean to cause offense, simply to point out that the solution seems worse than the problem, particularly when it may well be resolved just by going back onto cyclical for a while.

[Kai_63]

I have also found thar taking it rectally produces a heavier bleed and I've finally got the benefits of the sedative effect.

Taking orally made me wired, vaginally was messy and was causing itching and irritation.

It was desperation that lead me to try it rectally, but for me it is by miles the best option and the only regime I've stuck with.

Good luck with it... it may seem yukky to some, but it's been a great solution for me x

I'm glad it's working for you. As you say, may seem yucky to some but various other meds are routinely taken this way too!

[Kai_63]

I also use it rectally as some IVF practitioners recommend it. (My meno specialist says even says Cyclogest is not evidenced for endometrial protection taken rectally).

Despite this I still use it rectally as I get least side effects this way.

I wash a bit of the white coating off, squat, then push it up with my finger (a couple of inches).

Undignified but works for me!!!

The point is that Utrogestan is not designed to be used rectally AT ALL. There are no studies to indicate that it will be absorbed this way, notwithstanding that some gynaecologists are recommending it through ANECDOTAL rather than clinical evidence (though I am not up to date with studies - so may be there are trials using it for IVF?). However the manufacturers as far as I know have not tested its use this way. The structure of the capsule itself is not designed to facilitate rectal insertion.

re the comment about Cyclogest. The point is that Cyclogest is designed either for rectal or vaginal use even though there are no trials for its use in endometrial protection as part of HRT. Its shape and formulation enable it to be absorbed either route. Before utrogestan was available it was prescribed by specialists off licence as part of HRT eg the late famous John Studd....

I'm just sounding this note of caution to anyone who wants to try it without supervision, not to say it definitely won't work.

When I used Cyclogest as part of my HRT I was prescribed 400 mg for 11 days per month so I used to put one up the front and one up the back. Re the latter - this was absolutely horrible and had remarkable effects the next morning that I won't go into (far TMI!).

Kai - I suggest you ask your gynaecologist how you should insert it - and as you are being monitored then hopefully you will know whether or not it works. It's a soft capsule!

Hurdity x

Thank you, this is what I wanted to understand in terms of medical knowledge. It was a private appt that I paid for so the only monitoring that will be done is via the GP... not that hopeful on that front. Do you know much about irregular bleeding on the 25 day cycle and safety? She did say I could potentially have a scan to see what was on first but she didn't recommend 25 day if I was bleeding irregularly either way. It was working so well for me and I really don't want to go to back to 12 day but one way or another I will have to.

[Kai_63]

Dysfunctional uterine bleeding is extremely common in perimenopause and not a clinical concern assuming you have had pathological causes ruled out.

I did not mean to cause offense, simply to point out that the solution seems worse than the problem, particularly when it may well be resolved just by going back onto cyclical for a while.

Thank you, for me the solution is far better than the problem because the migraines and nausea on 12 day oral were affecting a very busy life with a lot of responsibilities.

She seemed to think it was unsafe to have spotting irregularly through the month. She did say I could have a scan but in all likelihood it was safer for now to be on 12 day, however I took it.