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[Tabitha73]

Hello, I am new to this forum! I’m 59 and have used HRT (Estraderm MX 50 + Mirena IUS) for 10 years. I also have a history of heavy periods caused by anovulatory cycles pre-menopause with inadequate endogenous progesterone, which meant that I needed repeat Mirenas since my mid 30s. So altogether I’ve had at least 5 Mirenas and all were inserted under general anaesthetic because I otherwise found the pain unbearable.

My latest Mirena needs changing but I don’t want another general anaesthetic. My GP suggested I take 100 mg Utrogestan orally every day, but I found the side effects (headache, nausea and insomnia) intolerable. I had hoped Utrogestan would make me sleepy, but it had the reverse effect. I’m aware that oral Utrogestan can be used off label so I’ve been using it that way for the past week. Much better in terms of unwanted side effects, except I’m getting bleeding every day.

My questions are as follows:

1. For those women using Utrogestan vaginally, how much do you use per day and do you use it every day?

2. Did you have bleeding when you first started to use Utrogestan vaginally?

Thank you!

[CLKD]

   ....... hopefully some1 will be along with advice

[sheila99]

It's the same dose regardless of how you take it if conti it's 100mg every day. It's worth trying vaginally but it makes no difference to my symptoms (interrupted sleep, sedated in the day).

[bombsh3ll]

Officially the guidelines are to take the same dose vaginally as you would orally.

Unofficially, based on clinical studies showing a uterine first pass effect (similar to transdermal estradiol being dosed much lower than oral) a lower dose can be used vaginally.

I would seek your prescriber's guidance on this, and also I would be hesitant to suggest this in someone with a history of possible premenopausal endometrial hyperplasia, however the long term use of mirena is protective, even for some time after it is stopped.

I have only ever used utrogestan vaginally (as an IVF patient) and had no issues with it and certainly no bleeding. I was on 200mg three times a day, from embryo transfer until after 12 weeks gestation.

It shouldn't be making you bleed given that you still have a mirena in situ, so first off I would exclude other causes of bleeding such as VA and also make sure your smear is up to date.

[Tabitha73]

Thanks. Yes, I do have a history of endometrial hyperplasia given my anovulatory cycles and that’s why I had Mirenas from age 35. My last few hysteroscopies were thankfully normal; likely due to the Mirena.

I think it would be a good idea to have a chat with my GP about getting a pelvic/transvaginal ultrasound to look at endometrial thickness.

[AM16]

Hi there, you could think about trying Cyclogest pessaries for progesterone. I tried utrogestan but it gave me horrible insomnia and anxiety. After a failed coil fitting I went privately to explore options and I am on a 75 patch and 100 cyclogest continuously. It works brilliantly for me - I take the pessarie after dinner and am nicely tired at bedtime. I sleep through 7-8 hours every night and have had no other side effects apart from a bit of tiredness in the morning but that wears off after breakfast. I’ve had no bleeding and it’s definitely the most stable regime I’ve tried. Sadly my GP won’t prescribe the Cyclogest only the patches, so I still have to get them privately, but it’s a price I’m prepared to pay for feeling better. I hope you get it sorted!

[Kathleen]

Hello Tabitha and welcome to the forum.

I was prescribed Cyclogest from Newson Health and I found it very good. I am now back with my GP for HRT and they will only prescribe Utrogestan orally. Frustratingly an NHS consultant wrote to my GP last year and suggested that I be prescribed Lutigest as an alternative to Cyclogest but the surgery refused.

It seems you are unlikely to get Cyclogest on the NHS so privately may be your only option.


Wishing you well.

K.

[sheila99]

There's also provera and noresthisterone that can be prescribed by the NHS bit they're both oral.

[Tabitha73]

Thanks again for the responses. Interestingly, I did ask my GP about Cyclogest and Lutigest. I don’t think it’s that they’re unwilling to prescribe progesterone pressures, but rather that these are not ‘on the system’ to prescribe for HRT. My GP looked and told me “I’m sorry but the system won’t let me prescribe it to you”.

Cyclogest seems to be available through The Independent Pharmacy online to buy, but it’s expensive!

I can deal with irregular bleeding and cramping provided they’re not signs of endometrial hyperplasia or worse. So if my ultrasound scan is okay (endometrial thickness < 4 mm with no obvious other pathology) I’ll stick with vaginal Utrogestan daily.

