Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Loubylou on September 14, 2018, 06:26:43 PM
-
So after not agreeing with utrogestan as it made be bloat, awake at night and awful wind I was given a vaginal bio identical pessary called Lutigest.
I was asked to take it for 12 days 100mg. I was worried because it is a big tablet but also because of previous side effects with rapid weight gain and emotions.
So, I have been taking it for 14 days now. I am now losing weight instead of putting it on. I feel a lot calmer. People have been telling me I look good. I was only supposed to take it for 12 days but I want to carry on and take it for 21 and then have 7 day break. Is that ok?? My natural progesterone levels are practically zero through early menopause and I thought that If was taking the pill as hrt as I have done before I would be taking 21 days combined estro and progest anyway. What do you think?
I also have 50 estradot patch that I change twice a week.
So the lutigest is great! However, the discharge is a lot!! It is watery and thick white discharge due to the tablet breaking down. I'm single at the moment but in a relationship I'm not sure its good for a sex life.
-
Hi I don't think many ladies have experience of this progesterone but I would do as your doctor prescribed. Or ask your doctor if you can change the length of time x
-
I haven't heard of this progesterone Loubylou but as I'm prog intolerant I will watch with interest. Thanks for bringing it to our attention x
-
I thought this sounded familiar as I remember posting about it here:
https://www.menopausematters.co.uk/forum/index.php/topic,40628.msg643922.html#msg643922
... and this is what I said about it:
It would be interesting to see how it works in terms of sdie effects. May only comment would be if you compare the doses used in fertility treatment Lutigest is given 3 x per day ( ie 3 x 100mg = 300 mg), and vaginal Utrogestan the same frequency (ie 3 x 200 mg = 600 mg) ie twice as much implying that Lutogest is more concentrated - but maybe the formulation is such that more gets to the uterus easily - and hopefully fewer side effects!
We'd love to have a description of the tablet and how you get on with it!
racjen I've talked about dosing on another thread today in response to your comment - can't remember where now!
Hurdity x
Presumably there won't have been any trials looking at how much is needed to protect the endometrium if used as part of HRT but its dose for fertility is a guide - so if it's twice as concentrated (in terms of the formulation and how much is absorbed) compared with utrogestan then 100 mg for cyclical use sounds as though it could be about right.
Progesterone levels are always low or very low during peri-menopause because when you are not ovulating you do not produce any - not in large quantities anyway.
It is unlikely to do you any harm if you continue to use it for 7 days longer than prescribed but with low doses of oestrogen and when you are post-menopausal - sometimes an excess of progesterone can overthin the endometrium. Why not try it for a but longer and see how you get on, and mention to your doc too?!
Hurdity x
-
Loubylou - not sure if you're still out there and come on the forum occasionally, but I'd love to know the outcome of your trial with Lutigest.
I hate hate hate Utro and had all the symptoms you describe plus more. I'm about to run out of fem7 conti patches so need to find an alternative prog. This might be of interest to other Scottish ladies too, as I believe there might be a ? over Utro prescribing here.
If anyone knows Loubylou please let me know.
-
Loubylou - not sure if you're still out there and come on the forum occasionally, but I'd love to know the outcome of your trial with Lutigest.
I hate hate hate Utro and had all the symptoms you describe plus more. I'm about to run out of fem7 conti patches so need to find an alternative prog. This might be of interest to other Scottish ladies too, as I believe there might be a ? over Utro prescribing here.
If anyone knows Loubylou please let me know.
Also in Scotland, also interested :)
-
It's an interesting one. Hopefully the drums will beat and Loubylou will reply.
