Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Hurdity on November 02, 2019, 12:38:42 PM
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As this comes up frequently I thought I would do an information post on this topic. I thought I had done a separate thread about it but can't find it so maybe not - here it is now:
Utrogestan (micronised progesterone) is manufactured by Besins, Belgium to be taken orally or vaginally (see below) - it is only in the UK that it is licensed just for oral use as part of HRT.
Previously both 100 mg and 200 mg capsules were available and packaged for HRT in UK. Some while ago the packaging of the 200 mg HRT capsules ceased (no idea why!) so only the 100 mg capsules are now available for HRT (but without applicators as they are not officially used vaginally in UK).
However the identical 200 mg capsules have always been available in UK for fertility purposes which in the UK are indicated for vaginal use. These are provided with an applicator. https://www.medicines.org.uk/emc/product/3244/smpc
Anyone who would prefer to have the 200 mg capsules - even if you want to take them orally - should ask for these. If the doc says Utrogestan 200 mg is not licensed for vaginal use for HRT – they are the same capsule. You can mention that they were just withdrawn - not for any medical reason since the cyclical dose of utrogestan as part of HRT remains at 200 mg.
In the French database of medicines (the "base de donnees publique des medicaments") this product is listed as: "UTROGESTAN 100 mg, capsule molle orale ou vaginale " (soft oral or vaginal capsule) - similarly for 200 mg. In the info it gives the indication for vaginal route, amongst other uses, if side effects are experienced with oral use:
"Dans toutes les autres indications de la progestérone, la voie vaginale représente une alternative à la voie orale en cas:
• d'effets secondaires dus à la progestérone (somnolence après absorption par voie orale)."
Translation: In all other indications of progesterone, the vaginal route respresents an alternative to the oral route in the case:
.. of side effects due to the progesterone (sleepiness after absorption by the oral route).
A post giving summaries of the studies looking at the use of vaginal progesterone in protecting the endometrium (womb lining) as part of HRT is here:
https://www.menopausematters.co.uk/forum/index.php/topic,43633.15.html
Hope this information is helpful :). I'll bump it from time to time when there are Qs about it.
Hurdity x
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Hurdity :thankyou:
Not sure if I imagined this but, I think I remember reading in another of your post saying that a paper outlined/recommended halving the dose from 200mg to l00mg if you are taking it vaginally and not orally as your doc prescribe the 200mg for? Is that a thing or am I making it up lol!
Just so I'm being clear(bcz I don't think I am :-\)Is 100mg vaginally equivalent to 200mg orally? Please confirm or correct.
TD
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Hi TD- it's not a different dose. You take 200mcg for 12-14 days if you're on a cyclical basis regardless of method of dosage. 100mcg regardless of method if you take it daily ( no bleed )
Anything less should be done under medical supervision x
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Hi TD- it's not a different dose. You take 200mcg for 12-14 days if you're on a cyclical basis regardless of method of dosage. 100mcg regardless of method if you take it daily ( no bleed )
Anything less should be done under medical supervision x
That was always my understanding MicheleMaBelle, I've posted prescribing spec from C&W as, for new members this could become really confusing. Old hands at hrt know there's room for manoeuvre with doc approval but newbies shouldn't be confused.
https://www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause-and-pms-clinics/links/ProgestogenandProgesteroneRegimensinHRT130518AGREED.pdf
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Wow thanks girls for clearing that up.
Since I've upped to 2 pumps I haven't had a bleed on 100mg x12.
I saw the specialist only once and was cut loose to find my own way. My GP is good but admits when he is clueless.
Now I'm on 2 pumps I should up my utro to 200mg, to fall in line with the guide. Could have sworn I read that 200mg orally is 100mg vaginally.
Thanks again, my brain fog is hindering all my thinking faculties atm.
TD
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Hurdity :thankyou:
Not sure if I imagined this but, I think I remember reading in another of your post saying that a paper outlined/recommended halving the dose from 200mg to l00mg if you are taking it vaginally and not orally as your doc prescribe the 200mg for? Is that a thing or am I making it up lol!
Just so I'm being clear(bcz I don't think I am :-\)Is 100mg vaginally equivalent to 200mg orally? Please confirm or correct.
