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Author Topic: Is this dosage correct?  (Read 927 times)

Sherbet4

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Is this dosage correct?
« on: July 30, 2022, 02:27:17 PM »

Hello again,

I don’t know if anyone remembers my  last post where I explained I was having anxiety around taking tablets and issues with patches falling off… my dr said I couldn’t have vaginal.. since then I had a referral call from a specialist at the hospital who seemed more confused than the drs. She told me that Femseven conti that I’d ended up on didn’t contain eostrogen anyway and then looked it up and and corrected herself. I asked if I could try vaginally as others have tried on here and she said yes and issued a prescription. I have just picked it up however and she has given me 21 days of 200mg per night utrogestan and no estrogen gel.

That’s too high a dose isn’t it? I also don’t know why I’ve got 21 days when I should be on continuous. I have no gel and no way of contacting her as she referred me back to the drs for follow up and don’t know what to do.

Seriously considering shelling out to go to the Newson clinic as I am now at the top if the waiting list.

What should I do? Any advice gratefully received.
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sheila99

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Re: Is this dosage correct?
« Reply #1 on: July 30, 2022, 04:18:41 PM »

If you're meno you take 100mg every day, if peri 12 days x 200mg then you have a bleed a couple of days after you finish. No point in it if you have no oestrogen though. The capsules are the same so you can ask for oral utrogeston and just use it vaginally. It isn't licensed for vaginal use for hrt in the UK though it is in the rest of Europe, and the 200mg are licenced for vaginal use for ivf. There is no vaginal oestrogen for hrt so you need a patch, gel or spray. Perhaps ask for oestrogel if you don't get on with patches. It's the ostrogen that controls your symptoms, the progesterone is just to protect your womb. Your gp should be perfectly capable of prescribing something suitable. I'd suggest you do your own research so can tell her what you want if she doesn't know.
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joziel

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Re: Is this dosage correct?
« Reply #2 on: July 30, 2022, 04:33:28 PM »

This is just absolutely awful treatment Sherbet...

Has she given you the 200mg a night pessaries or is she giving you the oral utrogestan 100mg to be given two of, each night? If the latter, you can take them however you want. (Ie just use 100mg if you want to use vaginally continuously.)

I think you need to get really angry with someone. Probably your doctor, who can in turn either prescribe something right or get angry at the specialist - - hopefully they have a way of contacting them??

But I'm sorry to say, I think in many instances you do need to go private and get the private GP to write to your regular doctor to continue what you have settled on. The luxury of a 45min appointment is worth every penny of £250 IMO  ;D ;D

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Sherbet4

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Re: Is this dosage correct?
« Reply #3 on: July 30, 2022, 04:41:35 PM »

I haven’t had a period since November so was put on continuous.

I was on the oral utrogestan tablets and gel until I had issues with swallowing tablets due to anxiety. I asked my gp if I could use it vaginally and she said no and put me on patches but all my symptoms came back and the patches kept falling off anyway. The gp then referred me to this specialist. I asked her if I could have vaginal and she issued this  prescription.

The current prescription from this specialist is 21 x 200mg vaginal tablets and there was no gel on the prescription. So that’s not even continuous is it?
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joziel

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Re: Is this dosage correct?
« Reply #4 on: July 30, 2022, 05:08:59 PM »

If it's the 200mg vaginal pessaries (which are usually used during IVF) then it's way higher than you want to take for continuous. I mean, even if you were to take it orally 200mg would be double the usual continuous dose of 100mg/daily. But when taking it vaginally you can halve the usual amount (which would be 100mg every other day) or at the very least take the same dose (100mg every day). 200mg continuous would be too much progesterone unless you are really having a bleeding problem and need to really try to stop it.

(I take 200mg orally continuously to suppress endo - but that's orally. And I have a specific reason to do it.)

If you want to use your original utrogestan vaginally, it's really best not to ask your GP about it because not all GPs know about using utrogestan vaginally and sadly you abdicate all power when you ask ignorant doctors about stuff they really should know  >:( >:(

Here is the very readable sheet from the BMS about progesterone dosage: https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

By the way, I do think you should be able to cut a capsule open and mix with some water and drink it. It might taste gross though. I only say that because Lara Briden talks in her blog notes about poking a hole in a utrogestan capsule to squeeze some out if you are not on estrogen and you just want to take a bit of progesterone but not a whole capsule. If you can do that, you should be able to cut it open. No idea if that will be a faff but you could experiment. Seems a shame if it suits you otherwise not to take utrogestan.