-
Hi girls,
Here's a recent review of the clinical efficacy of vaginal progesterone for luteal phase support that includes Utrogestan (capsules), Lutigest (vaginal tablets, also marketed as Lutinus and Endometrin), Crinone (vaginal gel) and Cyclogest (pessaries). I know nobody here is interested in luteal phase support for reproduction purposes ::), but the interesting part is about 'comfort and tolerability'.
https://reader.elsevier.com/reader/sd/pii/S1472648318300555'token=50A3283062E23F2E8F4815C44F54BA1F1FF983FE76C21059F0DD65DA7F5FB1DC54F30EC1A81641506F3F9AE8F2ECC6F0
'Where patient-reported outcomes such as comfort and tolerability were measured, some studies did show variability in terms of patient preference between the regimens. Five studies investigated patient preference and convenience (Bergh et al., 2012; Ludwig et al., 2002;Ng et al., 2003, 2007; Simunic et al., 2007). Four of the five studies included Crinone in one of the treatment arms, and all subsequently identified Crinone as the significantly preferred intervention, over Cyclogest (in one study) and Utrogestan Vaginal (in three studies)(allP<0.05) (Bergh et al., 2012; Ludwig et al., 2002; Ng et al., 2003; Simunic et al., 2007). The reasons stated for preference of Crinone included: ease of administration, convenience for daily use, lower incidence of leaking, discharge and interference with coitus. The fifth study presenting patient-reported outcomes compared Cyclogest with Endometrin and found a significantly greater number of patients reported difficulty with administration of Cyclogest over Endometrin(P= 0.002) (Ng et al., 2007).'
I suspect Utrogestan 100mg is not marketed in the UK for vaginal route because Lutigest 100mg vaginal tablets might still have some sort of commercial designation industrial property.
BeaR.
-
The key question re all the progesterones and their use as part of HRT is primarily their efficacy in protecting the endometrium and secondly, of course their tolerability, the chief part of which relates to their systemic absorption (at the doses needed for endometrial protection), as it is this aspect which seems to be most problematic for many women (the local irritability etc being minor).
Maybe as other HRT preparations are gradually phased out (if they are that is) then more research will be carried out into these other preparations at various doses so that we have more choice. Although not licensed for HRT Cyclogest has long been used for this purpose and there have been studies looking at Crinone and Cyclogest and the endometrium.
Hurdity x
-
BeaR - thanks for the info, really interesting. Just to clarify, it's the Crinone which ladies found most comfortable to use and with least side effects? Do you know if it's available, even off licence, for hrt use?
-
Crinone is theoretically available off-licence for HRT - if you do a search you should find members who have used it. I think Night_Owl is one - through NHS - but menopause specialists I think at the C and W. I don't think she got on with it - but I don't want to speak for her. From memory it used to be available at 4 % but now only at 8% which is too strong for many women re side effects. You can find it listed on our database of medicines.
https://www.medicines.org.uk/emc/product/1283/smpc
Iif you look at the studies I posted on the thread about vaginal utrogestan you will see the review of progesterone studies (the last one I posted) which includes reviews about Crinone. Also there was a paper specifically about this one:
"Endometrial Protection: Which Progestogen Is Best? 2015
By Jeffrey T. Jensen, MD, MPH Leon Speroff Professor and Vice Chair for Research, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
March 1, 2015
https://www.ahcmedia.com/articles/134766-endometrial-protection-which-progestogen-is-best
Extract
“The commercially available 4% vaginal progesterone gel (Crinone®) has been evaluated for endometrial protection in combination with transdermal estradiol. This product delivers 45 mg/day, and no cases of endometrial proliferation were observed in a small study involving 35 subjects. However, this is not approved for HRT and is quite expensive.â€
Maybe start another thread specifically about Crinone (or post on an old thread if there is one!) so that interested members can find information easily?
Hurdity x
-
BeaR - thanks for the info, really interesting. Just to clarify, it's the Crinone which ladies found most comfortable to use and with least side effects? Do you know if it's available, even off licence, for hrt use?
Hi KiltedCupid,
CRINONE ® was produced by Juniper Pharma Services, a former UK company which was developing an intravaginal ring with bio-identical progesterone and bio-identical estradiol for HRT.
https://seekingalpha.com/filing/3930569
Page 9 under Hormone Replacement Therapy.
‘Our Solution – JNP-0201
We believe that JNP-0201, our combination estrogen and progesterone IVR product candidate, has the potential to offer patients multiple benefits as compared with currently available therapies, including: integrated administration of natural progesterone and natural estrogen; improved patient compliance; improved side effect profile; and continuous local vaginal delivery of natural hormones, while eliminating the need for daily administration.'
