Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Dancinggirl on August 20, 2015, 03:33:32 PM
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Hi all
Ways of using Utrogestan seems to vary so greatly and though there are specific licensed guidelines, there is still the issue around the amount of oestrogen one can or should use alongside.
I am currently using Oestrogel with Utrogestan sequentially. At 59, having the withdrawal bleeds is a nuisance as I get quite nasty cramps and quite a heavy bleed. My gynae said he thought I could move to Utrogestan continuously as I am getting problems with erratic spotting and heavy bleeds but I am wary of using any progesterone continuously - I do feel a bit short tempered on Utrogestan although I think I am generally ok when I'm taking it.
I am also using a very low dose of Oestrogel - about 1.25 pumps per day - which my gynae thought was probably a bit low to get a good balance of hormones - so I may need to increase this a bit.
I want to hear from any ladies using conti Utrogestan.
What amount of oestrogen do you use?
How long did any spotting last? Do you still get the occasional spotting?
Do you generally feel better using it in the conti regime as opposed to sequi?
Also, do you take the 3 day break and, if so, do you get a bleed? Or do you just use it every day?
I hope this might be of use to many ladies out there? DG xxx
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I would hate to be still having a bleed at 59 :o
At 55 I would not even contimplate any regime that meant that.
Women by nature are not supposed to be having a cycle at that age. Our fertile years are past so bleeds should be a thing of the past.
I know that a lot of women....and rightly so ...try to use HRT in the most natural form possible....ie Utrogestan.
I don't know that I agree that triggering a bleed at this age is the best thing or the most natural but of course if we want to use oestrogen then progesterone has to play its part.
What the answer is I really don't know.
I use a half Evorel conti patch.
I have no bleeds but have the advantage of both oestrogen and progesterone.
If Mother Nature had intended us to be fertile into our 60s then menopause would never be an issue......but she didn't so therefore a no bleed regime must be the most natural scenario.
Honeybun
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Hi
I am 57 and use utrogestan continuously alongside Elleste Solo 1mg. I was using Estrogel for a few years but was struggling. I do not have the 3 day break as I see Nick Panay in London who told me to use it continuously, I've had a few scans which do not show a build up in the lining of the womb.
Hope this helps you.
Lesley
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hooneybun - you make a very good point. I think my gynae would be happier if I was on conti Utrogestan as it probably causes less problems with erratic bleeding and there fore reduces the risk of womb cancer. I am getting erratic spotting all through cycle now, even on the oestrogen only phase!!! My thoughts around sticking to the sequi regime is to avoid too much progesterone of any kind. One has to take Utrogestan on an empty stomach and this is a discipline that can be challenging to maintain. I have problems with VA and urethra pain so don't want to use Utrogestan vaginally. The progesterones in the conti patches are all synthetic which really don't agree with me so I feel Utrogestan is the only option for me. I always suffered cramps with my periods and later on with HRT sequi through my 40s (been on HRT since 37 due to prem meno) but the heavier bleeds with this new regime have been a surprise as I hadn't experienced such heavy bleeds ever before. Previously I had a Mirena for 4 years in my mid 50s which was OK but in hindsight I did get rather a lot of headaches and sedation with this. Utrogestan has not given me that many side effects.
Stellajane - I did reduce my oestrogen down to one pump per day and I am doing a slightly longer cycle - 3 weeks of Oestrogel and then 14 days of adding Utrogestan - so a 5 week cycle. My problem is that my bleed starts on day 8 of the Utrogestan and then continues to about 5 days beyond the 14 days of Utrogestan. I tried shortening the cycle to the the licensed regime but it made no difference. My feeling now is that I should perhaps try 1 - 1.5 pumps of oestrogel per day with 100 mg Utrogestan daily to see how that goes but I wanted to hear from others who do this or similar to see if it works OK. Also, is the 3 day break really important or can one simply take it continually?
meno lesley - thanks for that feedback. Did you get any spotting in the first few weeks? Do you get any spotting now? DG x
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Utrogestan gave me horrible cramps and very heavy bleeds. It also made my bladder ache so I can understand why you wouldn't want to use vaginally.
