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[Gig]

I am still confused- sorry

From what you say I've been doing it wrongly for 4 years and hae in fact beenhaving 10 week not 12 week cycles.

If you take your progestins every 8 weeks then you are not having a bleed at 8 weeks- you are having a bleed at 10 weeks- allowing for  the 12 days taking your progestin plus the downtime waiting for the bleed to start.

I thought my dr had told me to have a bleed every 12 weeks- which is why I took progestins 14 days before that.


I thought the bleed was the whole point- to shed the lining.  And i thought I was supposed to be shedding mine every 8th week. Just like on a 12 week cycle I was shedding it at end of week 12. NOT opposing the oestrogen at 8 or 12 weeks- but ensuring I had a bleed then.

Sorry if this makes me sound dim- but I was as far as I know following my dr's instructions. I am pretty sure he's said "Now you are having a bleed every 12 weeks?"


Put it another way- if I was taking progestins on 1 Jan, then the next lot would be 1 march, ( or 1 April if it was 3 monthly.)
I have been told by dr that it doesn't have to be precise but I am SURE he said have a bleed every 12 weeks which you can't do unless you start the progstins before the 12th week.

Aaaaaargh! have I really been having 10 week cycles for 4 years- not 12 week ones?

This cycle then is too early- it's only 7 weeks since the last time I took Noreths. 

Are you saying Hurdity that I could take 30mgs Noreths. say compared to someone taking 10 days@ 1 mg for one month, 20mgs for a 2 monthly cycle and 30mgs for 3 monthly cycle?  That would be 6 days x 5 mgs or more days @ 2.5 mgs.

What I don't know- and please say if you can!- is whether there is a direct correlation between days on unopposed oestrogen and amount of progestins needed.  we are assuming that's the case but it may be more complicated. 

[Cassie]

Well over thanks SJ, went over prematurely

[Hurdity]

Oh dear..... seem to have got in a muddle here - sorry if I am not explaining very well.

In a natural cycle the cycle length is the length between day 1 of the bleeds - but in an artificial cycle created by HRT the cycle length is counted as the total length of O and O+P irrespective of when the bleeding starts, so you are giving your body the same dose of each hormone each cycle. This is because some women start to bleed before they withdraw from the prog but you don't start counting any differently ie with HRT you don't change Day 1 of the cycle depending on when you bleed. Day one of a peri or cyclical HRT is the first day of the oestro only tabs or patch. That's all there is to it. If you start you prog on the 1st of the month then your two monthly cycle (ie just over 8 weeks) starts the 1st of the following two months. eg 1st Jan, 1st March, 1st May etc. In a 3 month cycle it would be 1st Jan, 1st April. It's very straighforward. You have made it a little more complicated by varying the number of days you take the prog for - as I said before 7 days in 3 months is not very long at all.

When I said forget about the bleed - I meant don't count from the bleed because it could vary in start time and length - although I think probably less so for vag prog as it doesn't go through the system. You will still be having a bleed every 12 weeks or 8 weeks. We are arguing about nothing - just a different way of looking at it or counting. The only reason I need to count is to remember when to start the prog (for me approx 9th of every alt month) - I don't worry about anything else. If you are going from a 3 month to a 2 month cycle, then count 2 months (or 8 weeks from the first day you started the prog last time) and start the next course.

I don't have time at the mo' to look into prog doses but all I will say is it is approx dose dependent but as always HRT is not precise. The amount prescribed for 1 month will be probably to cover a range of individual scenarios, and will have a big margin of error to ensure most women shed all lining for a range of oestrogen doses. If you look at the HRT preparations though often the prog dose is doubled for double the oestrogen - but for utro the oestro dose is not given - but again I imagine it must err on the side of caution which is why many women ( under the care of a specialist) are able to get away with lower utro doses than given.

I do hope that's clearer but do pm me if not cos I don't know what else I can say! I really think we are just counting differently!

Hurdity x

[Gig]

Yep- I do get it!

The reason i was confused is because I was counting cycles as if they were normal pre-meno cycles ( ie 14 days oestrogen then 14 days progest and a bleed on day 28)- so i was juggling the progestins to give a bleed at the end of every 12 weeks ( or 8 now.)

I have maybe over-egged the idea that I was only taking 7 days of progestins every 12 weeks.  Most of the time I was managing 9 or 10- some occasions I stopped at 7-8 if my bladder was really irritated.

And now from our chat I can see that i was in fact having 10 week cycles- by your calculations- not 12 week ones. so I was having at least 35mgs Noreths. every 10 weeks.

I know my dr did tell me that some women started the progestin on the 1st day of each month but he then went on to say it wasn't critical- which is why I;ve ended up confused!

Once I have had this bleed I will go back to taking every 8 weeks. I will also ask my dr if i can reduce the amount- such as 2mgs over 10 days not 5mgs over 10 days.

Does this sound about right?

[Clovie]

This has been very intersting reading for me, ladies,

and Stellajane I do hope you get a dosage that suits you!

I asked my GP last week for Utrogestan after having the most AWFUL PMS-type reaction on the synthetic progesterone I was taking - and she had never heard of it!!!! 

I too, would like to try Utrogestan vaginally (to hopefully avoid systemic absorption of progesterone as it would appear i am clearly prog intolerant) so am having to wait for a referral to see a gynae.
If the appt is not forthcoming quite soon I will ask to see someone privately.

Very interesting reading, as I said above, so thank you. 

[Hurdity]

No it doesn't seem to be heard of so much by GPs but it is a licensed product so it is up to us to educate them! Ditto my GP Stellajane!

Just remember anyone who wants to ask for it and the doc hasn't heard of it - to ask for "Micronised progesterone" because that is how it is listed in the magic book. That will appear on your prescription but you will get Utrogestan.