Unfortunately Juniper has been acquired by Catalent in July 2018. 'Catalent will continue to support Juniper's CRINONE® (progesterone gel) franchise marketed by Merck KGaA outside of the U.S. Juniper's Intravaginal Ring development pipeline was previously licensed to Daré Bioscience, and Catalent will not be involved in the further development of this program.'
Fortunately, Daré Bioscience seems to be initiating DARE-HRTI (Intra Vaginal Ring, combination bio-identical estradiol + bio-identical progesterone) phase 1 this year in Australia.
https://darebioscience.com/pipeline/
Let's hope they succeed!
BeaR.
PS. Yes, according to that study, the subjects found Crinone was the most comfortable and yes, I think it's available off licence for HRT, but it's very expensive and the dose (90mg) is not significantly different from Utrogestan (100mg), but it might suit those women who have intolerance to Utrogestan's inactive ingredients (sunflower oil and soya lecithin).
-
Oh BeaR - that ring sounds awesome! Good detective work.
Would you please update the forum if you come across any updates on it, I know I'd be interested.
Yes, I suspected the thorn in the side of Crinone would be £££'s. No harm in asking gp though - shy kids get no sweets, as they say.
-
Of course, KiltedCupid :) and keep us updated on your GP's reaction when you ask for posh Crinone ;)
BeaR.
-
Of course, KiltedCupid :) and keep us updated on your GP's reaction when you ask for posh Crinone ;)
BeaR.
Will do. I'll ask for Crinone or Lutigest and see what happens.
-
BeaR - that's interesting and I wonder if, I light of Clovie's post about utro being stopped in Scotland, they'll consider a generic here as obviously cost will be different?
I'm sure you mentioned something on another post about generics becoming a reality in the UK as they are in US. Although most ladies in US seem to prefer branded products according to their websites.
Does make you wonder also if this hrt shortage is part of something other than Brexit stockpiling. It's really becoming quite harsh and unfair on one particular demographic.
-
Hi KiltedCupid,
Sorry, I had to remove my previous post because the link to the article wasn't working.
Here it is:
Hi girls,
I forgot to say that the article I quoted above https://reader.elsevier.com/reader/sd/pii/S1472648318300555'token=50A3283062E23F2E8F4815C44F54BA1F1FF983FE76C21059F0DD65DA7F5FB1DC54F30EC1A81641506F3F9AE8F2ECC6F0 mentions the generic version of Utrogestan, called Progestan, marketed in France by Laboratoires Besins International.
'The following vaginal progesterone preparations used as monotherapy for LPS in assisted reproductive technology cycles were eligible: Utrogestan Vaginal (including Progestan and publications where the brand of micronized progesterone preparation was not specified but known to be Utrogestan Vaginal; in addition, Prometrium and Progeffik were considered to be equivalent preparations), Cyclogest, Crinone and Lutigest (including Endometrin and Lutinus).'
I didn't know that Besins had a generic progesterone oral/vaginal capsule, not to mention other manufacturers' generics (Mylan, Sandoz, Biogaran). Apparently the other manufacturers had their products withdrawn (Ratiopharm and Teva).
https://www.vidal.fr/actualites/4239/progestan_ge_100_mg_et_200_mg_capsules_molles_orales_ou_vaginales_nouveaux_medicaments_generiques/
BearR.
-
Do you know if it's available, even off licence, for hrt use?
Hi kilted cupid – I think you must have missed my post made soon after yours. If you look after the one of yours I've quoted I responded to your general question (above) about Crinone – and its use as part of HRT including studies into endometrial effects as well as saying it is available . If you are wanting info about it then do have a look at these studies – and the thread on vaginal progesterone (now on the next page) as there are several very relevant references to Crinone as HRT.
