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[Stellajane]

Is anyone using Utrogestan vaginally on a cyclical basis? If so, would be interested to know what dosage you're taking and whether there are any particular side effects.

[Hurdity]

Hi Stellajane

I was sure there would be others out there doing the same thing! Maybe they are not looking in at the moment!

Yes I use Utrogestan vaginally on 2 monthly cycle 200 mg - 12 days per 2 calendar months (just about to start at the weekend...).

Side effects I notice are: initial tiredness especially in the morning, more foggy headed than usual - but not unbearable, intolerance of alcohol while taking it ( ie a small amount of alcohol will set off a migraine) - but that is avoidable! A degree of fluid retention but not uncomfortable, and the need to get up to pee in the night more often (sometimes twice). This is more a pressure on the bladder thing (like when pregnant) rather than actually having a full bladder.

After a few days I generally get used to it but for me the worst but is sometimes having a migraine on withdrawal of the progesterone. This hasn't happened every time so I can't understand why sometimes and not others.

One thing I thought was that I must be absorbing more systemically the times I get a migraine on withdrawal - and the only reason I could think for this was that my vaginal tissues were thinner than usual. This time therefore I am going to use Vagifem every day until Sunday when I take the Utro and see if this makes a difference.

Also because of the difficulty of using vag oestrogen at the same time as vag Utro I may have missed a few over the 12 days, which could have thinned the tissues sufficiently so that more prog was absorbed.

So for me - nothing major - apart from the migraine.

Hope this is helpful and I also would be interested to hear others using the same method...

Hurdity x

[Diana]

Hi,Hurdity & StellaJane.

I am on the Utrogestan 200mg on a 3 monthly cycle.It's great just on the Estraderm patch for 10 weeks!
Didn't have any real problems with the first use(vaginally)of the Utro.
I started on the 2 monthly course.The Doc said it is up to me if
I'd like to take it 3 monthly.So long as there is no breakthrough bleed,it is OK.
I am due to start the 2nd course of it mid April so,fingers crossed I won't get any
nasty side effects.It's so much better than the nasty Norethisterone.
Doc said it should only cause a normal period type bleed but if very heavy drop back
to 2 monthly cycle.
Will let you know how the 2nd course goes .

[Gig]

Please tell me more about why Norethistorone is 'nasty'

I react badly to progestins because I have a bladder condition ( like IBS but bladder is the easiest way to describe).  The 2nd half of my normal cycle pre meno was always the worst for me.  Now when I take Noreth, the side effects of weeing more tend to kick in after about 5 days, so I just grit my teeth to get through to the 9 or 10 I need to take.
It's for this reason that I won't have a Mirena because although I think it's good in theory i am not going to have any progestins drip-  dripping into my  system all the time.

I have never thought about trying Utrogestan and surprisingly my dr never suggested it, even though he is wildly enthusiastic about Oestrogel and bio hormones generally.

[Hurdity]

Hi Diana
Would be interested to hear about what sort of bleed you have with the three month cycle. For me the bleed is just about right with two months. Since I am almost 60 - in a few weeks (eek!) and have been on HRT for 6 years I don't want to have heavy bleeds so I feel that another 4 weeks of unopposed oestrogen before adding the prog would be an inconvenience too much. I don't want to start worrying about flooding and when am I changing tampons all the time and with a two monthly cycle I don't worry. Have probably 1 1/2 heavy days or so. Also - as an aside - when I told my husband this morning that I was bleeding he said he didn't want to know! He used to be really sympathetic and lovely when I had natural periods and was feeling rubbish, but goes deaf when I talk now about all my added hormones!!

Gig I imgine your doc chose norethisterone because he can get away with prescribing it for 7 days if you are prog intolerant and are monitored regularly, but really I would have thought most private docs would choose bio-identical over synthetic. I presume it's a balance between negative symptoms. As I said on the other thread - don't want to repeat the argument - but I would not take synthetic progestogens at all and would recommend anyone planning to stay on HRT for a long while after menopause to do the same if they possibly can (ie use bio-identical - Utrogestan), especially after 60. There really needs to be more research done.....

