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[Greyhoundgal]

Hi

Has anyone come across any research backing up the efficacy of the vaginal rather than oral use of utrogestan tablets in achieving greater general absorption and protecting the uterine lining? I'm not tolerating it too well orally and want to find a safe, alternative method.

I know it's not licensed for vaginal use in the UK but is in Europe. I'd like to have a sensible, evidence based conversation about vaginal use with my GP, rather than the conversation immediately being shut down on UK licensing grounds.

I'd also like to know that it's a safe option, as I can't imagine my GP will refer me for regular scans to check lining health if I choose to use utrogestan in an unlicensed way.

Huge thanks.

[chucklesista]

Hi greyhound gal,

Your question intrigued me as I did wonder on what basis Dr Louise Newson says vaginal Utrogestan 100mg alternate days provides sufficient endometrial protection. I have a personal curiosity re this as I have just switched to using it this way but in my 2 wombs (alternating days). It would be great if I could reduce the amount I take overall (as one womb is smaller than the other so I reckon it doesn't need as much) but obviously like yourself I don't want to put myself in a situation where I don't have gp back up. I am getting further advice to find a specialist who has experience/knowledge of uterus didelphys / Mullerian duct abnormalities in peri and meno.

So after all that that lead-in  - Not sure if the following is sufficient back-up from a research point of view as it is from an American source but it does review studies done worldwide. It definitely endorses the safety of Utrogestan overall and also states clearly the dosage amounts related to different administration routes which provide protective action on the womb lining. 

https://pubmed.ncbi.nlm.nih.gov/27277331/

I hope this is vaguely helpful. I was also interested in your comment re regular NHS scans being done to check womb lining thickness. Does this happen as a matter of course where you are?

Chucklesista

[sheila99]

As long as you use the same dose vaginally as orally I don't think you're doing anything unsafe. The manufacturer specifies the same dose by whichever route and this is presumably how it is licensed in Europe. I share your concerns about using half the dose. It's probably safe for low - medium doses but I'm not aware of any proper research at high doses (and I would expect Besins to have tested their own product more thoroughly than Newson). If you're worried I would either use the standard dose or arrange your own scans to ensure the lining is staying thin. You may never get your gp to agree to vaginal use as it isn't licensed for this in the UK so it makes her personally responsible if anything goes wrong. But she isn't watching (I hope  )...
  I use the standard dose vaginally because I'm not convinced the half dose has been sufficiently tested. What side effects do you get? It might be that you don't get them vaginally.

[Stella2]

I am also interested in changing from oral to vaginal usage because I experience heartburn. I would also consider using the standard dose to  ensure that my womb is protected but I am unsure if the change from oral to vaginal would cause any side effects such as bleeding (I am postmeno).

[chucklesista]

Ah Sheila 99 so you have concerns re using half the dose? Well I'd better go back to taking it by mouth then.

[sheila99]

Using it vaginally usually stops the digestive track problems so you shouldn't get heartburn. In theory more gets to where it's needed so it should be more effective not less if you take the standard dose. Taking less should be done with medical supervision, if you want to go off piste then you really should arrange your own scans. Newson patients are all private so I expect they have regular scans anyway, unlikely to get it on the nhs.
The other option if you're meno is to use it on a long cycle sequi regime (6 weeks) so you have more 'good' time. I get fatigue on it (used vaginally) so this is what I do.