No not licensed for vag use in UK but is in rest (or some part) or Europe. I have the translation from the French SPC (product info) which I sent for from the manufactuers about 18 months ago. If anyone wants them I can pm it (if you can add attachments).

Hurdity x

[Cassie]

When I originally asked my GP for it, his response was oh ok will give you two months trial, but I hope that I dont get into trouble with your Gynae, had never heard of it! My very clued up lovely pharmacist lady told me about it when I was looking for a more natural approach to  progesterone as the cream was not strong enough to oppose the oestrogel. And I have always used it vaginally, I know that orally, it would make me feel grotty, I get nauseous very easily. This method so much easier, just pop it in at night and sweet dreams

[Gig]

I just wanted to update this after having read what my dr has said in his book on this.

He calls  bioidentical progesterone 'micronised'.  It can be given orally, vaginally, rectally ( ouch) or with a gel. He states that orally, 300mgs is needed to overcome the 'bypass' issue- meaning a lot of the product is lost via the liver, and this dose of 300mg may give unacceptable side effects for some women ( digestive.)  I don't know if this info. has been updated since the book was published because you all take 200mgs.

Vaginal pessaries he says are not licensed in the UK for use with HRT but can be used for PMS and infertility. I think they are licensed in France but they are a gel in a pessary and not a hard oral tablet.  Obviously this is not the same as using the tablet vaginally.  Tablets are not licensed for vaginal use in the UK - but again, if your GPs have said okay then they must be. 

[Hurdity]

Hi Gig

Thanks - yes this is out of date - we have posted several times about these preparations. Those of us who use bio-identical prog have researched it quite a lot over the last couple of years or more - here it is again:

There are 3 main brands of bio-identical progesterone - you will see from my post below that somepreparations are referred to as micronised

Cyclogest - these are waxy pessaries/suppositories used for infertilty but prescribed by some GPs for HRT as endometrial protection - the dose usually given is 400 mg - but I feel this is too high for endo but because not licensed there is no other yardstick. My GP started me off with this after I couldn't tolerate Evorel sequi

Utrogestan - these are the micronised progesterone capsules (small oval shape containing the micronised prog suspended in arachis oil) which are licensed for oral use in UK. Usual dose 200 mg for oral use for sequi. 100 mg for conti ( 26 out of 28 days). As I have posted before on this thread and elsewhere it is licensed in France for V use but not in UK for HRT and there is quite a lot of research giving dosage for endometrial protection by V use (lower than oral because of uterine first pass effect ie goes straight to womb and not through liver)  although admittedly small trials.

I have also posted that I do have the French SPC if anyone wants them (translated) which I obtained from manufacturer.

Finally Crinone gel - not many women seem to use this and I don't know much about it but theroetically it is available but again not licensed for HRT in UK. It is now only available at a higher concentration - the lower concentration - probs more acceptable for meno women - was withdrawn a while back

We have discussed all of this before.

They are not tablets (Utrogestan) - because progesterone does not come in tablet form. Presumably something in the manufacturing process means it cant be done, which is why Femoston is dydrogesterone - not progesterone.

Some docs do prescribe it vaginally but probably only a very few - and the notable ones like Nick Panay and some of the private ones. I expect Dr Currie would too.

I told my doc I was using it V and she was OK with that although it does not say that on my prescription.

Not trying to be difficult Gig but we have covered a lot of this ground and are well up on it!! Also had some good Friday vino so a bit hurried!

Hurdity x

[Gig]

  Not everyone has been on the forum for ages and read everything. Apologies if you find it irritating that I've posted things you and the others know already or , that I am showing my ignorance.

Will go away now.

[Hurdity]

Gig - I didn't mean it to come out like that. Of course I realise not everyone has read it all which is why I re-posted about the 3 diff types of prog in more detail as this hasn't been posted in this way for quite a while, but it's just that I have posted several times recently in the last couple of days pretty much exactly the same things as you said re vag use, micronised progesterone and the french thingy - in fact in my reply just before yours in answer to stellajane! I would not ever think anyone is showing ignorance and you have just changed your post! It just made me feel as if I might as well not have said what I said earlier or that my posts aren't read which is why I did feel a bit irritated I suppose.... sometimes I take ages writing a long post which I have thought about carefully and the member doesn't even respond, so probs overeacted because this has happened. I'm not looking for big thanks but sometimes I have spent 20 mins or so writing it specifically for someone and the post is ignored.   Perhaps my posts are too long and people just switch off. Anyway going away for 3 weeks soon so I won't be posting at all.
Soz folks - I'm just trying to help. Sometimes it comes out wrong 
I don't normally edit my posts after I have posted - I do so beforehand -otherwise threads don't read right afterwards. So I will leave it as it is and you have my apology and explanation.

Hurdity x

[Gig]

That's okay- no offence taken. 

[Meeka]

Ive read the whole thread and am i understanding correctly that Utrogestan is absorted more effectively if used Vaginally?   I only take 100mg for seven days so i would like to get the full absorbtion and would be happy to try this method.  Thanks.

[Cassie]

Hi Meeka, interested to hear that you are one of the ladies taking 100mg for 7 days only. What oestrogen dose are you on with this and do you have to for regular scans? Any breakthrough bleeding on this dosage? I was also on it but it didnt seem to work for me

[Cassie]

Sorry Meeka, have replied on your other thread which I just saw where you stated your dosage. Hoping that the 100mg works well for you, I def prefer the V route.

And just a question for the ladies using Utro cyclically but not monthly (perhaps every 2 or 3 months) is this a dosage discussed with  and prescribed by your Drs or do some of you do what I do and tweak my dosage a bit by myself, which I know is naughty,  and how often do you go for scans of the uterus.
x