TD
Apologies if I confused you Turkish Delight. The licensed dose is as Michelemabelle said. However some gynaes and menopause specialists (and some GPs) do prescribe lower doses for vaginal rather than oral use (notably Louise Newson). This is why I posted the studies on the other thread - firstly to show that it can be used vaginally, and secondly the preliminary studies which show that half the vaginal dose is sometimes effective (in protecting the endometrium) compared to when used orally. I think someone once linked to something that Louise Newson wrote about this - but she prescribes privately and therefore supervised.
Interestingly the French instructions still give the same dose for vaginal as for oral use in their prescribing instructions.
No brain fog at all! Unless under medical supervision then go by the licensed dose....
Hurdity x
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PS in fact there is information in the main thread where I have quoted all the studies - about variation from the licensed regime. The last study in the list was published in Climacteric - the Journal of the International Menopause Society:
"P. Stute, L. Wildt & J. Neulen (2018)
Climacteric, 21:2, 111-122,
https://www.tandfonline.com/doi/full/10.1080/13697137.2017.1421925
Abstract
Postmenopausal women with an intact uterus using estrogen therapy should receive a progestogen for endometrial protection. International guidelines on menopausal hormone therapy (MHT) do not specify on progestogen type, dosage, route of application and duration of safe use. At the same time, the debate on bioidentical hormones including micronized progesterone increases. Based on a systematic literature review on micronized progesterone for endometrial protection, an international expert panel's recommendations on MHT containing micronized progesterone are as follows: (1) oral micronized progesterone provides endometrial protection if applied sequentially for 12-14 days/month at 200 mg/day for up to 5 years; (2) vaginal micronized progesterone may provide endometrial protection if applied sequentially for at least 10 days/month at 4% (45 mg/day) or every other day at 100 mg/day for up to 3-5 years (off-label use); (3) transdermal micronized progesterone does not provide endometrial protection"
One of the other studies compares 100 mg with 200 mg used vaginally - so this is what gynaes and menopause specialists are basing their recommendations on.
Hurdity x
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That's brill thanks Hurdity for replying :)
I'm confused a lot in mono, sometimes it feels like my brain is just toying with me like a cat with a ball of string.
I feel so much better for knowing the extra info, and have peace of mind knowing that I haven't been doing it all wrong by taking 100mg for the 2 months I've been on 2 pumps, and that nothing bads gonna happen to me bcz of it. I'm not under any supervision whatsoever, not even an initial first 6-month check, so I will go with the standard 200mg from now on instead. Phew, one less thing to worry about is a good start to my Sunday lemme tell you.
I'll probably start another thread on what tests I am supposed to be having to avoid any of the hrt pitfalls, like scans I've read about others having etc.
I'll have to go and petition for them as I mentioned I'm in this alone, no one is looking out for me except you girls of course.
:foryou:
TD
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Bumpity bump... for Macca65
This one do you mean Macca?
Hurdity x
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Bump for Kittykats and others new to utrogestan and vaginal use especially if their GP or specialist has not heard of it being used like this.
Hurdity x
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Bump for friend of lhasa ipso and Emm225. :)
Hurdity x
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Bump (again!) for Emm225 - I see I've already bumped it for you a couple of weeks ago!
The posts fall off the page so quickly though so easily lost! :)
Hurdity x
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This is great info thank you :)
I started Utro on 1st of May and have been using it vaginally (2x100mg) despite the pharmacist at my surgery telling me it wasn't licensed for use that way.
It's very odd ???
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Thank you for this. I spoke to a doctor on the phone...one from the practice I haven't seen before but she was the only one available... the other day as had a few side effects taking orally...just v tired etc. She categorically told me they shouldn't be taken orally and weren't licensed for it. She suggested I had either a Mirena fitted (I had one taken out before xmas because of bleeding...had Mirena for a good 15 years, no problems and no periods until recently...I would have thought the reason I didn't have another in was because of bleeding?!) Womb lining is thin as had every scan and test under the sun when had bleeding as they were worried was cancer or something. Thankfully once the Mirena was removed bleeding stopped...but has started again this week after 3 or 4 weeks of HRT patch and pill.
