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[Kai_63]

So I've now definitively realised that I can't get on with branded Utrogestan. It makes me depressed and unmotivated among other things. BUT... I sleep amazingly well on it.

Meanwhile Gepretrix gives me no side effects BUT... I don't sleep well on it.

I wondered whether anyone had tried mixing the two brands together e.g alternate days for example?

I want to give it a try but I'm about to start a big new job so might be best off sticking to the Gepretrix in the meantime.

For reference I take both orally (200mcg 12 days a month) because I use Vagifem and Blissell and I therefore prefer not to.

[joziel]

You can use utrogestan rectally. Many find it much easier and less messy than vaginally....

And whilst the progesterone tests available in the UK are invalid if you take oral progesterone (because it causes lots of metabolites which get registered falsely as real progesterone, so you will get a false high result), if you take it vaginally or rectally, your result will be accurate and reassure you that your P levels are enough to protect you.

[Kai_63]

Thank you. I did actually ask on here a while back and the replies that came back particularly from the ever helpful Hurdity didn't fill me with confidence in trying it that way (as the studies haven't been done etc).

For me it's a choice between oral and vaginal and the latter would impact an already complicated sex life due to vaginal atrophy and related medications (I'm in a newish relationship)!

[sheila99]

It might be better to use 100mg of each rather than changing every other day. If you get more out of one than the other it might trigger a bleed before time.
I know it's only anecdotal but I used utro rectally for about 7 months (sequi) and it gave me better bleed than vaginally.

[Kai_63]

Thank you. Yes that's a good point, I'll have a think about it.

[joziel]

Kai, there are studies indeed on rectal absorption. Here is a wiki page about progesterone - if you scroll down you'll see the graphs showing how it is absorbed vaginally, rectally and orally. (Orally is worst and also causes most side effects.) https://en.wikipedia.org/wiki/Pharmacokinetics_of_progesterone

There is also a great FB group here which has loads of women in the US using P rectally, and info about that: https://www.facebook.com/groups/329681332452

[Furyan]

Kai, there are studies indeed on rectal absorption. Here is a wiki page about progesterone - if you scroll down you'll see the graphs showing how it is absorbed vaginally, rectally and orally. (Orally is worst and also causes most side effects.) https://en.wikipedia.org/wiki/Pharmacokinetics_of_progesterone

There is also a great FB group here which has loads of women in the US using P rectally, and info about that: https://www.facebook.com/groups/329681332452

Hi Joziel - I know that rectal progesterone does work and is just as effective as vaginal route according to studies but is this also true for Utrogestan? It’s something I’ve investigated before but it’s all anecdotal, no studies mentioning that particular brand though.

[joziel]

Yes. At least, it's what the women in that FB group mentioned above are using. Also, you can test for yourself and see for £50. Take rectal for a cycle. Order a Randox home Tasso Female Hormones blood test (from your arm) for £50 on day 21 of your cycle. See what your progesterone levels are.

Be warned that P has a short half life. The first time I tested taking 300mg of vag P in the evenings only and my result was pretty low the next morning. So now I take 300mg vag P in the evenings and another 200mg in the AM vaginally. I tested 2 hours after the AM dose and it's now a decent level. To keep levels up and high, it's necessary to dose twice a day. There is so much about HRT which is suboptimal in this country....

[laszla]

You can use utrogestan rectally. Many find it much easier and less messy than vaginally....

And whilst the progesterone tests available in the UK are invalid if you take oral progesterone (because it causes lots of metabolites which get registered falsely as real progesterone, so you will get a false high result), if you take it vaginally or rectally, your result will be accurate and reassure you that your P levels are enough to protect you.

There's endless discussion here about optimal levels of E2 when on HRT and fully dependent on an exogenous source of hormones but no mention is ever made of optimal prog levels, whether absolute levels or in proportion to serum levels of E2. Working on the John Studd model that E2 needs to be at least 300, with some women needing as much as 800 or so, does anyone have any intel on what plasma prog levels should be?

[joziel]

Yes. If you join the FB group I mentioned above, they have a lot of useful info on P including recommended ranges. I can't remember off the top of my head.

But if you take oral P you can't test accurately in the UK. And most women on HRT take P orally. So doctors just completely disregard P. My Newson Health meno doctor literally said 'we don't look at progesterone' when we were going through my blood results. At the time, I didn't know why. I thought it meant it was unimportant. When really, it's because they can't accurately test for it if you take it orally.

