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[CherryC]

Hi, Aged 63 and I'm on 3 pumps Oestrogel and 100m Utrogestan nightly.  I currently take the Utrogestan orally but still seem to get a period like bleed maybe two or three times a year.(have had it tested).   It seems to me the Utrogestan just isn't strong enough to keep the lining from thickening.
Has anyone had success with using Utrogestan vaginally for this amount of oestrogen? Anyone found it more effective this route?
I would appreciate experiences please.

[bombsh3ll]

Official guidelines recommend using the same dose vaginally as you have been prescribed orally, however there is limited evidence that it has a more potent and targeted effect on the endometrium when taken vaginally.

This makes biological sense for two reasons, one is the idea of a first pass effect, in that it is taken up preferentially by the uterus and surrounding blood vessels due to anatomical proximity, and secondly the fact that when taken by mouth it largely gets converted to other metabolites such as allopregnanolone, with relatively little actual progesterone entering the systemic circulation.

There is more published evidence to support the latter, however I believe it is a combination of both and possibly other unknown mechanisms.

As you are looking for a more potent effect, and also because I cannot recommend reducing your dose unless you are under a specialist and being monitored, I would suggest using your current dose vaginally and seeing if this has the desired effect.

There is also one small study indicating that vaginal progesterone doesn't antagonise the vascular benefits of estrogen in the same way that oral does.

[CherryC]

Thank you for taking the time to reply Bombshell - I will give it a go for a while and see what the effect is.

Does anyone have any experience on using Utrogestan vaginally continuously for 3 pumps of oestrogel or 75 patch?

[KittyKats]

Hi - I did but I am now having lots of issues. I've had heavy bleeds for years taking it this way with three pumps of Oestrogel. The gyns at UCLH were not happy about it. They said there is no long term safety data. It is a gentle progesterone. My advice is to stick to oral if you can but do get advice. I've been too chicken to try it orally because I get lots of palpitations!

[CherryC]

Thank you for your reply Kittykats - that is very interesting. I'm carrying on with oral for now anyway - I may try to reduce the patch to 50mg at some stage if I can to see if that prevents lining build up. 

[Glammie]

I had this problem of bleeding starting again after Mirena coil removed . Took utrogestan 100mg daily with Evorel 25mg ( lowest patch available ) and still bleeding . Had all normal investigations including hysteroscopy.  Asked about vaginal utrogestan but was told the same . GP specialist however referred to some evidence of increasing oral utrogestan to 200 mg daily . This did the trick and have been able to reduce to alternate days 100mg and then 200 mg with no bleeding

[YellowSunflower]

I am on x3 pumps of oestrogel and use utrogestan vaginally.I find it definitely stops the spotting you get when taken orally,I've just had my hormone levels checked and my progesterone level is wonderful.I used to take it orally but I had bleeding all over the place,I'm post menopause so I just thought I would try it vaginally and I do not regret it.

[CherryC]

Thank you all for your replies - YellowSunflower it's good to know that you are having success taking Utrogestan Vaginally when on 3 pumps of Oestrogel - and Glammie good to hear how you are managing it - thank you.

[sheila99]

Everyone is different. You might need 200 to control your bleeding when someone else only needs 100. They say it's more effective vaginally but I don't know if it's true as the the dose is the same either way (in Europe as it's only licensed vaginally for ivf in the UK). I don't know how long you've been bleed free for but at 63 it's possible though unlikely you're still peri. The synthetic progestogens seem to be more effective at controlling bleeding than utro so that might be another option to consider.