As you are going privately would your consultant not support a much longer cycle with a scan every year just to check things are the way they should be.
Can I ask what your long term plans are regarding bleeds. Surely you can't go into your mid 60s to 70 and still have a period.
Very difficult but it just doesn't seem right somehow.
Honeybun
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Hi
I did get some spotting when I had the three day break but do not get any now.
Lesley x
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Thanks ladies - this is really helpful. I have just read the Utrogestan leaflet again - they seem to have re written it and in the side effects section it mentions erratic bleeding, cramps and heavy bleeds. It does state that if you suffer with problematic bleeding then 'your doctor may adjust the way you use Utrogestan' - so I interpret this as possibly switching to taking it continuously. The leaflet only states the sequi way to take Utrogestan - I'm sure previously it described the conti version as well?!!
I do seem to be getting cramps rather a lot - even during the Oestrogel phase so I think I will either have to switch to conti or perhaps try using Provera(MPA). I haven't tried MPA so this might be OK for me, especially if I'm allowed to use it on a long cycle.
Being back on HRT has given me so many benefits - - being able to sleep has been great plus VA and burning has been much better - I generally have much more energy. I really don't want to throw in the towel because of these cramps and the erratic spotting.
My gynae is lovely but I can't really afford to keep going back to him - my GP is simply following his instructions. I think at this stage I need to try one more cycle and then move onto the conti and move forward from there.
Any more feedback or thoughts anyone?
DG xxx
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Someone recently directed me to these notes when I was considering taking Utro on a continuous basis; here it refers to both choices : http://www.netdoctor.co.uk/womens-health/medicines/utrogestan.html
I liked taking Utro but had terrible withdrawals after stopping it each month - I developed post-MT! At the time my GP wouldn't consider letting me take 100mg for 26 days because I was 43 and still having regular periods. However, others on here in that situation do take it. There seems to be a fair difference in GP's approaches to this particular drug, doesn't there?
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I would hate to be still having a bleed at 59 :o
At 55 I would not even contimplate any regime that meant that.
Women by nature are not supposed to be having a cycle at that age. Our fertile years are past so bleeds should be a thing of the past.
I know that a lot of women....and rightly so ...try to use HRT in the most natural form possible....ie Utrogestan.
I don't know that I agree that triggering a bleed at this age is the best thing or the most natural but of course if we want to use oestrogen then progesterone has to play its part.
What the answer is I really don't know.
I use a half Evorel conti patch.
I have no bleeds but have the advantage of both oestrogen and progesterone.
If Mother Nature had intended us to be fertile into our 60s then menopause would never be an issue......but she didn't so therefore a no bleed regime must be the most natural scenario.
Honeybun
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Can I ask what your long term plans are regarding bleeds. Surely you can't go into your mid 60s to 70 and still have a period.
Very difficult but it just doesn't seem right somehow.
I would hate to take a synthetic progestogen such as norethisterone - found in Evorel conti on a continuous basis...
There are several of us on here in our 60's still on HRT and having bleeds - as you know I am one of them so surely I can (go into my mid 60's and have a bleed)? It may not seem right to you but actually, it does to me - well the least of evils at the moment - and it is no less natural than taking a synthetic progestogen continuously. We are all trying to work out how to stay healthy when we are likely to have one third of our lives or more in our "natural" hypo-oestrogenic state that characterises post-menopause - say from age 50 to 80.
There are several choices available once we are post-menopausal:
1 Stop taking oestrogen/HRT and accept the consequences - whatever they may be
2 Take HRT on a continuous combined (no bleed) basis - and thereby take continuous progestogen - either synthetic, or progesterone
3 Take HRT on a cyclical basis - which gives a withdrawal bleed.
None of these are more "right" than others, but we have to make this decision based on our own personal biology of our bodies, general health, and weighing up the objective scientific evidence of risk factors.
