Thank you for your reply and advice.
These new BMS guidelines do seem to be a one size fits all, regardless of the individual's biochemistry and hormonal levels. I asked a BMS nurse about these new dosing guidelines and how they didn't make sense to me. She just said that the BMS does a lot of research into this and we have to accept what they say. That's why I'm interested in what Dr Newson now says, as she doesn't seem afraid to prescribe with more flexibility.
We seem to be allowed to experiment with the oestrogen side of dosing by going on symptom response, whilst the progesterone side is fixed. It doesn't make sense to me. Our own body could still be making it's own progesterone as well as oestrogen in perimenopause (though at fluctuating levels I know). So there are some of us who feel over-medicated on Utrogestan at these fixed doses, as we would oestrogen, if those doses were fixed too.
Hi mumto3
Have had a quick read of ths thread.
As per sheila99 - the guidelines have not changed at all. Vaginal use of Utrogestan for HRT is unlicensed in UK though off license (label?) women have been prescribed and have used it in this way ever since it was first licesned for HRT. And as per sheila, the manufacturers, Besins, in their product guidelines for its use in France, give vaginal use as an alternative to oral intake for those who do not tolerate oral dosing, and give the same dose for each.
The Newson approach - to halve the amount when taken vaginally to give the same effect, was based on limited trials which showed that for low to medium dose oestrogen ( 25 mcg -50 mcg patches if I recall correctly), alternate day dosage did not lead to thickening of the endometrium under the conditions of the trial.
I can find you the thread where I posted the abstracts of the papers if you like?
As a result of these trials some private clinics, notably Newson Clinic, generalised this to be a universal recommendation. In fact the research simply has not been done for higher doses of progesterone as far as I know and this was being taken as proper guidelines - whereas it was just the recommendations of one private clinic, in the same way that Studd used to recommend 7 days per 28 progesterone for prog intolerant women.
It;s a good thing BMS came up with the guidelines, due to the widespread use of HRT and esepcially vaginal use of progesterone. It's great if it can be personalised but the NHS just can't afford to scan everyone - who take less than licensed doses, hence these recommendations.
It does make sense to require a higher dose of prog for a higher dose of oestrogen because it has always been known that the protective effect of prog on the endometrium is duration and dose dependent, and dependent on the dose of oestrogen.
Hope this is helpful
Hurdity x
