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[K80m]

I am on 4 pumps of oestrogel and have finally reached a place where I can tolerate the utrogestan part of my hrt (2 tablets for 12 days every month) having really struggled with it on m I was on 3 pumps of oestrogel. I finally feel like I’ve got it right. Last time I spoke to my doctor, however, she said the guidelines have changed and I need to up my dose to 3 tablets. I haven’t done it yet because it’s school hols and I don’t want to feel awful and spoil the summer…I really don’t want to up the dose…do I need to? She said I need to to protect myself. Is there another way to check everything is ok with a scan every now and then for example? It’s taken me a year to get the balance right and I don’t want to mess it up! Thank you 

[joziel]

You can try just taking 2 orally and then insert one vaginally? Or have you already tried that? I take 300mg almost continuously but I can take any amount of utrogestan, it's great. 

[K80m]

When I was struggling with my dosage I tried taking 1 vaginally and it was horrendous - much worse side effects than 2 orally which was a surprise because I knew it was meant to be an option for people who struggle to tolerate it.

[sheila99]

Although vaginally avoids digestive issues I'm not convinced it helps for others symptoms, it doesn't help mine. If 2 weren't OK for most people I think the guidelines would have changed long ago so I suspect the proportion of women who actually need 3 is fairly low though of course you don't know if you're one. Having a scan a couple if times a year will tell you if it's building up.

[oldlady1961]

Read the new BMS guidelines here summarised on page 16

https://thebms.org.uk/wp-content/uploads/2024/07/01-BMS-GUIDELINE-Management-of-unscheduled-bleeding-HRT-JULY2024-A.pdf

GP is technically correct if following new guidelines but hormones are so powerful and life changing that it has to be a shared decision and right for you.

[K80m]

Thank you @sheila99. What do you mean by digestive issues? Linked to which part of the hrt? I’ve been having the most awful Ibs/trapped wind/gut issues since I started hrt that the doctor has run some tests for but says there’s no link to hrt. I can’t eat wheat since starting and it’s looking like dairy might be an issue too.

[K80m]

Thank you @oldlady1961…this is really useful

[Hurdity]

Thank you @sheila99. What do you mean by digestive issues? Linked to which part of the hrt? I’ve been having the most awful Ibs/trapped wind/gut issues since I started hrt that the doctor has run some tests for but says there’s no link to hrt. I can’t eat wheat since starting and it’s looking like dairy might be an issue too.

Some women don't tolerate taking Utrogestan orally as it can affect your gut which in turn may affect absorption if it insufficient reaches the liver and then the bloodstream. The recommendations then are to take it vaginally.

Yes one way of determining whether or not you are protected is by having a scan but this must be done immediately at the end of the bleed when the lining is at its thinnest. This will only be informative if you are post-menopausal because if you are still having a cycle then your lining will be thickening irrespective of your HRT cycle. As always any abnormal bleeding which worries you should be referred to your doctor.

Also here are the latest BMS guidelines on progestogens:
https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

Hurdity x

[joziel]

K80 estrogen affects the gut microbiome. Basically we have diffeeent gut bugs when we are estrogenised- healthier ones. But the transition period can be interesting as your body is adapting.

[bombsh3ll]

If taking less than the recommended dose of progesterone, you should get a private scan every year or so just to make sure you are keeping your endometrium thin.

This is fairly easy to find and afford. I've been getting one since my early 30's for ovarian screening.

With the NHS, there obviously aren't the resources to offer every woman regular scans so they just have to err on the side of caution and give doses that will be universally protective, even for individuals at higher risk.

Unfortunately this means many women are overtreated, who would be perfectly fine on a lower dose.

Deviating from this is clinically reasonable as long as you are monitoring the endometrium.

[K80m]

Thank you to everyone who has replied, this is all so helpful. I’m going to see if I can stay on the same dose and suggest I get myself scanned privately.

My gut issues are really bad but I don’t want to come off the hrt so I guess I just have to put up with it 

[joziel]

Have you thought about trying a Mirena? Then you could just forget about utrogestan altogether....

[K80m]

@joziel I tried the mirena years ago and ended up having it removed because it gave me anxiety/depression so I’m really nervous to try it again… otherwise it would be ideal. I had a really strong reaction to taking utrogestan vaginally (1 tablet) so wondering if the localised dose doesn’t work for me…? Who knows?!!