... and bear re the dosage – maybe also check out the refs if you are interested? You will see from the studies in my earlier post that they were carried out using 4 % Crinone which is 45 mg (now no longer available) but the trials used 45 mg per day in sequential treatment and 45 mg twice a week in continuous combined therapy – so this is far less than the 100 mg daily Utrogestan - even at double the strength maybe even less could be used than for these trials? It is described as a sustained release gel which is why lower amounts are needed than eg for Utrogestan.
Here is an extract from the particulars I linked to in my post:
“5.2 Pharmacokinetic properties
The progesterone vaginal gel is based on a polycarbophil delivery system which attaches to the vaginal mucosa and provides a prolonged release of progesterone for at least three days.â€
The daily dose of 90 mg is for luteal support during pregnancy – so the amount required for HRT could be as little as one third of that.
Obviously the trials were not using this concentration but since it would be prescribed off-licence anyway I imagine gynaes who do prescribe it have worked out a possible dosage – based on the research trials, and the properties of the gel,. There is a danger of more of a “hit†(ie comparable with Utrogestan 100 mg) with one dose – but if it was not taken every day it may not be such an issue. Information about the systemic absorption would also be necessary to help understand whether side effects might be experienced comparable with the dosage – I also mentioned that in my other earlier post.
I hope this is helpful Kilted cupid and to anyone else considering Crinone – seem to have strayed away for the topic of Lutigest!
Hurdity x
-
Hi KiltedCupid,
Yes, generally speaking generics are always cheaper than the branded version, so it's good news for the NHS and everyone!
Regarding Brexit... I've just come across this webpage on shortages in Belgium, more than 600 meds! That tells us Brexit is just one complicating factor but not the real culprit of shortages. I suspect the UK overreliance on HRT imports from EU members (the technical term is 'arrival', because the EU is considered one country, so whilst the UK is part of the EU, these are not considered imports), and of course, the parallel import, is the main reason why drug shortages had such a profound effect on HRT products in the UK.
Oops, forgot to post the link http://banquededonneesmedicaments.fagg-afmps.be/#/query/supply-problem/human
BeaR.
-
Do you know if it's available, even off licence, for hrt use?
... and bear re the dosage – maybe also check out the refs if you are interested? You will see from the studies in my earlier post that they were carried out using 4 % Crinone which is 45 mg (now no longer available) but the trials used 45 mg per day in sequential treatment and 45 mg twice a week in continuous combined therapy – so this is far less than the 100 mg daily Utrogestan - even at double the strength maybe even less could be used than for these trials? It is described as a sustained release gel which is why lower amounts are needed than eg for Utrogestan.
Here is an extract from the particulars I linked to in my post:
“5.2 Pharmacokinetic properties
The progesterone vaginal gel is based on a polycarbophil delivery system which attaches to the vaginal mucosa and provides a prolonged release of progesterone for at least three days.â€
The daily dose of 90 mg is for luteal support during pregnancy – so the amount required for HRT could be as little as one third of that.
Obviously the trials were not using this concentration but since it would be prescribed off-licence anyway I imagine gynaes who do prescribe it have worked out a possible dosage – based on the research trials, and the properties of the gel,. There is a danger of more of a “hit†(ie comparable with Utrogestan 100 mg) with one dose – but if it was not taken every day it may not be such an issue. Information about the systemic absorption would also be necessary to help understand whether side effects might be experienced comparable with the dosage – I also mentioned that in my other earlier post.
Hurdity x
Hi there,
Since the 4% presentation is no longer available, I don't think this is relevant any more.
BeaR.
-
Of course it's relevant bear! Kilted cupid asked a question specifically about crinone as part of hRt and have posted the information that I have found re the research and its availability. The 4% has not been available since not long after I first came across it on this forum - probably more than 8 years but the study was quoted in the recent review of progestogens and their effect on the endometrium so the menopause academics seem to think it's relevant. Like I said the dose concentration in the research is lower than currently available but this makes it all the more interesting because lower doses appear to be effective in that particular trial so may not be associated with quite the same side effects. Like I said with the 8 % you would get more of a hit but still worth investigating as kilted cupid seems to want to try?