Hurdity x

[Gig]

Hi be interested to know more about your feelings on Noreths.  Is this due to a possible link with b cancer?
I don't think my dr has given me Noreth due to any intolerance of progesterone because when he first prescribed this wasn't even mentioned by me.  My prescription is for 10 days- but when I told him how I sometimes had side effects with it he said I could take a couple less each time if that helped.  But the actual script says 10 days, and as far as I can I stick to that.  I think I also have mild vulvodynia and when taking progesterones, the burning feeling gradually incrreases over the course.  It stops as soon as I start bleeding.

[Gig]

StellaJane- sorry to hijack but my bleeding on Noreth is pretty much like that. I find tampons uncomfortable some of the time (I had a prolapse repair ) but they also seem to make period pain worse- like a dragging -crampy feeling.
My first day of bleeding is pretty awful- compared to the periods I had before HRT and painful too.  last bleed I felt nauseous, very weak for a few hours, upset bowels, and there is no way I could have worked- I am s/e and manage my bleeds around my working day.

I am now trying a 2 month cycle for the 2nd time, and hope it may not be so bad.

[Gig]

The pain was worse last cycle than before.  I take 5mgs Noreths. for up to 10 days but sometimes only 8-9 if my bladder is irritated by it.  The flow is heavy and free flowing- no clotting. if you took 1mg a day I assume that was every day for 30 days?  ie 30 mgs in total? 

[Gig]

yes but remember that I am only taking it once very 12 weeks- or was- and now every 8.  I may cut it back with his consent to 7 days if that's ok- he said so but need to check.  When I told him the bleeding was pretty heavy he suggested 6 weekly bleeds instead of 12 , but that would mean taking noreth every 4 weeks for 10 days then a bleed 3 days later- and I said no. so we compromised on 8 weeks.

One thing I need to check- maybe you kind people can help- if the bleeds are every 8 weeks that means I bleed on the 8th week- which means taking the progestins after 6 weeks , for 10 days and then the bleed starts 4 days later.

Does that make sense or would you START taking progestins on the 8th week if you are on a 2 month cycle?

[Hurdity]

Gig if you are on a two month cycle you just start the progestins 8 weeks (or two months) after you started taking them the last time.

My cycle is 2 calendar months but I keep the utrogestan to the same number of days - ie 12 per 2 months and take it at approx the same date - but usually forward or back to a Sunday so the withdrawal migraine if it occurs will come mostly at a weekend and not mess up my working week ( although this didn't work this timne as got migraine before!).

Basically if you have an 8 week cycle you take prog for the last 2 of them (or 10 days or whatever you do) and the cycle resets. Doesn't matter what you call the first week etc as long as the interval is the same. It is the total length of time of oestrogen and then oestrogen and prog which is the length of the cycle. I start my timing from when I start the prog which is easier to remember. If your bleed is consistent you could time it from that but I don't just in case it varies if you see what I mean?

In your case then - just go 8 weeks from when you last started the prog and take it again for the 10 days. If you took it only for 7 days then shorten the cycle a bit - after all you are trying to reduce the time of unopposed oestrogen if you want to make your cycle shorter. This is 6 weeks for an 8 weeks cycle and 10 weeks for a 12 weeks cycle (approx).

Is this really garbled? Sorry if so. Think I need to go to bed...

Hurdity x

[Gig]

Thanks I THINK I understand and i was managing fine with the 12 week regime but now this new 8 week regime has thrown me- which is a bit daft!

What your first line here said
 Gig if you are on a two month cycle you just start the progestins 8 weeks (or two months) after you started taking them the last time.

seems different to this:

Basically if you have an 8 week cycle you take prog for the last 2 of them (or 10 days or whatever you do) and the cycle resets

The first part of your post says take them at 8 weeks, the 2nd says take at 6 weeks ( presume that's what you mean?)

When I was having a 3 month cycle ( which i was for years- have just changed to 2-monthly after Xmas)  then i was taking progestins every  10-11th week and would bleed around 14 days later.  I know that now I am moving this forward by 4 weeks. 

I just wanted to check though that a cycle means the actual bleed- not when we start taking the progestin- which will be 10 days plus 4 after stopping before the bleed starts. 

Does this make sense? i can ask my dr but not due to see him for another couple of months for routine check up.

Basically the question is- does an 8 week cycle mean you start the progestin at 8 weeks , or you take it before so you bleed by the 8th week?

[Gig]

StellaJane

My friend who sees the same dr was on oestrogel but as she is younger than me was told to have monthly bleeds and she was taking the same as you were - 1mg Noreth. for 10 days each month.

