Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Dana on March 18, 2014, 01:32:41 AM
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Just wondering if anyone has had any experiences with the alternate day dosing method of 100mg Utro. How effective/safe do you think it is as a conti method?
I did try it a couple of years ago, for a few months, but I kept getting break through bleeds, but maybe I didn't give it enough time to settle in.
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I am not entirely sure that its a good idea, I think everyone is different, what is your reason for wanting to use the Utro this way? If it is to cut back, then I would rather use it 15 days in a row, else you are likely to get breakthrough bleeding as your levels dip and rise again. I am sure that someone else will be along shortly who can advise... I take Utro 100mg for 12 days in a row and that seems to be working well, so far so good, touch wood :) Of course used that way, it will not be conti and you will get a bleed, but I would imagine you will get bleeds or at least breakthrough bleeds, used the other way as well...
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Dana- conti means 'continuous'!
It's not meant to be alternate days for the reasons Cassie has said.
The levels particularly of Utrogestan will rise and fall too much and are likely to give you bleeding.
If you want to reduce the amount you take then it would be better to take less but over 15 days, or 21 days.
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Sarah2 - for the purposes of HRT every alternate day is also conti. Conti means the same dose is taken continuously without a break for a withdrawal bleed. It doesn't have to be every day.
The alternate day regime though is only suited to vaginal or rectal methods of getting progesterone though - because of the lower availability of progesterone taken orally, as you say.
Dana - I briefly reduced to 25 mcg oestrogen patch a few years ago and took Cyclogest 200 mg every other day (normal dose for cyclical HRT was 400 mg ie twice as much as Utrogestan) - this was a conti regime, but an unofficial one. I worked out the dose along with another member on here and we agreed it together! It did seem to work but my oestrogen dose was low
There was a prospective study done which was published in Climacteric in 2010. I have a copy of the paper but not the ref and as it's pdf can't quote easily from it - but could send you a copy by e-mail if you pm me your e-mail address Dana. It was a trial on 30 post-meno women given vaginal P along with oestrogen gel. The outcome was favourable re reducing oestrogen stimulation of the endometrium - but it was only a small study, and would be important to do this under medical supervision only, and only for vaginal use of progesterone.
Hope this helps.
Hurdity x
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I am not entirely sure that its a good idea, I think everyone is different, what is your reason for wanting to use the Utro this way? If it is to cut back, then I would rather use it 15 days in a row, else you are likely to get breakthrough bleeding as your levels dip and rise again. I am sure that someone else will be along shortly who can advise... I take Utro 100mg for 12 days in a row and that seems to be working well, so far so good, touch wood :) Of course used that way, it will not be conti and you will get a bleed, but I would imagine you will get bleeds or at least breakthrough bleeds, used the other way as well...
No particular reason. I'm just curious about other people's experiences, and if they are willing to share. It's just all about being informed of all our options.
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Dana- conti means 'continuous'!
It's not meant to be alternate days for the reasons Cassie has said.
The levels particularly of Utrogestan will rise and fall too much and are likely to give you bleeding.
If you want to reduce the amount you take then it would be better to take less but over 15 days, or 21 days.
I do know what "conti" means, and as Hurdity has noted this is considered a "conti" method. Maybe because you haven't been a member of MM for that long, you aren't aware of the fact that there have been women on MM and other meno forums who have used this method in the past. I was just interested in their experiences. It may or may not work for some women. That's why we ask these questions.......
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http://www.nhs.uk/Conditions/Hormone-replacement-therapy/Pages/How-it-works.aspx
Continuous combined HRT
Continuous combined HRT is usually recommended for women who are post-menopausal. A woman is usually said to be post-menopausal if she has not had a period for a year.
As the name suggests, continuous HRT involves taking oestrogen and progestogen every day without a break.
Isn't the reason for continuous so that levels in the blood stream remain constant?
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Sarah - the important point about what we are discussing, is not the definition, but what is meant by a continuous combined method as I said below ie one without a withdrawal bleed. As I mentioned what we are talking about (alt day vag use of utrogestan) is one that is not licensed or generally used (which is why the definition is as you correctly reported below) but as you know there are all sorts of variations to the regimes mmainly tried by specialist gynaes or private consultants.
This particular one as I pointed out was the subject of a trial and as such is of interest to those who do not wish to take progesterone every day.