Many women experience unpleasant and debilitating side effects, and/or erratic bleeding from continuous progestogens and therefore either a regular/predictable bleed, or as long as possible on oestrogen only (ie long cycle) - are preferable.
Don't get me wrong - I most certainly don't enjoy having a bleed and would prefer not to have them, but I would rather do this than have to take progesterone all the time - although I am tempted sometimes (when the bleed happens) but I also usually want to throw in the towel and give up when I'm on the progesterone phase too - and wonder how much longer I can put up with it! It's a question as always of what makes us feel better for most of the time and has the least harmful effect on our health - short and long term (the latter we cannot know!). At the moment I feel so much better when on oestrogen only for 5-6 weeks it's worth it.
Dancinggirl - it is a difficult one. I do sometimes wonder about taking utrogestan 100 mg all the time but I know how I feel when I'm on it, especially after about 5 days in and until I stop, so the prospect is not attractive. In your position though - I wouldn't want to have those cramps. At the moment I only get them during the bleed as expected. It's great though that you are feeling generally better - but you are struggling with what all of us older women with wombs are having to do!
Briony - what you experience for the few days after you stop progesterone is a normal part of PMT. Progesterone is at its highest about a week following ovulation and the following week it declines rapdily (along with oestrogen) and that is when women often experience bad pms - from the oestrogen dip, and the progesterone withdrawal. With HRT this is prolonged in a 4 week cycle because there is often 14 days on progesterone and the few days after withdrawal possilby giving 2 1/2 to 3 weeks of pms instead of two!
Hurdity x
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Briony - what you experience for the few days after you stop progesterone is a normal part of PMT. Progesterone is at its highest about a week following ovulation and the following week it declines rapdily (along with oestrogen) and that is when women often experience bad pms - from the oestrogen dip, and the progesterone withdrawal. With HRT this is prolonged in a 4 week cycle because there is often 14 days on progesterone and the few days after withdrawal possilby giving 2 1/2 to 3 weeks of pms instead of two!
Hurdity x
Thanks. Never thought of that before, but now you say it it seems so logical! x
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So are you saying that I am not doing the best I can by using a synthetic progesterone.
Urtogestan was a nightmare for me....absolutely horrible....but at least I'm not having a bleed which in my mind is far more natural than bleeding into my 60 and beyond.
It might seem right to you but it seems unnatural to me as that is not what nature intended.
I did say that I did not know what the answer would or should be. I don't think you can be sure of that either.
But...bleeding into your 60s to almost 70 or perhaps beyond is not natural nor ever will be. It's not how our bodies were intended to function.
What I take may not be anymore natural but being bleed free mimics the natural process slightly more so perhaps.
A lot of women are scared of life after meno...perhaps we are both guilty of that.
You don't have the definitive answer and neither do I.
Honeybun
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It's all quite difficult not straightforward at all.
I can sort of understand women wanting/needing to have bleeds to keep their womb lining thin.
However it wouldn't be my option of choice.
Some might say it's about as natural as the 65 year old German lady who gave birth to quadruplets this week.
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Which was not natural at all ;D
Heaven help her....and her children too.
Honeybun
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1 and a bit pumps of oestrogel and 100mg of Utrogestan for 12 days works well for me will continue this regime as long as i can, dont mind the bleed its heavy for 2 days then tapers off the last 2 days, way prefer this than having to take Utro every day it keeps me awake and gives me tinnitus!
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I actually know a lady who has used HRT well into her 80s and she kept to a sequential HRT!!!!
She has been amazing - continues to work and you can tell that her bones are really good.