Really helpful to get feedback from other here!

[Penguin]

Thanks again for the responses. Interestingly, I did ask my GP about Cyclogest and Lutigest. I don’t think it’s that they’re unwilling to prescribe progesterone pressures, but rather that these are not ‘on the system’ to prescribe for HRT. My GP looked and told me “I’m sorry but the system won’t let me prescribe it to you”.

Cyclogest seems to be available through The Independent Pharmacy online to buy, but it’s expensive!

I can deal with irregular bleeding and cramping provided they’re not signs of endometrial hyperplasia or worse. So if my ultrasound scan is okay (endometrial thickness < 4 mm with no obvious other pathology) I’ll stick with vaginal Utrogestan daily.

Really helpful to get feedback from other here!

Annoying, cyclogest on the NHS is only prescribed for ivf and as part of treatment for miscarriage prevention. Defo a good option if you can afford to get it privately.

[Hurdity]

Just to add also that Cyclogest is not available in doses lower than 200 mg and as they are a waxy capsule, without knowing how the progesterone is distributed through the capsule, would be difficult to know through cutting it how much you would be getting - and also the shape doesn't lend itself to cutting in half though potentialy longitudinally?

Also I'm not convinced that the dose needed for endometrial protection for cyclologest is necessarily identical to that for utrogestan - just because the total amount contained in the preparation is the same. Usually the mode of delivery affects the amount abosrbed and looking at the doses prescribed for IVF suggests to me that a higher dose of Cyclogest might be needed than for utrogestan, though the British Menopause Society recommendeds the same dose for each (not based on research as far as I know, but possibly ancedotal).

Hurdity x

[sheila99]

Just another thought. I went for a mirena recently and they put an anaesthetic gel on the cervix. Once it took effect it wasn't painful so really I was wondering if that would be an option for you instead of GA? There was a fair amount if prodding as the cervix wouldn't open enough to get it in.

[Kathleen]

Hello again ladies.

When I was prescribed Cyclogest from Newson Health I was told to cut the 200mg pessary in half as I only needed 100mg per day. The pessary is waxy and slippery and tapered at one end like a bullet. Cutting it length wise was very difficult and there was a tendency for it to crumble when handled. I ended up cutting horizontally though this meant that one half was larger than the other due to the pointed shape. Although I didn't have any problems on Cyclogest I wasn't happy about this amateurish way of using it.

As we all know hormones are powerful and having to fiddle about and guess the dosage is very concerning. I am now taking Utrogestan orally and this seems to be okay so far. My Nurse Practitioner was adamant that I shouldn't use it vaginally and I tend to agree with her. I have used it this way in the past as advised by Newson Health but I always worried about endometrial protection.

I was hoping to try Lutigest as suggested by my NHS consultant but the surgery said that they would only prescribe Utrogestan.

A greater variety of progesterone products and doses would be extremely helpful to those of us who are simply trying to balance our hormones!

Take care ladies.

K.

[AM16]

Just to add also that Cyclogest is not available in doses lower than 200 mg and as they are a waxy capsule, without knowing how the progesterone is distributed through the capsule, would be difficult to know through cutting it how much you would be getting - and also the shape doesn't lend itself to cutting in half though potentialy longitudinally?

Also I'm not convinced that the dose needed for endometrial protection for cyclologest is necessarily identical to that for utrogestan - just because the total amount contained in the preparation is the same. Usually the mode of delivery affects the amount abosrbed and looking at the doses prescribed for IVF suggests to me that a higher dose of Cyclogest might be needed than for utrogestan, though the British Menopause Society recommendeds the same dose for each (not based on research as far as I know, but possibly ancedotal).

Hurdity x

I know advice given on here is well meaning but unless given from a GP it’s best to refer to a professional for advice when taking off licence products like Cyclogest for HRT. Newson Health are monitoring many, many women (like me) taking the 100mg dose (successfully) by cutting pessaries in half width ways. Anecdotal research on using the product for IVF is also in no way comparable to using it for HRT. x

[sheila99]

Not long ago Newson Health were telling everyone you could take half the licensed dose of utrogestan if you used it vaginally. Now they don't so presumably they (or the nhs as they get the fallout) have found out it wasn't sufficient. They may find the same thing with cyclogest only this will take longer to come to light as so few people are on it.