Although the study does not mention serum levels of progesterone, the point about these is that vaginal application delivers progesterone directly to the uterus and serum levels will be more stable than with oral use - ie not subject to the vagaries of the digestive system and liver. The result from this limited trial showed the majority of women had no bleeding after an initial settling in period of a few months.
Some women withdrew from the study because of bleeding - and as expected this would not suit every individual just as with HRT preparations now - but it sounds like a promising possibility that could suit women who don't want high doses of progesterone.
The main problem would be re sexual intercourse as I am sure this would upset the progesterone levels so many women would not want to take this on an alternate day basis - but it depends on your circumstances!
Also personally it definitely affects my bladder - but only once or at the most twice in the night - and I can live with that 12 days every 8 weeks, but wouldn't want to do this every other day.
You're right Stellajane, there was someone who did this.
Also Sarah - you're right re blood levels - I doubt whether 100 mg oral Utrogestan on alternate days would achieve this - and I imagine there would be more spotting, and perhaps greater incidence of endometrial hyperplasia.
Hurdity x
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I think it's only something someone should try if they were having regular-ish scans.
Although it's fine to take lower amounts of Utrogestan- Studd for example suggests 7 x 100mg per 4 week cycle which is pretty low- that dose will still bring on a withdrawal bleed.
The potential issue with alternate-day doses of 100mgs is perhaps it won't necessarily promote a bleed as there is no withdrawal,( but there may be spotting) but on the other hand it may not be enough to prevent endometrial thickening, especially if it's taken orally.
How would anyone know without a scan?
Is there any research on this?
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I was on 7 days of 100mg was getting a monthly bleed so thought I was ok, until I started getting breakthrough bleeds and discovered on scan that my lining was rather thick! I personally couldn't do the 7 had to go up to 12 and will see later this year how the lining is looking on that. So perhaps a bleed does not necessarily mean that the whole lining is shed simultaneously, think this was discussed on another thread?
Hurdity was that study you mentioned on using the Utro on alternate days vaginally?
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As I've said before - John Studd can recommend regimes to women who are paying because they will pay for the necessary scans. He knows from his own research and trials that the incidence of endometrial hyperplasia rises with lower monthly doses of progestogen and the dosages we now have recommended in the HRT available I think are due to his pioneering work.
Re research on endometrial thickness - that was the main point of the research! ie could this dose prevent thickening, as this is the main function of progesterone in HRT, which it did. I did mention this in my first post about this research below. Because it was such a small study, it is not sufficient for this regime to be approved and licensed but it was a promising start, and of course scans would be recommended if anyone decided to decide to do this.
Again for anyone reading this, it would be important only to do this under medical supervision and if you can afford regular private scans.
Hurdity x
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Thanks for all your very good information Hurdity :) The study is promising, but I suppose more work needs to be done, as with most things relating to HRT.
I was lurking around MM up to 2 years ago and I was aware of discussions about this method, and that there were a couple of people testing it out. So I was just trying to get an update on that information, if those people are still here posting.
I think it's good to have this kind of discussion because, as I said above, it's all about being aware of all the options available. For those who are newer to MM, it will be interesting information for them.
Of course everyone should only make changes to their HRT routines in conjuction with medical supervision.
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Hello All
I've found this thread by chance - and it's exactly what I was going to post about. I have tried endless variations of utrogestan dosage and have really struggled with sedation effects - overwhelming tiredness, detachment, inertia, fogginess. I then started to get blinding headaches. I tried all kinds of doses and routes: but struggled with all of them. Then I suddenly had the idea that the problem was taking it two days in a row as for some reason I seemed to be taking much longer to metabolise the drug than research suggests I should. So, as a final ditch attempt I agreed with my gynae that I would try taking it orally every other day. I've been doing this for three months now - and it has been fantastic. I feel absolutely amazing: calm, brilliant skin - all the good things progesterone can give you - and none of the bad stuff. And I've not had a bleed or any spotting at all, which suggests that the dose is doing its job. i'm slowly trying to raise the number of days I take it as my body gets used to it. I'm now able to take it for four days every week, which means I'm on 2/3 of the recommended dose (16 days rather than 25) and my aim is to try to get my dose up to 20 days in a month.
