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[Lydgate]

I’m 56. Haven’t officially stopped periods yet, but been prescribed continuous 2 pumps E, 100mg P daily for last 2.5years. I’ve had the odd period/breakthrough bleed in that time, but generally very well. Sent for hysteroscopy 12m ago, all good. 6 months ago, all meno symptoms came back, so oestrogen was upped to 3 pumps daily. Initially felt better. Then told I should up P to 200mg a day to stop build of womb lining. I’ve been on this 1 month now. Boobs are murdering me, and I’ve been bleeding lightly but with nasty period pain, and annoyingly for 2 weeks. Bright red. I’m wondering if I could take the P vaginally, and it might suit me better? Am I right in thinking a GP would not be able to suggest this method? I’m extremely reluctant to have a mirena. Thanks in advance helpful people…

[CLKD]

It mayB that 200mg a day is too much?

[bombsh3ll]

I would not reduce from your prescribed dose unless you are willing to get a private scan every year or so, because endometrial protection cannot be guaranteed on lower than recommended doses.

It is absolutely worth trying your progesterone vaginally, the same dose can be used. There is some evidence that this improves delivery to the uterus vs oral but not enough evidence officially to be able to recommend lower doses, although some specialists do (with monitoring).

Your GP may or may not be supportive of vaginal use as it is off label in the UK, but not in other countries. Unless they have a camera in your bedroom however this is not an issue.

[Lydgate]

I would not reduce from your prescribed dose unless you are willing to get a private scan every year or so, because endometrial protection cannot be guaranteed on lower than recommended doses.

It is absolutely worth trying your progesterone vaginally, the same dose can be used. There is some evidence that this improves delivery to the uterus vs oral but not enough evidence officially to be able to recommend lower doses, although some specialists do (with monitoring).

Your GP may or may not be supportive of vaginal use as it is off label in the UK, but not in other countries. Unless they have a camera in your bedroom however this is not an issue.

Thank you. I just wondered if taking it vaginally might ease these awful bleeds/cramps or if it might settle eventually. I’ve only been on the increased P for 1 month…. Thanks again for replying

[Lydgate]

It mayB that 200mg a day is too much?

It does say that with 3 pumps Oestrogen there should be 200mg P, but I did wonder about 200/100 alternate days might be more tolerable for me, and still keep the womb lining down…. What a pain this is. 😳 Thanks btw ☺️

[bombsh3ll]

I think trying it vaginally in the first instance is a good plan as this is already within your gift to do without having to obtain a new prescription.

However if this doesn't suit I would highly recommend looking into alternative oral progestins which can offer better bleed control and tolerability as much lower doses can be used.

Given you describe sore swollen breasts you might find Slynd (drospirenone) taken continuously a really good option. There is also desogestrel 150mcg taken continuously.

Both are off label but supported by the BMS as endometrial protection, however at 56 you are unlikely to be given either by your GP and would likely need to see a specialist (unless a younger female in your life could buy it on your behalf as contraception).

[Dotty]

Hi the advised dose for 3 pumps of Oestrogel is 100 Utrogestan.

4 pumps is 200 Utrogestan.

[Lydgate]

Hi the advised dose for 3 pumps of Oestrogel is 100 Utrogestan.

4 pumps is 200 Utrogestan.

Thanks. I think they maybe thought I should have higher utrogestan because of previous breakthrough bleeds. I’m just trying to work out if it’s the extra utrogestan or the extra oestrogel that’s causing the breast pain, cramps, and bleed. I also know I need to keep my womb lining thin. 😩 My excellent gp has just retired 😩.

[Lydgate]

I think trying it vaginally in the first instance is a good plan as this is already within your gift to do without having to obtain a new prescription.

However if this doesn't suit I would highly recommend looking into alternative oral progestins which can offer better bleed control and tolerability as much lower doses can be used.

Given you describe sore swollen breasts you might find Slynd (drospirenone) taken continuously a really good option. There is also desogestrel 150mcg taken continuously.

Both are off label but supported by the BMS as endometrial protection, however at 56 you are unlikely to be given either by your GP and would likely need to see a specialist (unless a younger female in your life could buy it on your behalf as contraception).

Thank you, that’s really helpful. I’m going to try them vaginally I think….. see how I go. Appreciate your wisdom. 🙂