Kilted cupid? is the information I have provided helpful to your quest? re the generics issue - I posted about this recently ref Jeremy Corbyn's proposal at labout Party conference - and posted elsewhere about this the other day - briefly!
Hurdity x
-
Of course it's relevant bear! Kilted cupid asked a question specifically about crinone as part of hRt and have posted the information that I have found re the research and its availability. The 4% has not been available since not long after I first came across it on this forum - probably more than 8 years but the study was quoted in the recent review of progestogens and their effect on the endometrium so the menopause academics seem to think it's relevant. Like I said the dose concentration in the research is lower than currently available but this makes it all the more interesting because lower doses appear to be effective in that particular trial so may not be associated with quite the same side effects. Like I said with the 8 % you would get more of a hit but still worth investigating as kilted cupid seems to want to try?
Kilted cupid? is the information I have provided helpful to your quest? re the generics issue - I posted about this recently ref Jeremy Corbyn's proposal at labout Party conference - and posted elsewhere about this the other day - briefly!
Hurdity x
I'm afraid I don't have time to read your posts, they're a bit lengthy and I have a business to run.
-
I'm afraid I don't have time to read your posts, they're a bit lengthy and I have a business to run.
Wow what a put-down :(
Hurdity x
-
I'm afraid I don't have time to read your posts, they're a bit lengthy and I have a business to run.
Wow what a put-down :(
Hurdity x
Not at all. You asked if I'd read the link and I explained.
-
There are some lengthy posts on here that can be boring but they don't come from Hurdity x
-
Perinowpost - I didn't say anything about boring, please don't put words in my posts that aren't there. I'm sure all the lengthy posts have their own merit, personally I prefer to do my own research when I have the time.
-
Perinowpost - I didn't say anything about boring, please don't put words in my posts that aren't there. I'm sure all the lengthy posts have their own merit, personally I prefer to do my own research when I have the time.
For information kilted Cupid - you say you prefer to do your own research but you asked a question about Crinone and so I answered you personally in an attempt to be helpful. None of the posts I made about this were long (although I do sometimes do long posts!). I did not ask if you had read the links but the posts. I am not normally one for posting links alone as that puts the onus on the reader to have to read, and interpret and work out what the point of them is. I posted extracts from the links relevant to your questions about crinone to actually make it easier for you so you didnt have to do that! We are asked ( in forum rules etc) to post links where we provided infomration - which I try to do if I have them to hand. Of course members can't respond to all posts on threads - there are far too many - but when a question is asked and someone responds to you by name - it is usual on this forum at least to acknowledge even if you have no time to read, otherwise we think you have missed it and also it makes people feel like they have wasted their time. I realise you are a newish member but that is how it works on here (or should do).
Hurdity x
-
Perinowpost - I didn't say anything about boring, please don't put words in my posts that aren't there. I'm sure all the lengthy posts have their own merit, personally I prefer to do my own research when I have the time.
Of course members can't respond to all posts on threads - there are far too many - but when a question is asked and someone responds to you by name - it is usual on this forum at least to acknowledge even if you have no time to read, otherwise we think you have missed it and also it makes people feel like they have wasted their time. I realise you are a newish member but that is how it works on here (or should do).
Hurdity x
The original question was asked directly to BeaR and she replied directly to me. Having checked back, your post, in between ours, wasn't addressed to anyone.
I'm aware of how the forum works, thank you.
-
Of course it's relevant bear! Kilted cupid asked a question specifically about crinone as part of hRt and have posted the information that I have found re the research and its availability. The 4% has not been available since not long after I first came across it on this forum - probably more than 8 years but the study was quoted in the recent review of progestogens and their effect on the endometrium so the menopause academics seem to think it's relevant. Like I said the dose concentration in the research is lower than currently available but this makes it all the more interesting because lower doses appear to be effective in that particular trial so may not be associated with quite the same side effects. Like I said with the 8 % you would get more of a hit but still worth investigating as kilted cupid seems to want to try?
Kilted cupid? is the information I have provided helpful to your quest? re the generics issue - I posted about this recently ref Jeremy Corbyn's proposal at labout Party conference - and posted elsewhere about this the other day - briefly!