I just don't seem to get answers from my doctors...husband said they seem to be treating it as art rather than science. When it's my body and it involves medication I would rather it was science!
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Bumpity bump for IZA
Hurdity x
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I would be grateful for clarity about the dose. I always tell new members to use 12 x 200mg if peri or 100mg daily if meno unless they have the agreement of their doc and/or regular scans. Often someone will say 12 days or less x 100mg. I feel very uncomfortable with this given the health risk of a thickened lining. My reasoning is that the manufacturer should have done more extensive testing than anyone else so they should be right. Maybe there are only a few people who need this much but you don't know if that's you.
Thoughts anyone?
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I mentioned taking it vaginally to my doctor and she wouldn't hear of it. So I am stuck with bloating , thinning hair and bad skin.... >:(
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I think the one thing I’ve learnt on here is how individual HRT is for each of us although there are guidelines, it takes tweaking to get it to suit, which I’m still doing 18 months later.
I struggle with patches, doses and taking utrogestan as I am histamine intolerant and it all causes many side effects but the horrendous hot sweats I used to get before, are mostly under control, so I persevere.
Next thing to try is taking the Utrogestan vaginally, as advised by Louise Newson, an expert. If it works for so many taking it this way on here and experts advise to take it this way..... it has to be safe to use this way.
What I’m trying to say is, sometimes you just have to do what’s best for you x
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I agree Traceyjd....I just am a worry wart about it re going against what my doctor says. I may ..reluctantly...go privately to be sure. What better use for the money I've saved in lockdown.......
Can anyone recommend where to go...is there a "guild" or something....I live in the Midlands
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Emm225, if you want to see a private meno specialist & you're in the Midlands, Newson Health are in Stratford-on-Avon. I believe they are back to seeing patients face to face in clinic but were doing virtual clinics/teleconsults earlier in lockdown & may be willing to see you that way if your part of the Midlands is too far from them to be convenient. Their costs are published on their web site.
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I’d recommend the Newson clinic. Just good to speak to specialists in this, reassuring and they advise ways to use HRT to suit you, whereas often GP’s follow the standard. For me it gave me confidence re using and adjusting HRT because I can be a “worry wart” too 😁
I was one of those that used to say “I’ll never go on HRT....... But when your life is changed drastically in various ways due to the menopause, just at the time when you want to have your best life, you’ll try almost anything to get back on track.
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Hi I would like to start taking utrogeston vaginally as I feel I’m getting side effects from taking it orally. I take 2x100mg at the moment does anyone know if I can take these vaginally or do I need to get the capsules that are 200mg?
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Bump for grumpymum
Hurdity x
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Thank you Hurdity. I’ve been taking it vaginally (as advised by this group). When I take it orally I have no bleed whatsoever. Doctor didn’t see why I was taking it cyclically when I could be on continuous now but I tried to explain that it felt like permanent PMT, and I was just emotionally waiting for a period.
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Bump for sfifties
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Bump for joziel
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Bump for sherbet
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Hello Everybody !
I live in Germany and while my doctor is sympathetic to HRT and has prescribed it for me, I feel she is not as knowledgeable as you all are on this forum.
I am 62 and on a 100 estradiol patch (Estramon) that I change twice a week and 100 Utrogestan that I take morning AND evening. Brain fog is severe and am very fatigued.
I'd like to try the Utrogestan vaginally to see if the brain fog improves- am I correct in thinking that I can use 2 100 tablets vaginally ?
My other worry is that I had a vaginal ultrasound this week to check the endometrial thickness. It was 5.8 mm which I understand is quite thick, although the gyno was completely unconcerned and said that this was fine for someone on HRT.
I used to see a brilliant reproductive endocrinologist who has sadly died - his opinion was that the endometrial thickness should ideally be around 2 cms.
Is my German gyno right?
Many thanks in advance, this forum is a life-saver
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Yes, you can use the same capsules vaginally. I get fatigue on utro and it makes no difference which way I take it but it would be worth trying (I use long cycle sequi).
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Hello ladies.
Kkay - Like many ladies here I have used Utrogestan vaginally without problems although I have only used one capsule I don't see why you can't use two at the same time.
I did wonder if vaginal use was less effective at controlling any breakthrough bleeding but I was also using the equivalent of six pumps of gel at the time so that may explain it.