This really has been a godsend for me - I was about to come off HRT as I couldn't cope with any of the progestins. However, it's obviously risky taking less than the recommended dose and I wouldn't do it without medical supervision. I'm going back to the gynae in a couple of months for a review, and suspect she'll ask me to come back for a scan in a year. Spreading the dose like this however does mean that I'm now able to take much more each month than I could when I took it every day - the most I lasted was 12 days on 100mg per day - I was then so ill I had to take time off work. So this is much, much better!
I feel really positive now: this has transformed my life. Here's hoping it stays this good...
Good luck everyone!
Susie
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Thankyou pls let us know how your scan looks and whether the lining shows any thickening taking it in this manner.
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Thanks for letting us know. Do you mind me asking who your Gynea is?
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Hi SusieJ
Glad this is working for you :)
A couple of questions - firstly do you have the three days off as you mentioned you take 16 days out of 25? If you do not take Utrogestan from days 25 - 28 do you get a bleed at some point?
Also what oestrogen dose do you take and in what form as this will have a bearing on how well a lower dose of utrogestan keeps the womb lining thin?
While I'm at it - how old are you and whereabouts in menopause, how long on HRT etc?!
Hurdity x
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SusieJ, well done, I tried to use 100mg Utrogestan vaginally every other day and only got to about day 6 before getting a migraine so I had to ditch it. If you can use it in this way and it works then that is great. I hope it continues to go well for you.
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Your way of taking it is good to know Susie, I'm 51 and a bit and looking forward to the day when I don't have to have a period and all that that entails and this may be the way forward. I've attempted long cycle and delayed my bleed to fit around holidays etc, bit I don't feel well when I do this. I do better when I have some progesterone, definitely calmer. Are there any benefits re weight (I have permanent water retention around my tummy) or libido?
Thanks in advance.
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Hi peri - progesterone depresses libido unfortunately so it is not likely to improve when taken continuously. It also can lead to more water retention although I have heard that this can also occur temporarily with increase in oestrogen in some women. I am always more bloated when on the progesterone phase of the cycle - so pleased to keep this to the minimum every 6-8 weeks - now trying 2 monthly. There's a fine line between calming and sedating/depressing/causing fatigue! The dose in menopause is higher than many women can tolerate and higher than is produced naturally (except in pregnancy) as I understand, hence the side effects.
It would be good to be able to take a lower dose and keep the womb lining thin although personally I still wouldn't want to take it continuously. I have never taken it orally though so have no idea how I would feel for example taking 100 mg - but since I get side effects from 200 mg vaginally I imagine I would still get them!
Hurdity x
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Hi Hurdity, thanks for that it's all helpful to know. It's not that my current regime doesn't work it's just I'm always open to tweaking it to make it even better. I take utrogestan vaginally too, I find it builds up and makes me tired (always sleep well when on it) + it makes my bladder sensitive but definitely preferable to the other progesterone s I have tried. The bloating and libido are other memo issues I'm attempting to resolve, otherwise for the most part I feel good, it's all a balancing act isn't it.
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I usually take utrogestan vaginally but thought I would try it orally this time. took 200mg for 7 days and although I could really feel its affects, it didn't produce a bleed for me. I do get a bleed when I use 100mg vaginally for seven days so I guess it is definitely more effective used vaginally. It makes my bladder feel very sensitive though. I get a migraine either way.
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hi All
Sorry for the long delay in replying - I've been away for a while...
To answer your questions:
Hurdity: I'm 45, perimenopausal rather than post menopausal and have been on HRT after severe early menopausal symptoms (primarily vasomotor) for three years. I'm taking Utrogestan orally every other day and not having a three day break. I haven't had a bleed at all. My gynae recommends that women take 100mg every day for continuous use without a break although I've read research which suggests this is more likely to cause spotting: the 25 day, three day break regime is intended to regulate break through bleeding. However I've also read research which suggests that women take it for 21 out of 28 days, or 25 days in a calendar month. So I suspect this is a rather imprecise science though of course it's always best to follow the manufacturer's directions where women can...
Meeka: I live in Edinburgh where there's a specialist menopause clinic run by Dr Ailsa Gebbe, and she's my doctor. She's quite happy for women to manipulate their dose, though is clear about increased risks etc. My GP is much more anxious about it so I'll have to see how it goes...
