Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: AndieKC on February 19, 2025, 09:09:04 PM
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Hello ladies
Anyone has had a similar experience? Keen to hear your thoughts on Utrogestan/low estrogen problem
Have been established on HRT for a few years - 3 pumps of oestrogel + Mirena coil + Androfeme testosterone (slightly more than half dose). My estrogen levels have always been low - around 130 (should be 250 or more) and testosterone about 0.6 (within NHS normal range)but I felt my symptoms were controlled well. I never worried about absorption too much. Then I decided to not replace my Mirena coil, just remove it after 5 years. Private menopause GP recommended to trial oral 100mg utrogestan whilst the coil was still in. I liked the sedative effect but hot flashes, night sweats, palpitations, sleeplessness etc started returning. My estrogen went down to 64!
Increasing oestrogel to 3 and 1/2 pumps helped a bit. The private GP recommended to go even higher and prescribed Sandrena 2 sachets daily, which is equivalent to possibly 4 pumps oestrogel. Also advised to increase Androfeme to full dose 0.5ml. But I’m still getting mild hot flashes, palpitations, sleeplessness, itchy skin etc. To improve absorption i am having warm showers before applying HRT, I’m waiting 10 minutes before putting clothes on. I’m avoiding workouts for a good few hours after applying HRT so as not to sweat off the HRT. So I wonder whether trying Utrogestan vaginally would be better than orally?
I know the advice generally is that oral goes through liver, vaginal acts locally on the womb. But none of my symptoms were a problem on the Mirena coil, so it seems it is the utrogestan that is affecting the availability of whatever estrogen I have. I don’t think my skin suddenly stopped absorbing.
In the past I tried 4 pumps oestrogel (whilst on the Mirena coil, no utrogestan) and the blood test showed a very respectable estrogen level of 390. I wish now I had stayed on that. I could always go back on the coil for progesterone but I thought utrogestan is safer for breast health and other reasons. So does anyone know whether 2 sachets of Sandrena with 100mg utrogestan vaginally OR orally is enough for control of vasomotor symptoms if i just wait longer? Which way Utrogestan is better, oral or vaginal?
If anyone can make sense of the attached article - see link - it seems to suggest that vaginal U absorbs faster and causes higher levels of it in plasma - I presume in bloodstream. Therefore causing estrogen to go down systemically, not just in the uterus?
I will ask all these questions when I have my review with the private meno doctor but it’s a while away. The doctor had advised that if, after 4-6 weeks of 2 sachets of Sandrena + 100mg Utrogestan orally + 0.5ml Androfeme, I still get symptoms, then increase to 3 sachets Sandrena. But that would then need double Utrogestan, I think, according to NHS guidelines. And I think the Utrogestan is the problem, not my skin’s low absorption. So I can’t see how more Utrogestan would be an answer.
Utrogestan vaginally is definitely waking me up more, 3-4 times every night. I was almost down to waking up only 1-2 x a night before. Any advice welcome
I’m 53, otherwise healthy, exercising, eating very healthily, completely teetotal.
Thank you
Link here - it’s paragraph 5.2 that’s relevant
Utrogestan Vaginal 200mg Capsules - Summary of Product Characteristics (SmPC) - (emc)
https://www.medicines.org.uk/emc/product/3244/smpc (http://)