I'm now on day 12 out of 14 days of Utrogestan 200mg and I've had a proper withdrawal bleed for the last 2 days - I will complete the 14 days as my gynae has prescribed. On my last 2 cycles I started spotting by day 7 but the bleed didn't start properly till after I finished. If I still have quite a heavy bleed after finishing Utro this time, this could mean I'm bleeding for well over 12 days which can't be right!!! Whether I continue to bleed heavily this time will be interesting!!! I've never had heavy bleeding before - so maybe I've developed a fibroid?!
I have actually felt Ok on the 200mg of Utro - a bit tetchy and short tempered and I've slept quite well but with vivid dreams. I've not had fatigue during the day, so I can't say it doesn't suit me generally - it's just this problem of the spotting and erratic bleeding.
I have this feeling that my body isn't metabolising Utrogestan properly for some reason or perhaps it's simply not right for me. I think I may do a normal cycle of 14 days of oestrogen alone and 14 days of Utro next time to see whether this settles better and if not it's back to my gynae.
It's really helpful to hear everyones thoughts.
I do think that, whilst Utrogestan is the most natural form of progesterone and possibly ideal in many respects, it possibly isn't as stable and predictable to use as the more synthetic forms.
Perhaps my year out from HRT resulted in my uterus going into deep atrophy and it's now struggling to cope with the hormones?
DG xxx
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Had a dreadful night of cramps - took some Cocodamol at 3.30am and in the morning the cramps were better. Over this morning the cramps have got progressive worse again. This is getting to be a real pain in every sense of the word. I'm not bleeding excessively and I've still got 2 days of Utro to take!!!! I really don't think I will be able to stick with sequi HRT if the cramps are going to be this bad and for so many days. I fear that Utro is triggering these nasty cramps but I also had some mild cramps over the last few weeks while just using Oestrogel - so I am actually a bit concerned that my uterus is just rebelling.
Whether things would be better on conti Utro it's difficult to know - I think I will have to try this first before throwing in the towel. I'll probably go back to my gynae once I'm back on Oestrogen only, if things don't settle .
Back in my 40s when I was using Oestrogel with Dydrogesterone for 10 days each month, the bleed often started on day 9 and I got nasty cramps for a few hours but these would subside quickly and the bleed only lasted 3-4 days and wasn't heavy. I found the dydrogesterone gave me slight PMT symptoms and the odd headache but nothing too bad. It's shame that this type of progesterone is only available in Femoston these days and not separately as it once was.
I would be devastated to stop HRT as it has made me feel so much better in many ways - during the year without HRT I did feel I was leading a half life.
To be honest, if my gynae suggested a hysterectomy I would probably seriously consider it - although I know this is not ideal.
I do appreciate all your support everyone. DGx
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Sorry to read this DG. It's exactly what Utrogestan did to me and I just couldn't cope with it. I had terribly painful cramps as a teenager that improved as I got older and had my children. I was so surprised to end up curled up in bed with a hot water bottle suffering cramp in my 50s. I tried for a good few months but it just got worse. I think Utrogestan is far too strong for me.
Perhaps having gone so long without any periods at all is not helping your situation.
Are patches not even something you would consider trying....I use a scant half as I'm getting a bit older. It's just enough to keep the flushes at bay and help me sleep.
Hope you feel better soon.
Honeybun
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Thanks honeybun - it's interesting to know you suffered the same way. Unfortunately both the combined patches, Evorel and Femseven, have synthetic progesterone which gives me nasty PMT so I would be very wary of using these. I did have a Mirena for 4 years in my 50s which was OK but I think I absorbed too much of the progesterone (again synthetic) in the first year or so and felt sedated/sleepy quite a bit.
As I mentioned, it's a shame that Dydrogesterone isn't available on it's own, so it can be used alongside Oestrogel. I haven't tried MPA (Provera) so this might be an option as it isn't as testosterone based as Norgestrel, Norethisterone acetate and Levonorgestrel.
I don't need a high dose of oestrogen either - I'm feeling good on just 1.25 pumps of Oestrogel, which I think would only be about 1mg in pill form, so really quite low.