Peri: I suspect everyone is different, but Utrogestan has definitely increased my libido. Apologies if this is much too much information and do skip this bit if you're of a sensitive disposition - one of the effects of utrogestan for me is that it has increased the production of vaginal fluids and my sexual responsiveness has been greatly enhanced. This is one of the reasons why I've really wanted to persist with it...
The big change for me is that with a conti regime everything is much more stable: I don't get bloating or mood swings and that's a real advantage. I was very resistant to a conti regime before just like Hurdity, but actually I do feel much more stable and I don't miss having a bleed.
Having said all this, after three months of taking it like this I have recently found myself getting very tired again and I am wondering whether this is chemical - I'm having to go to bed at 9pm and feeling like I'm plodding through the day. This could be related to me trying to up my dose a bit (taking it two days in a row, then a break, then once, then a break, then two days in a row, and so on). Or of course it could be completely unrelated and I might be getting a virus! So, I'm going to try taking a break from it for a few days and see if I feel different, then start again. So I guess it's possible this may not be a sustainable option after all - and of course I don't know how the scans are going to look. But I'm really hoping it works. I'll keep you all posted.
Good luck everyone!
Best wishes
Susie
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Thanks for your reply Susie , it's certainly interesting to know there is another way to take utrogestan. I'm thinking of waiting until I'm 52 (only next summer) when I'm calculating my periods should have stopped anyway and then trying the conti regime.
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Hi SusieJ
Progesterone has a sedative effect which some women find calming at low dose, but often it becomes more like fatigue or depressing at the higher doses needed to be taken orally to keep the womb lining thin - because so much is lost due to digestion, the liver etc
It does seem to have a cumulative effect too - at least with some women - I usually start to feel progessively worse - more tired and foggy headed after about Day5 of taking 200 mg vaginally and that doesn't disappear until a few days after stopping taking it. Oh I think I said that earlier! I have never taken it orally, nor 100 mg though.
Hurdity x
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Hello All
I haven't been on here for a while as I've been doing so well on an alternate day dosing of Utrogestan. I promised to check back in after I saw the specialist for my annual review, which was yesterday, so here I am.
So. For the last 18 months I've been taking utrogestan every other day. This was because I was getting so exhausted on daily dosing that we thought I was just taking a long time to metabolise the drug and spacing it out would help. And it has! I feel absolutely fantastic - not tired, no bloating, no problems with mood. However because this is an unlicensed dose I need to go back for annual scans. So I had my first scan in 18 months yesterday.
The great news is that the scan shows that the alternate day dosing is doing its job at the moment. The endometrium lining is very thin, and I'm not having any bleeds (I initially had a few days bleed around every 10 weeks but that's stopped). So I know this works for me - but I am taking a very low dose of oestrogen (1mg) so I probably can get away with a lower dose of progesterone than many, and everyone is different in any case.
However, even though all is great and I feel great, the specialist would still ideally like me to up my dose to get to a full dose by this time next year. This is because in general utrogestan is a little weaker (i.e. less protective of the womb lining) than the synthetic progestins, and so taking less than the licenced dose is particularly risky. Of course there is the issue that because utrogestan is relatively new there aren't yet different licenced doses for people taking different amounts of oestrogen (like there are in the synthetic progestins). So the licenced dose assumes a 2mg oestrogen dose rather than the 1mg I'm taking. But all the same, the advice is ideally to do what is on the label. I've found over the last 18 months that I've got increasingly used to the utrogestan: to start with, a dose every other day was making me feel tired but now I don't even think about it. So I'm going to start building up the dose very very slowly and hope that by this time next year I'll be on something that is nearer to standard. However, if the side effects return I'll go back to the alternate day dosing and just keep it all under very close review.
Again - this is me and how my body works: it may be different for everyone else and it may change for me in the future. But for now, this has been a great solution and I feel like I've got my life and my self back!
xx Susie
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Hi SusieJ
Thanks so much for coming on here and giving us your update - this is really helpful to other women!
When you say 1 mg oestrogen I presume you mean orally? So you are taking a low dose oestrogen and managing with 100 mg oral utrogestan every other day. Did the clinic say what your actual endometrium measurement was on this regime?
