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[Nanny2two]

Hi. I've been on Evorel 75 and oral progesterone 100mg for about 7 years.
I also use Vagifem for VA.

I'm terrified to come off HRT as I had hot flashes every hour and was drenched in sweat. I wish I could ditch HRT though.

Currently my liver function tests have come back abnormal. My GP repeated them and no change (I don't drink alcohol btw)
Ultrasound of abdomen is in 2 weeks.
I also struggle with long term gastro issues.

So, to be kinder on my liver and gut, I'm going to ask my GP if they'll switch me from oral progesterone tablet to 100mg vaginal pessary.

How has anyone got on with the vaginal tablets please, both good and bad experiences?


Thank you

[bombsh3ll]

You can use the same micronised progesterone capsules you already have vaginally, you don't need to ask anyone's permission or get a different prescription.

It is currently recommended to use the same dose vaginally as orally. There is evidence supporting lower doses vaginally, as it is absorbed directly into the bloodstream, and in close proximity to the uterus, however the weight of evidence needed to change clinical guidelines hasn't been attained.

I used utrogestan vaginally 2x200mg, three times daily during IVF and didn't even notice it.

There are pessaries called cyclogest that are licenced for vaginal use (for infertility not menopause), however your GP is unlikely to prescribe these on the NHS due to cost.

There's no difference in the active ingredient, and having used both cyclogest and utrogestan on my infertility journey they are clinically equivalent.

The only meaningful difference is cyclogest are solid and waxy, and could if needed be cut with a sharp knife to achieve a lower dose.

[Nanny2two]

You can use the same micronised progesterone capsules you already have vaginally, you don't need to ask anyone's permission or get a different prescription.

It is currently recommended to use the same dose vaginally as orally. There is evidence supporting lower doses vaginally, as it is absorbed directly into the bloodstream, and in close proximity to the uterus, however the weight of evidence needed to change clinical guidelines hasn't been attained.

I used utrogestan vaginally 2x200mg, three times daily during IVF and didn't even notice it.

There are pessaries called cyclogest that are licenced for vaginal use (for infertility not menopause), however your GP is unlikely to prescribe these on the NHS due to cost.

There's no difference in the active ingredient, and having used both cyclogest and utrogestan on my infertility journey they are clinically equivalent.

The only meaningful difference is cyclogest are solid and waxy, and could if needed be cut with a sharp knife to achieve a lower dose.

I'd rather not use the oral pill this way, but thank you.

[sheila99]

What is it you're on now? If it's utrogestan it's the same capsule.

[Nanny2two]

What is it you're on now? If it's utrogestan it's the same capsule.

I'm going to ask about the pessaries.
They have an applicator which will be helpful to me.
Yes that's what I take now. As I'm very easily prone to BV, the peanut oil suspension in Urtrogestan pills won't be a good approach for me.

[chopsuey]

It's sunflower oil, if that makes a difference. As bombsh3ll says, most GPs will not prescribe either Lutigest 100 mg tablets or Cyclogest 200 mg pessaries for HRT purposes in the UK, as they are not licenced for this use. You may be able to get them privately though.

If you're worried about BV, you could try taking a vaginal probiotic (taken orally) which some have found helpful for this.

[Mary G]

Like others have said, only Cyclogest and Utrogestan are available for vaginal use in the UK and as bomb pointed out, if you are currently using Utrogestan, they are for both oral and vaginal use, you don't need a different prescription.  For some weird reason that nobody has ever been able to adequately explain, the UK boxes of Utrogestan don't say "vaginal or oral use" like they do everywhere else because they don't licence it for vaginal use there.

Progeffik is similar to Utrogestan and it it contains sunflower oil and soybean lecithin instead of peanut oil but it's not available in the UK.

[Nanny2two]

I wish I could add the screenshot here from NICE.
GP's can prescribe pessaries. Scroll up just a little, and they are there.
Whether they choose to prescribe (or not) is a different matter:

https://bnf.nice.org.uk/drugs/progesterone/medicinal-forms/#vaginal-capsule

[chopsuey]

If you click on the Indications and Dose section on that page, the only drug listed for HRT purposes is Utrogestan. The others are all licenced for reproductive purposes only, with the exception of Cyclogest, which can also be used for PMS.

[bombsh3ll]

Cyclogest is not usually prescribed on the NHS for hormone therapy due to cost.

No product in the UK has a license for endometrial protection when used vaginally, so if it is a choice between one off-label product which is relatively low cost (utrogestan), and another off-label product that is pricey (cyclogest) the lower cost item should be prescribed given that both achieve the same ends clinically.

It isn't an appropriate use of NHS resources to prescribe a specific brand unless there's a clinical reason, for example peanut allergy or the patient has actually tried the standard product and experienced a problem with it.

[Nanny2two]

If you click on the Indications and Dose section on that page, the only drug listed for HRT purposes is Utrogestan. The others are all licenced for reproductive purposes only, with the exception of Cyclogest, which can also be used for PMS.

My GP will need to seek a workaround, or I'll need to go private if safe to do, as that section states:

Hepatic impairment
For progesterone

"Manufacturer advises caution; avoid in severe impairment.

For Utrogestan® oral capsules, manufacturer advises avoid in acute or active liver disease"

My liver function results are very concerning, and I need to avoid causing more problems there.
It's also possible that I may need to wean off HRT altogether.

[Nanny2two]

Cyclogest is not usually prescribed on the NHS for hormone therapy due to cost.

No product in the UK has a license for endometrial protection when used vaginally, so if it is a choice between one off-label product which is relatively low cost (utrogestan), and another off-label product that is pricey (cyclogest) the lower cost item should be prescribed given that both achieve the same ends clinically.

It isn't an appropriate use of NHS resources to prescribe a specific brand unless there's a clinical reason, for example peanut allergy or the patient has actually tried the standard product and experienced a problem with it.

Re the last sentence, I am experiencing a problem with it. My liver function test results are off the scale.

Oral progesterone is tough for the liver to metabolise, and causes inflammation / speeds up liver diseases already present.

Even the manufacturer advises avoid or use with caution.

[KittyKats]

I've recently switched from vaginal to oral Utrogestan and I'm feeling pretty sick. I have Gilbert's Syndrome which causes raised bilirubin on the liver function test. Is this what you have? I have a hard time processing any oral tablets. You can just use the Utrogestan tablets vaginally. The other type is only for IVF. I recently asked my gynaecologist about this.

[Mary G]

Progeffik does contain peanut oil, I'm afraid I got that wrong so I just want to set the record straight in case someone buys it in Spain.  Apparently Utrogestan no longer contains peanut oil but people with peanut sensitivities should avoid it because of the soya content.

KittyKats, good point about Gilbert's Syndrome, I also have it so I know what you mean, it wreaks havoc with your bilirubin levels and I'm afraid it gets worse with the menopause. It runs in my family but I was borderline pre menopause and my sister was borderline until she became pregnant.

Something else to add to the mix is oral HRT and to a lesser extent transdermal HRT changes your bile composition so that can lead to additional gastric problems, particularly for people with Gilbert's Syndrome.