I'm going to have to be persistent and try different options. DG x
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As I mentioned, it's a shame that Dydrogesterone isn't available on it's own, so it can be used alongside Oestrogel. I haven't tried MPA (Provera) so this might be an option as it isn't as testosterone based as Norgestrel, Norethisterone acetate and Levonorgestrel.
. DG x
Interesting you say this as I searched everywhere to see if there was a combined contraceptive pill using Dydrogesterone that I could take rather than the Dienogest in Qlaira. I found an article saying it was in the research stages. Wonder why it's not available separately when it seems to well tolerated?
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Briony - it baffles me!! Maybe there is only one pharmaceutical company that has the rights to dydrogesterone?
It used to be available in pill form on it's own (that's what I used to use back in my 40s) and I think it is still available in other countries. Why it was taken off license in the UK seems odd when it is clearly a kinder type of progesterone. It would be great if it was in a patch but maybe it doesn't work in that format - for some reason they only use synthetic progesterone in patches.
I'm sure in time that newer and better tolerated HRTs will emerge as the demand grows. Now women are getting more informed and demanding treatment for the debilitating meno symptoms the pharmaceutical companies will surely meet this demand - after all there are so many different contraceptive pills out there now. My daughter uses 'The Ring', which she just replaces monthly - it contains oestrogen and progesterone that prevent pregnancy and it would seem to me that a similar thing could be ideal for meno symptoms. DG x
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My struggles with HRT made me wish for a hysterectomy at times.
After 5 years since my periods stopped, I think I have now reached a level of comfort. Natural progesterone was a big problem for me. Even with a 1mg estrogen patch, the continuous progesterone at 100mg caused constant bladder/urethral burning and occult blood in urine. It also burned my vulva when urinating. Going off HRT I would improve for several months, then low estrogen symptoms kicked in and vagifem alone was not able to keep VA in check. Hot flashes were mildly there, but the VA was much worse. Back on HRT, I would be fine until the progesterone levels built up (about a mo), then the unremitting bladder burning began. It took a while to realize it was the progesterone....almost 2 yrs!!
I am now on the US version of what I think is Evorel Conti in UK. In the past, I could never tolerate BCPs due to the PMT with norethisterone/norethindrone which made me depressed, fat, etc. I tried the COMBIPATCH (US version) with trepidation, expecting issues and have found none to my surprise after 2 1/2 mo!! The combined tablets did not work for me. I had hot flashes every night and persistent VA even combined with vagifem after a 3 mo trial but NO bladder pain. I researched the blood levels of estrogen and NE in the two available combined patches in US and found that the highest blood levels for estrogen and lowest NE levels are with the combipatch 50/.14 dose and my doctor agreed to prescribe it. Since the NE dose is lower in this one (the other one has .25 NE), there is some propensity for spotting but I have had none of that. The patch sticks very well and I change it twice a week. I have tried it on stomach and hip/buttock, the later of which gives slightly higher blood levels. I like the hip/buttock application better as I think the levels seem more even as I get closer to patch change day. I also leave old patch on for about 6 hrs after applying new patch before removing it. So far I have still been using vagifem also, but I may start to taper off it as it does irritate my parts mildly the day after using it. I also tried 1/2 combipatch with the vagifem and it wasn't enough to keep VA symptoms away.
If you haven't tried this after being post-menopausal for a while, I suggest you give it a go....as I am very glad I did so far. It might just work : )
Andius
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My Evorel Conti patch made me feel very flat, little enthusiasm for anything much. I also was pretty bad tempered off and on. Since I have gone down to a half patch my mood has improved.
I suspect at 55 (just) I am post meno. My period had been absent for seven months for the second time before I started HRT and I was 49 then.
I feel as if the half patch plus Vagifem just keeps things ticking over.
Andius is right...what have you got to loose because it really sounds as if Utrogestan is far too strong for you and despite chocolate cake ;D the side effects are debilitating. I know they were for me and I decided I was way too old for period cramps.