So interesting to know that you have no side effects from this dose which would be equivalent to 50mg per day - which many of us say should be available as a dose - especially vaginally! I can understand your specialist saying it would be preferable to take the licensed dose but as you say the licensed dose is very much a "one-size -fits-all" and for oral use only - which is generally fine, other things being equal, for medium dose oestrogen but more or less may be needed for higher or lower oestrogen doses.
Another option though would be to take a higher dose for one month a year maybe? Although I am on cyclical HRT (in my 60's) I am on a long cycle with vaginal utrogestan every 6-8 weeks - and my GP (Gynae specialist) is happy for me to do this as long as I have an annual dose of norethisterone for one cycle to "strip" the lining as she called it. Just a thought if you found that the licensed dose is too high.
So please to hear you have your old self back - many of us would love to be able to say this - although I feel pretty good considering I'm in my 60's!!!
Hope the good feelings continue SusieJ :)
Hurdity x
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Hi SusieJ, I too am taking Utrogestan 100mg on alternate days and have been doing so for 9 weeks now. Initially I felt a little rough, but like you, I now feel very good and have had no spotting. I was still a little low on Oestrogen alone, but my mood seems to have slowly lifted on the Utrogestan and can honestly say that I am back to my old self. I just hope it lasts!
I am under a private gynae for this regime and will be having a scan in March. If I do have any spotting, the scan will be brought forward.
Good to hear your experience!
Rhiner
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I'd totally forgotten about starting this thread. I don't use utrogestan anymore, but it's great to hear this method is working for you. It would be good if there was less of a "one size fits all" approach with Utro.
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Thanks for the update SusieJ and Rhiner. It is very informative and helpful.
I am currently also on alternative day vaginal progesterone 100mg with a Estradot 50mcg patch under supervision of my Dr. I will have a scan end Dec to see if it works well enough. If I take it daily I get a lot of periodlike cramping and backache which does not occur with alternative day dosage so I really hope it is effective. I have been on the 50mcg since 1 Nov (been on 37.5 before) and I am contemplating whether it might be a bit too much. My breasts are both a bit tender, lots of vaginal lubrication and I had a hot flush or two again. But I also do not want to change back to 37.5mcg before the scan in order to see the effect of the 50mcg. My Dr is on long leave atm. Any opinions ladies? Thanks
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Hey Matilda!
I went up to 50 mcg around the same time as you - but felt it was too much.I had very sore boobs, yet also felt 37.5 was not quite enough.
After 2 weeks I decided to snip a little bit off the 50 mcg patch and that brings the dose down to around 44 mcg.
It's working well for me!
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Its interesting to see that there are other ladies trying the alternate day dosing regime and great that we can share how its working. I am taking it orally at the moment.
I get a bit of a headache (not enough for painkillers) about once a week at the moment, which I am sure would be much worse if I took the Utro on a daily basis, (as suffered terribly with headache on conti femoston, with the synthetic prog). Im hoping this eventually settles.
The beauty of using patches is that you can cut bits off to find the in-between dose that suits, this is what I did before settling on the 75ug.
Matildamouse - Im sure someone more knowledgable on the effects of too much oestrogen will be commenting soon, although painful boobs may be too much oestrogen, although with the prog I can feel a bit of heaviness there, that wasn't a problem when i was just taking the oestrogen.
Rhiner
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Thanks again ladies.
Sonia interesting that 6mcg can make such a difference. I am definitely going to cut off a bit of the 50mcg to see how I go.
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Yeah - it really did Matilda! No more sore boobs.
Good luck:)
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Hello All
Thanks so much for all your warmth and support as always. This is such a lovely space!
Hurdity: yes, I'm taking 1mg oestrogen orally. For various reasons I didn't want to take it via a patch even though this was recommended by the doctor. I may change my mind eventually... And I know lots of women try to squish their utrogestan intake into a smaller time period as at least it reduces the amount of time that people feel rotten! I tried this for a while too but I couldn't cope with the daily dose as I got so exhausted and zonked I simply couldn't function. At one point I couldn't even get to the end of a sentence without forgetting what I had started to say. It just seemed I was right at the outlying end of the spectrum in terms of how long it takes to metabolise the drug, and taking it every day was leading to a build up in my system. After 18 months of alternate day dosing though it looks like my body is getting used to it, and I'm now gradually trying to add in an extra dose every now and then.