So that seems to make it clear to me that our dr prescribes different strengths depending on the length of the cycle.

[Gig]

Thanks.

I don't think the bleed has to be spot-on! When i was on my 3-monthly cycle I was quite cavalier and would go from anywhere between 12- 13 weeks for the bleed.

Then I had some incidents of spotting, and ny gynae got all worried.  I think now that this spotting was due to my fiddling with the oestrogel dose- trying to reduce it.  However, I had a biopsy and a year later a hysteroscopy.  This means he now keeps a very close eye on my bleeding.

When I mentioned how heavy the bleeds were he suggested I had a 2 monthly bleed instead just to be sure that I wasn't going to get endometrial hyperplasia/ cancer.

I haven't noticed any difference in quantity of blood loss etc if i take 7 days or 10 days.

I see your logic in suggesting 2.5 mgs might be enough.  My thinking is that if you need 12 mgs for 4 week bleeds, then you need 3 times as much for 3-monthly bleeds ( and therefore 7-10 days of 5mgs was roughly the same: 7 x 5mgs= 35mgs.)  Now that i am going only 2 months, I think 7 days might be worth trying.

I have scan now and then ( once every couple of years now,  but was every few months for 2 years because I had a benign ovarian cyst) and when scanned my lining was always over 6. About 6.4.  They like to to be below 5 post meno but my dr accepts 6.4 on the basis I am on HRT ( even though the scan was just post bleed.)

However, I know he is being careful re. this and we are balancing the risks of breast cancer and progestins, and uterine cancer.
He's trying to keep my intake of progestin to a minimum and so far this has meant taking it less often.  Whether I can also reduce the dose is something I need to ask.

I think I need to ask him at my next appt.

[Cassie]

I used the 200mg for the first time this past month after my gynae upped my dosage from 7 days of 100mg as he said that it was not enough, was told to use it for 10 days but was naughty and stopped after 8, I know I shouldnt!
Had a normal bleed, nothing major, didnt really notice the difference. Would love to use the Utrogestan for 12 days every 2nd month rather but wonder if I would get breakthrough bleeds again, thats what happened when I didnt use it regularly, have another one at the mo but this is my own fault, ran out of Oestrogel and boy, just a slight dose less and wammo! Hate it, but will start a separate thread for that whole saga!
x

[Hurdity]

Hi Gig

Well I did say it might sound garbled!

Those two statements that I made are actually the same!  What I was saying is just time it from whatever you use to time it ie when you start the oeostrogen only or start the prog or finish the prog (this doesn't count for odd days fiddling you said you do sometimes!).

It doesn't matter when you start the 8 weeks from if you see what I mean. It is the cycle length that is important and the bleed has nothing to do with it - sometimes these vary with different women and in the same individual (mine dont vary as they always come 3 days after the last prog).  As stellajane said it doesn't have to be that precise. I make sure I always start my 12 days Utro on a Sunday night approx 2 months since the last time - adjusted forward or backwards to avoid where the migraine might come. Does that sound clear?

I'm the same as you stellajane 12 days per 2 months. I must say I would imagine that if I was on 100 mcg patch then 200 mg utro every 3 months may not be enough prog. It certainly is supposed to be dose dependent ie you need more prog and/or for longer the more oestrogen you have and for longer - but I think some of the doses are given to cover a wide range of usual oestrogen doses. Remember we are messing with what is licensed.

Also Gig as you are with private doc who is also probably erring on side of caution re a high dose of norethisterone for the 3 month cycle.

By the way also if you have a 3 monthly cycle it is not 3 x as much prog as needed - but more!

I said this before when previously on the forum:

For the sake of argument - say you take prog for 2 weeks:

4 week cycle = 2 weeks oestro only + 2 weeks Oestro + prog
8 week cycle = 2 wks O + 6 weeks O+P (ie 3 x as much unopposed oestrogen)
12 week cycle = 2 wks O + 10 weeks O+P ie 5 x as much unopposed oestrogen).

That's why you need to make sure you have enough P when you lengthen the cycle to shed the (even more) lining that has built up.

However as stellajane says - you should be able to reduce the dose to around half - although you are having just over half the length of time of unopposed O ( ie 6 weeks instead of 10).

Hurdity x