Print

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

[Luculka]

Dear Ladies,

I would be very grateful for your support and insights regarding your experiences. I am 48 years old, perimenopausal, and no longer experience bleeding due to having had an ablation 2 years ago. I started HRT in October 2024, using one pump of Estrogel and 100 mg of Utrogestan continually.

Since I felt uncomfortable with the amount of progesterone, I did some research and repeatedly came across information suggesting that less progesterone is needed when used vaginally, and that it can be taken every other day. Based on this, I adjusted my routine to one pump of Estrogel and 100 mg of Utrogestan vaginally every other day—and I've felt perfectly fine following this approach.

However, I'm now confused after reading articles claiming that the idea of "needing less progesterone vaginally" is completely false and even dangerous. Have I potentially done myself harm? To complicate matters further, I have a check-up with the doctor who prescribed my hormones coming up in a few days. I'm worried she might notice from the ultrasound that I've been taking too little progesterone. Since I made this adjustment without her consent, I'm unsure whether I should confide in her about using an off-label approach—I’m concerned about how she might react.

My questions are:

    1.Is it possible that taking 100 mg of Utrogestan vaginally every other day has provided sufficient protection for my womb lining?

    2.If the doctor doesn’t find anything concerning during the check-up, would it be safe to continue with this alternate-day routine while on such a low dose of Estrogel?

Thank you all so much for your advice and support!

Warm regards,
Lucy

[sheila99]

It was Newson who advocated this approach, the nhs and the manufacturer always said the dose is the same regardless of the delivery method. She's changed her mind now so presumably they found it wasn't enough for everyone. You're on a low dose of oestrogen and you've had an ablation so it might well have been enough for you. I would keep quiet until you see the results in case they decide not to give you hrt at all but going forwards it would be safer to use it every day. If you use less you should have regular scans instead to check there's no build up.

[Luculka]

 Thank you, Sheila, for your fast reply—this is very helpful! Exactly, it was Dr. Newson, and I really felt I could trust that approach. I do feel bad now about potentially breaking the trust of my doctor. I’ll keep quiet for now and hope the scan results are optimal. Starting today, I’ll switch to the daily route as you suggested.

[bombsh3ll]

There is evidence that progesterone is more effective for endometrial protection when taken vaginally.

This is due to both the uterine first pass effect and the fact that it is absorbed as progesterone, whereas the majority of that taken orally is converted to other metabolites.

We can also look to the fields of infertility, IVF and miscarriage prevention - progesterone is ONLY used vaginally here, as oral is simply not adequate.

However the level of evidence required to change clinical guidelines is far higher than currently exists. It has to be absolutely cast iron, and unfortunately nobody is willing to fund the large scale studies that would be required.

I personally would be happy to use less than the oral dose vaginally based on my own experience in the IVF world and having read the available evidence, however I also believe in having an annual pelvic scan, which among other things monitors endometrial thickness.

I would not be comfortable recommending a reduced dose of progesterone for anyone who wasn't having any monitoring.

[Luculka]

Thank you Bombshell, I appreciate your insightful response very much. This is so very helpful and i deffinitely feel calmer now. I switched to the daily route already. Sorry for not having replied sooner, in the meantime I had a thyroid nodules surgery so I was out for 2 days.