So, for now this is all good - fingers crossed... The only problem on the horizon is that GPs in Scotland (where I live) are starting to be told they can't prescribe utrogestan as it is more expensive than 'normal' HRT. I don't know if anyone else has had this problem? I'm ready for a fight though!
Good luck everyone. And thank you again for your kindness - it has really helped me when everything felt so hopeless.
xx Susie
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Hi susie...found your messages and had hope! Im new to hrt...11.days in.....2 pumps.of estrogel.daily.and 100mg of utrogestan vaginally and on alternate days and on the instrcution of meno doc
I was confused at first as im.peri meno...im.48 nearly...hadnt had a proper period for 6 weeks prior to starting hrt...so wondered why she hadnt said to take cyclical.....so messahed her and asked again in case she got mixed up and thouhht i was post and she said no....alls ok keep taking..and dont worry.its early days! So i thought id stick with that...
Day 6.utro i had a 3 day bleed....cramp..headache...doc told me this may happen so i let it pass. The last 3 days though woke with a headaxhe which is now a migraine......and been feeling oh so tired and foggy. Not sure whay to do as feel disheartened and querying if i should have even started ...and thay i should have continued trying the natural route! I want my mojo back! Energy! Vitality! Then i saw yoire old post and it gave me a little hope! Do i need to just be patient and let ny body settle....will the migraine and tiredness lift?! Did you suffer anything similar to begin with and before you began to feel amazing?
I do hope you get this message....as yoire post has been the one ive been hoping to find...as so many have asked why im.on alternate days when still peri and its had me worrying ! The doc is a well reknown and respected meno doc so i know she knows why and what!
Would love to hear back from.you!!
JM
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Hi birdy..i know...i.thought id chance it!!
Oh well...the wondering and hoping continues haha x
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Hello All
I haven't been on here for a while as I've been doing so well on an alternate day dosing of Utrogestan. I promised to check back in after I saw the specialist for my annual review, which was yesterday, so here I am.
So. For the last 18 months I've been taking utrogestan every other day. This was because I was getting so exhausted on daily dosing that we thought I was just taking a long time to metabolise the drug and spacing it out would help. And it has! I feel absolutely fantastic - not tired, no bloating, no problems with mood. However because this is an unlicensed dose I need to go back for annual scans. So I had my first scan in 18 months yesterday.
The great news is that the scan shows that the alternate day dosing is doing its job at the moment. The endometrium lining is very thin, and I'm not having any bleeds (I initially had a few days bleed around every 10 weeks but that's stopped). So I know this works for me - but I am taking a very low dose of oestrogen (1mg) so I probably can get away with a lower dose of progesterone than many, and everyone is different in any case.
However, even though all is great and I feel great, the specialist would still ideally like me to up my dose to get to a full dose by this time next year. This is because in general utrogestan is a little weaker (i.e. less protective of the womb lining) than the synthetic progestins, and so taking less than the licenced dose is particularly risky. Of course there is the issue that because utrogestan is relatively new there aren't yet different licenced doses for people taking different amounts of oestrogen (like there are in the synthetic progestins). So the licenced dose assumes a 2mg oestrogen dose rather than the 1mg I'm taking. But all the same, the advice is ideally to do what is on the label. I've found over the last 18 months that I've got increasingly used to the utrogestan: to start with, a dose every other day was making me feel tired but now I don't even think about it. So I'm going to start building up the dose very very slowly and hope that by this time next year I'll be on something that is nearer to standard. However, if the side effects return I'll go back to the alternate day dosing and just keep it all under very close review.
Again - this is me and how my body works: it may be different for everyone else and it may change for me in the future. But for now, this has been a great solution and I feel like I've got my life and my self back!
xx Susie
Hi SusieJ - I don’t know if you’re still around after all this time but I just read this thread with interest. I’m currently trying to work out which element of my HRT regime is responsible for the bloating and fluid retention. I’m on a low dose patch by cutting Evorel 25 in half and taking utrogestan every three days vaginally. Trying to find different and acceptable ways of taking the latter to see of it will ease the side effects. Couple years on - how is/did the alternate oral utrogestan go? How is symptom control including uterine health?
Don’t know if I should have started a thread for this, as still trying to find my way around MM… x