Hurdity x
Hi there,
I've read your posts and I'm aware you have found the research, but I don't think it's relevant to discuss a presentation that's no longer manufactured. If KiltedCupid's GP or specialist agrees to prescribe it off-licence (I hope you agree with the term), s/he will prescribe the only available presentation, 8%. Menopause academics might think it's relevant, but I was referring to KiltedCupid's more urgent needs (her FemSeven patches are about to run out).
BeaR.
-
There are some lengthy posts on here that can be boring but they don't come from Hurdity x
Hi Perinowpost,
Are you referring to my posts? I hope not, but if you are, just skip them. :D
BeaR.
-
Of course it's relevant bear! Kilted cupid asked a question specifically about crinone as part of hRt and have posted the information that I have found re the research and its availability. The 4% has not been available since not long after I first came across it on this forum - probably more than 8 years but the study was quoted in the recent review of progestogens and their effect on the endometrium so the menopause academics seem to think it's relevant. Like I said the dose concentration in the research is lower than currently available but this makes it all the more interesting because lower doses appear to be effective in that particular trial so may not be associated with quite the same side effects. Like I said with the 8 % you would get more of a hit but still worth investigating as kilted cupid seems to want to try?
Kilted cupid? is the information I have provided helpful to your quest? re the generics issue - I posted about this recently ref Jeremy Corbyn's proposal at labout Party conference - and posted elsewhere about this the other day - briefly!
Hurdity x
Hi there,
I've read your posts and I'm aware you have found the research, but I don't think it's relevant to discuss a presentation that's no longer manufactured. If KiltedCupid's GP or specialist agrees to prescribe it off-licence (I hope you agree with the term), s/he will prescribe the only available presentation, 8%. Menopause academics might think it's relevant, but I was referring to KiltedCupid's more urgent needs (her FemSeven patches are about to run out).
BeaR.
Only just seen this. Because reference was made on another thread by kilted Cupid about potentially trying Crinone this point is actually important so at the risk of repeating myself ( !) – I disagree that the research is not relevant. Of course it is! See my comment above which well explains why! It is the only research into the use of Crinone as part of HRT and as such has direct relevance.
In terms of alternative progesterone, I'm going to ask my gp for Lutigest or Crinone gel if she can't give me utro and I'll post her reply so other members can be updated. I've only just started a new utro regime as my preferred hrt is no longer available, I'm not happy about that but once again, what can I do? I just have to pick my way through as best I can.
To explain further, the main criteria by which a progestogen is judged suitable for HRT (as opposed to luteal support in pregnancy) is its effect on the endometrium and specifically protecting it from over-stimulation by oestrogen.
In this case yes the dose concentration is different from that currently available but the crucial point here is that the dose tested was HALF THE STRENGTH of the current formulation and therefore if half the strength is effective (at the various dosages of Crinone and oestrogen studied) in these preliminary studies, then double the concentration will be too, although some guess work re dosage is needed – ie slightly less will be needed.
If it were the other way round you might have a point although the degree to which progestogens protect the endometrium is dose and duration dependent (as well as dependent on the dose of oestrogen).
Interestingly while trying to search for studies using Lutigest as part of HRT I came across this from the Chelsea and Westminster clinic – which mentions Lutigest but not Crinone as off-licence (off-label?) alternative progesterone preparations for HRT so for anyone who is interested in trying it - they are already recommending it.
https://www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause-and-pms-clinics/links/copy_of_GPPrescribingAlternativesDISCHARGEPLAN.pdf
I am surprised at the dosage being the same as utrogestan though because in terms of luteal support the amount of utrogestan is double that of Lutigest and by the same token one might decide that half the amount of Lutigest might be needed to protect the endometrium than utrogestan ie 100 mg for 12 days per 28 day cycle and alternate day 100 mg for conti use. Wihtout trials I imagine they are erring on the sdie of caution or using anecdotal observations from having already prescirbed it to women as part of hRT.
Hope this is helpful
Hurdity x