I have switched to taking it vaginally partly for this reason. I am on a high E dose (serum 850pmol) and I need to be sure I am absorbing enough P to counter that and I refuse to play guessing games(!). So I switched to taking it vaginally so I could use the tests available in the UK reliably. (Can do with rectal as well.) I wasn't getting enough when I was taking 300mg at night only. I wasn't sustaining a high level because it only has a 12 hour half life. It was pretty low when I tested the next morning. So then I took 200mg in the mornings as well and that is keeping my levels much higher. In the FB group mentioned above, many women take it vaginally AM and PM.

[laszla]

What's the name of the facebook group? The link is bringing up an error message saying content inaccessible or removed...

[joziel]

It's called Bio-Identical Hormone Replacement Therapy and has a picture of flowers as the icon. However, it's paused for 2 days at the moment, maybe due to Easter, so perhaps they've temporarily hidden it. Sometimes it gets incredibly busy and they limit new members as admins can't cope. It has almost 60K members.

[laszla]

Thanks, I'll check back in a few days

[Hurdity]

Thank you. I did actually ask on here a while back and the replies that came back particularly from the ever helpful Hurdity didn't fill me with confidence in trying it that way (as the studies haven't been done etc).

For me it's a choice between oral and vaginal and the latter would impact an already complicated sex life due to vaginal atrophy and related medications (I'm in a newish relationship)!

Kai, there are studies indeed on rectal absorption. Here is a wiki page about progesterone - if you scroll down you'll see the graphs showing how it is absorbed vaginally, rectally and orally. (Orally is worst and also causes most side effects.) https://en.wikipedia.org/wiki/Pharmacokinetics_of_progesterone

There is also a great FB group here which has loads of women in the US using P rectally, and info about that: https://www.facebook.com/groups/329681332452

Hi there

Just to clarify - Kai-63 was quoting what I (presume I) said, correctly in that she was talking about Utrogestan as was I. As far as I know studies still have not been carried out into rectal use of Utrogestan and its role either in fertility or as the progestogen component of HRT.

Yes joziel indeed there are studies on rectal use of progesterone - but this is for Cyclogest - as it quotes in the Wiki article. Cyclogest is licensed for use rectally or vaginally for fertility and is also prescribed off licence (or label!) for HRT - because there is evidence that it is absorbed that way and has been manufactured to do so.

However Utrogestan has not been studied in this way - that's not to say it won't be absorbed rectally but it may be that something about how it's made could make rectal absorption less efficient? Yes there is ancedotal evidence from individuals but it could only be ascertained by trial and error and regular scans....

It (rectal use) is unlikely to be as efficient as vaginal delivery because this (the latter) ends up in the uterus where it is needed, but may be more efficient in some women, than oral intake....

As far as I know there are no absolute progesterone levels that indicate the amount needed for endometrial protection - which depends on so many factors, so measurement of progesterone levels in the blood is not helpful or necessary - especially when progesterone is used vaginally as it is the amount held in the uterus that is critical irrespective of blood levels.

Kai-63 sorry I have no experience of Gepretix though I did do a comparison somewhere on here some months ago and they looked to be almost excatly the same though as far as I recall potentially slightly different sized capsules??

I haven't read any studies recently so please correct me if I'm wrong!

Hurdity x

[joziel]

"A number of studies have assessed progesterone by the rectal route.[159][160][161][162][163][118][164][165] Levels of progesterone following rectal administration have been found to be 6.4 ng/mL after a single 25 mg suppository, 22.5 ng/mL after a single 100 mg suppository, and 20.0 ng/mL after a single 200 mg suppository.[156][162] The absorption of the rectal route is variable, with a wide range of maximal concentrations of 15 to 52 ng/mL progesterone after a single rectal dose of 100 mg progesterone.[18][161] Levels of progesterone peak after 6 to 8 hours and then gradually decrease.[18][156] Progesterone levels have been found to be similar and non-significantly different after administration of rectal and vaginal suppositories in several studies.[156]"

https://en.wikipedia.org/wiki/Pharmacokinetics_of_progesterone

Pretty easy to see how you are absorbing it, by simply taking it and then doing bloods. Since everyone absorbs differently, you're not really getting any guarantee by reading studies on broad populations anyway.