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[flaxhigh]

If anyone is on Gepretix, would they be so kind and help me figure out if the capsule is able to be pierced with a needle and the contents squeezed out?

I'm currently reducing my dose with Utrogestan and this is fairly easy to do by piercing with a needle and carefully squeezing out a drop or two.

Would you mind wasting one of your capsules to see if the same can be done with Gepretix? I don't have the prescription yet and want to argue with my GP that it can't be done so she should continue to prescribe Utro instead. But I don't know if this is true or not!

I'd be soooooo grateful - thank you!

[bombsh3ll]

Yes the contents of any gel cap can be squeezed out or withdrawn with a needle and syringe.

However this is not medically advisable with any type of progesterone capsule (including utrogestan) if you are relying on it for endometrial protection.

The reasons for this are:

a) impossible to accurately measure dose
b) even at the lowest dose of estrogen, less than 100mg micronised progesterone has not been shown to be sufficient for endometrial protection
c) potential for inappropriate use eg some patients have been rubbing it into their skin in the belief that it will be absorbed - it won't
d) if using vaginally, a pierced capsule is no longer suitable for use as further product is likely to leak out before/during insertion.

If you require a smaller dose than 100mg and using one cap alternative days is unsuitable, you would be much better asking for cyclogest which can be cut down to size, crinone gel, or using a compounding pharmacy to make up the dose of micronised progesterone that you require.

Obviously if someone is using micronised progesterone alone and is not taking estrogen, it doesn't matter if they pierce the capsules because there is no endometrial risk.

[flaxhigh]

Thanks but I'm under supervision of my consultant at the Menopause clinic on Harley Street and he is fine with it. I'm hoping someone will trial the Gepretix capsule as I'm not convinced it will be easy to pierce with a needle as the utrogestan.

He says - if you're interested - that actually according to his and others research a third of the dose is sufficient for most people for endometrial protection (100mg).

[sheila99]

It may be ok for some women, it certainly isn't enough for everyone. If you use less than the recommended dose I'd strongly advise you have regular scans to check the lining isn't building up, though perhaps you already do this.

[bombsh3ll]

With close endometrial monitoring a Harley Street consultant does have more freedom and it is on them if they have sanctioned using the product in an unorthodox manner.

Some of the old greats like professor Studd did used to have patients on very low dose estrogen such as a 25mcg patch or 0.3mg of premarin with no progestogen and they would have regular scans.

Most of them were absolutely fine with no endometrial pathology.

But such a small dose of progesterone is almost certainly not being used in the setting of therapeutic estrogen replacement.

Also no clinician working in the NHS is likely to support the practice of dividing utrogestan capsules due to the potential repercussions should that patient run into problems with endometrial hyperplasia.

[flaxhigh]

Yes, I originally was under the care of Prof Studd and am now with Mr Neil Watson - he's very experienced. He told me to reduce by a third but I'll never get anywhere near that as I'm too sensitive to change. I'm sticking with a couple of drops out or three max and that's all I can manage!

[bombsh3ll]

Just out of interest what dose of estrogen are you on, and are you taking the progesterone orally or vaginally?

I am always curious to know what the leaders in the field are.doing even if it is unlikely to change routine practice.

I also believe the majority of women are overtreated with progestogens however in a system without the resources to monitor them all with scans and identify those who need more, this is the only pragmatic and defensive option.

[flaxhigh]

I'm on Evoral 50 plus a tiny sliver more. I can't increase...though I've been recommended to, as it gives me palpitations.

On 100mg Utrogestan but started feeling very drowsy during the day. Studd told me to take it vaginally. Been taking it no problem for 5 years: I'm 60 and firmly post-meno. Mr Watson wanted me to come off for a month, then start on a monthly basis just 10 days out of the month and then continue like this.

However, I wanted to reduce slowly as I knew I had a terrible time coming off progesterone in the past. I tried to take out the equivalent to what his dose would be albeit nightly rather than episodically as Watson was proposing but it made me feel as if I was completely drugged. So I started with a tiny drop and increased slowly over the last few months to two larger drops squeezed out each night. There are probably about 10 drops in a capsule, so I'm probably taking out a fifth from my monthly dose in all rather than a third as he suggested.

Not had much difference on the daytime drowiness tbh, so perhaps it's another issue.

[bombsh3ll]

Are you taking the contents of the capsule orally?

I would ask him about cyclogest or crinone if you want a vaginal option that you can customise to your required dose.

It might cost more but it would last longer and you would be able to control it more precisely.

That way you can bypass the conversion to sedating metabolites.

[flaxhigh]

Taking vaginally. I don't dare move on to something new unfortunately from past experience. But thanks for your suggestion!