Honeybun
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Thank you andius and HB - very interesting feedback. As you both may remember, I have suffered badly with burning urethra. Vagifem aggravated the burning and I used the Estring for a few months when not on systemic HRT with some success - however I did get a couple of bouts of thrush which was very unpleasant. I think one can be more prone to thrush when having lots of flushes - naturally much more hot and sweaty around that area!!!
Since being on the Oestrogel and even when taking the Utrogestan, the burn gin has gradually improved - I haven't had this discomfort for some time now so I think the oestrogen is doing it's job. I wouldn't use Utro vaginally in case that aggravated things again.
When I was young and on BCP I tolerated this very well. After having my babies they put me on the newer type of BCP and it made me feel really ill !!!! I think the older types suited me better or I was already going into peri meno!!!!
I did try patches back in my 40s and found them far too strong(I felt really spaced out and sweaty on them) - I know I could cut them up but it seems strange to me that they don't come in different strengths.
For me it's the idea of using progesterone continually that is the issue - particularly if they are synthetic - because I've had such bad experiences with PMT, headaches and fatigue. I do feel OK on Utro - it's just these wretched cramps and erratic bleeding. DG x
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fwiw.....i am almost 60 and my baseline estradiol level is 5 pg/ml or 18.35 pmol/L and that is while using vagifem but no systemic HRT for 5 mo. My progesterone level is less than the tests can pick up without HRT, so the lowest level they can test for is always reported. No woman on either side of my family has ever had breast cancer or endometrial cancer whether they took HRT or not, so this may be a genetic type thing. All have lived past 80 for at least 2 and some for 3 generations back (the ones I know of) and mostly died from strokes.
If your baseline estradiol or progesterone levels are higher, then I think that might dictate what hormones and what doses you might be able to tolerate.....of course, you would probably have to go off hormones for a while to get the baseline levels done. Some women never develop VA, and I think this means they must have higher natural levels of estrogen or their receptors (for estrogen) down below are maybe less sensitive to depletion?
In my case, since my baseline estrogen is low in full menopause, I think the natural progesterone that is currently available to take other than the creams is just too strong for me or builds up too high in my system. Most doctors fail to feel confident that creams or low doses of progesterone (less than 100,200mg) are protective for the endometrium without exhaustive studies or protocols saying so, of which there are NONE. As the lower urinary tract forms with the vagina in an embryo, estrogen depletion can affect both as we ladies know too well. I think the progesterone may have actually blocked the effect (in myself) of the estrogen I was taking, if that makes any sense. Why the norethindrone/norethisterone doesn't do the same thing....I have no clue. ??? except that it is not the natural kind of progesterone.
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I will be 60 in 6 months time, Ahhhh!!!!!
Very interesting andius - I had a premature meno and I think my hormone levels without HRT are very low. I developed VA and the burning urethra in my mid 40s when I was on HRT - I was on quite a low dose and I think it wasn't enough to keep everything plumped up in this area.
I continued using some Vagifem when I started with my current systemic HRT but it still tends to irritate so I've stopped using it now - urethra really much better and sex is definitely better :bed: - so happy hubby.
Naturally I don't want to disrupt all the benefits - I'm hoping I can find a good compromise that I can sustain for a few years yet.
I think we tend to get really excited about the notion that Utrogestan is natural and potentially safer but it clearly is not always ideal. As we keep saying, "we are all different". DG x
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Utrogestan has been said to be....on this forum anyway ...by some ...to be the best that you can use.
Unfortunately this is not always the case at all. It was originally used for fertility treatement and now there is a crossover to HRT.
Most of us at one time in our lives have been on the pill for birth control reasons.
Synthetic progesterone.....did we question it....well I know I didn't.
Maybe we should just open our minds to whatever preparation works best and stop getting over enthusiastic and perhaps unrealistic over bio identical and use whatever suits is best.
Honeybun
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