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Sherbet4

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Re: Is this dosage correct?
« Reply #5 on: August 05, 2022, 07:31:44 PM »

Hi again,

Sorry for the delay in my reply, I’ve been feeling quite overwhelmed and having quite a few panic attacks in the last few days.

I finally got up the courage to talk to the dr again today. This was the head dr in the practice btw. I told her that the specialist had given me too high a dose of progesterone for vaginal use. She categorically insisted that 200mg is the correct dose and kept telling me it needs to be higher as it isn’t absorbed as well vaginally. She would not listen at all and told me I was completely wrong. So I asked her why the specialist only gave me 21 days and she said that I shouldn’t be on continuous (despite the fact that another dr put me on it) and the specialist was happy with that even though for some reason she only gave me 21 days.

I gave up on that so I asked her if my current anxiety could be due to not having the right dose of hrt and she said no. She said people can get depressed but not panic attacks like I’m having. She wanted me to go on antidepressants which I said I didn’t really want as would be worried about side affects. I’m seeing a therapist once a week as I feel so dreadful and I mentioned this to the dr. She told me that if I’m anxious about taking anti depressants it would be a good idea to get my therapist to help me get my head around taking them!

I give up!
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joziel

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Re: Is this dosage correct?
« Reply #6 on: August 05, 2022, 07:42:24 PM »

Oh dear Sherbet, it sounds like you need a more understanding GP. Can you change doctors or practices or see a private menopause doctor?
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Hurdity

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Re: Is this dosage correct?
« Reply #7 on: August 06, 2022, 09:35:57 AM »

Hi Sherbet 4

This is terrible!  >:(

It is absolutely shocking that women are subjected to this sort of treatment from sadly ignorant doctors, but not only that, insisting their ignorant opinion is correct!!!

Utrogestan is manufactured in France for vaginal and oral use. As joziel said it is only LICENSED in UK for vaginal use for IVF but is exactly the same caspule that USED to be licensed for ORAL use only for HRT until for some reason this was discontinued in UK and we only have the 100 mg capsules.

I wrote a post on this where I gave a translation of the French product info from their equivalent website to our eMC and I will find and bump that for you. It's here: https://www.menopausematters.co.uk/forum/index.php/topic,45782.msg738193.html#msg738193

In addition there are studies which demonstrate the efficacy of vaginal administration of utrogestan and again I will bump that thread too. Here: https://www.menopausematters.co.uk/forum/index.php/topic,43633.45.html

If you have a read of these threads as well as the BMS link joziel gave, this should help your understanding.

You absolutely should not have to go privately. Are you aaying your doc is refusing to prescribe oestrogen? I wouldn't worry too much about being given the "wrong" dose of utrogestan because you can adjust this so as to use the correctly licensed dose ( unless there is a good medical reason for you to have an increased dose which differs from the licensed dose - and if so they should tell you this), but if you are wanting HRT to help with menopausal symptoms then you should insist on being given oestrogen as well.

You should get back to the hospital department that gave you progesterone without oestrogen and say that you have been given the wrong prescription - ideally write - and this will then be referred to someone higher surely? You should also write to your doctor at the practice also outlining that you have not been given oestrogen. I think putting things in writing concentrates the mind - yours, but more particularly, theirs as they cannot fob you off in a letter.

So sorry that you are having to deal with this.

The other option is to write to Dr Currie ( costs £30 per question - facility on this website) so think carefully about what you want to ask - which could be a brief outline of your menopausal status, and what has happened, what you would like to try and and then ask for her recommendations - saying you would like to show her response to the docs in your practice.

There is a similar facility offered from Women's Health Concern....

You absolutely should NOT have to go privately for such basic advice/medical treatment and if you feel up to it - it would help other women for you to pursue this unsatisfactory treatment with the NHS. It also sounds like you neither want nor need anti-depressants though the frustration of having to deal with all of this is enough to make anyone anxious and depressed!

All the best and if we can help further, let us know :)

Hurdity x
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