About a year ago I had a scan and my womb lining was 2mm which the consultant said was just right.
I hope this helps you and take care.
K.
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I use two capsules vaginally st the same time, and haven't had any issues. White gunk in the morning but that's it.
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Hello Everybody !
I live in Germany and while my doctor is sympathetic to HRT and has prescribed it for me, I feel she is not as knowledgeable as you all are on this forum.
I am 62 and on a 100 estradiol patch (Estramon) that I change twice a week and 100 Utrogestan that I take morning AND evening. Brain fog is severe and am very fatigued.
I'd like to try the Utrogestan vaginally to see if the brain fog improves- am I correct in thinking that I can use 2 100 tablets vaginally ?
My other worry is that I had a vaginal ultrasound this week to check the endometrial thickness. It was 5.8 mm which I understand is quite thick, although the gyno was completely unconcerned and said that this was fine for someone on HRT.
I used to see a brilliant reproductive endocrinologist who has sadly died - his opinion was that the endometrial thickness should ideally be around 2 cms.
Is my German gyno right?
Many thanks in advance, this forum is a life-saver
Hi Kkay, I don't know what measurement of the lining is safe, but I know the only time I had mine measured I was about 36 and it was "about 6mm" which I was told was quite thick for only a week after my period, but nothing to worry about because when I get my period I bleed heavily, so that is why. They gave me a mirena coil and I've not seen them again in the 18 years since, it didn't need to be followed up and I've had no ill effects from it, I was checked for fibroids about five years ago and my lining is perfect I was told, no lumps, bumps or lesions.
A thickened lining is associated with problems but it's also a normal variation between women.
Edit, sorry, 6cm was a typo, I've changed it to 6mm now.
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I don't think I have ever had an endometrial thickness of 2 mm!!! The lowest I think mine has been on scans has been just under 5 mm but last measurement was about 9 mm (immediately after withdrawal bleed) . Specialist gynaes are not unduly concerned with those on cyclical HRT because thickness varies throughout the cycle and of greater important is the health of the lining determined by hysteroscopy and biopsy ( carried out following abnormal bleeding).
I have only ever used utrogestan vaginally - the 200 mg used to be licensed for HRT in UK but then the license removed so that this product was only licensed for fertility. Thereafter women were required to use 2 x 100 mg Utrogestan. Recently I have managed to get the 200 g vaginal utrogestan prescribed - as these are easier to insert (and come with applicators though I don't use them), and I wonder whether there is any difference in efficacy between 1 x 200 or 2 x 100.....? The only reason I ask is that my lining has thickened since changing to 2 x 100 mg ( were talking about over several years though), but since I've also changed HRT patch it could be due to increased oestrogen from the latter.
Anyway, whatever - unless anything has changed, yes the capsules are exactly the same for oral and vaginal use which was ascertained from the French product info (quoted at the beginning of this thread).
Hurdity x
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Thank you everybody (so much!) for taking the time to answer and share your experiences. I really appreciate it.
I wanted to thank each of you individually but brain fog came between me and figuring out which button to press.
I will go the vaginal route, fingers crossed...
Best wishes from Germany
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Hurdity - is the 200mg capsule much bigger than the 100mg one? I use 2 x 100mg vaginally and wondering if I'd get less gunk with one larger capsule.
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When I previously took Utrogestan, I mainly took it vaginally every other day because I couldn’t tolerate every day orally or vaginally. I’ve played around a lot with oestrogen dose in that time, going from low to moderate, and a recent scan showed endometrium thickness of 3.3cm. So I could assume that this regime has worked so far for me. That’s not to say it won’t change, but for those ladies wanting to try taking it this way, it’s worth consideration if you really struggle with every day high dosing, provided you do it under supervision and are prepared (if required) to attend regular scans. I would not have tried every other day dosing if I wasn’t prepared to have it checked.
I’ve just this week gone back to combining a lower dose oestrogen patch with compounded Biest cream, which means I can risk taking Utrogestan every other day again (was on Cyclogest past few months, which was good, but GP refuses to prescribe and I need to save cash where I can!)
Keep sharing your experiences ladies, I found reading this thread really helpful x