Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[KittyKats]

I've been using it this way for neary five years but the gynaecologists wanted me to switch to the oral route as they said there is no longterm safety data for using off license. I now have severe internal pain and can barely insert it. I am waiting for a GP appointment. I have a history of fibroids and bleeding on HRT but hadn't had much until a few weeks ago. I am now in a lot of pain everywhere and really worried. Has anyone else used Utrogestan long term like this? Or switched to orally? I haven't had a scan for over a year.

[bombsh3ll]

Many women use it vaginally, this is especially common in Europe.

IVF patients also use it vaginally, where the stakes are a lot higher, so that would also not be done if there were any concerns about absorption or effectiveness of this route.

When ingested orally, most of your micronised progesterone gets converted by the liver into other metabolites, so there is actually much LESS progesterone available to the uterus vs the same dose vaginally, which is absorbed into the circulation directly, into vessels in close proximity to the uterus.

Many products are used off licence indefinitely, and it is disingenuous for a clinician to imply that this is in any way controversial. I bet they would prescribe you an antidepressant in a heartbeat - that's not licensed for menopause either.

If there is any concern about whether your endometrium is adequately protected just get a private scan every year or so. This is good practice anyway and I personally think we should all have regular well woman scans like a mammogram or smear.

I would also think about vaginal atrophy if you are having pain on inserting the pessary and maybe try some vaginal estrogen.

[KittyKats]

Thanks for your reassurance. The gynaecologists I have seen were on the NHS and they have to go by NICE guidelines I guess. I also have the complications of the fibroids. I have very heavy bleeding and pain. I was taking it alternate days but now every day and I'm in a right state but might not be connected. I have dysautonomia so was worried about the oral route as progesterone can make SVT/palpitations worse!

This was what they said to me at UCLH:

Meantime I explained that where estrogel (or other estrogen) is used for menopausal symptoms, then progesterone is needed to prevent thickening of the endometrium from the estrogen and potential development of endometrial hyperplasia or malignancy. The recommended and licensed dose of oral utrogestan is 200 mg daily at bedtime, for twelve days in the last half of each therapeutic cycle (beginning on Day 15 of the cycle and ending on Day 26). Withdrawal bleeding may occur in the following week. Alternatively, 100 mg can be given at bedtime from Day 1 to Day 25 of each therapeutic cycle, withdrawal bleeding being less with this treatment schedule.
Vaginal utrogestan may be effective but is not licensed for endometrial protection and she is only using 100mg on alternate days. This may in fact be why she is having irregular bleeding.
 
She has agreed to try the oral utrogestan (she could start with 100mg oral capsules continuously), and I would be grateful if the GP could prescribe this. She is slightly anxious as feels the oral route may worsen her palpitations, but hopefully this will not be the case.

[bombsh3ll]

I also have dysautonomia!

From that point of view I think if you tolerate progesterone vaginally when it is going straight into your bloodstream unadulterated, you will be more than ok taking it orally.

Most of that is converted into allopregnanolone anyway which has GABA like activity. If anything this may improve your cardiac symptoms.

I don't tolerate my own progesterone very well so am on long term continuous COCP to prevent ovulation.

Taking your progesterone alternative days is more of a problem than whether you use it orally or vaginally - she is correct there that this cannot be assumed to be sufficient, so I would definitely take the quantity that you are prescribed.

However unless they have a camera in your bedroom it remains within your gift how you take it. Some people even use it rectally!

[KittyKats]

Oh wow! You have dysautonomia too! Very few even know what it is. Sorry you have it.

Yes I've been scared of taking it orally but thanks so much for your reassurance on this. Despite taking it every day vaginally I have this heavy bleeding and pain. You are right that I have vaginal atrophy. She told me I did but I wasn't sure if I could use vagifem alongside the progesterone. Maybe this is why I hurts so much to insert the Utrogestan.  I am currently still waiting for a GP to see me so I can get referred back to gynaecology. With my history of fibroids and bleeding they don't seem to prioritise me. I was booked in for embolisation last May but got whooping cough. I then chickened out after my autonomic consultant said GA and sedation could cause a drop in my BP.

So you are tolerating the COCP ok with dysautonomia? I'm guessing this is a synthetic progestin?

[bombsh3ll]

Absolutely yes my combined pill is a real blessing because it keeps me bleed free and hormonally stable - I take active pills every day so no withdrawal bleeding.

I was already on a combined pill prior to my brain injury at the age of 34 and so didn't realise just how much it was helping me until I lost access to it during the pandemic, and was noticeably more syncopal around menstruation, plus the fluctuating hormones made my fludrocortisone difficult to titrate as natural progesterone has anti mineralocorticoid activity.

Fortunately I tolerate synthetic progestins well as they don't antagonise my mineralocorticoid replacement - obviously I would never take drospirenone as that has diuretic properties but others are fine for me.

When I got back on a combined pill I chose Zoely, which has 17 beta estradiol and NOMAC which is a really kind progestin, however previously I used marvelon and microgynon, and have also used the nuvaring.

I have also used vaginal utrogestan in the past for IVF however that was before my accident so I am not sure what it would be like for me if I choose it as my progestogen when the time comes to graduate from the pill to MHT.

You should definitely get some vaginal estrogen to help with the atrophy regardless of which way you decide to take the progesterone.

[KittyKats]

That's great the combined pill works for you and that you are stable on it. I'm sorry you had the brain injury and dysautonomia though. I have a lot of other neurological symptoms so it's tough.

I was also prescribed fludrocortisone but didn't take it as I sometimes have blood pressure spikes. You know you said natural progesterone has anti mineralocorticoid activity? Would this include Utrogestan? My fear has been it would lower my BP more orally but I think you said some enters the bloodstream vaginally too and I have been generally ok on it.

I saw my GP yesterday and she said I have bad atrophy but also the top half of my vagina is closed which has really worried me    She thinks it's the atrophy but I am on a two week cancer pathway to check the unscheduled bleeding and she will get the gyns to check that too. It's all fun and games at 55!