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[dands]

Hello, I've been prescribed Estradot 100 mcg and Utrogestan 200mg.

The gynae told me in clinic that I was to take the Utrogestan for 12 days and then have a 3 day break. The letter received today confirms that I take it between Day 1 and Day 12. From what I've read on here I should be taking it from Day 15-26 which mean a 2 day break.

I'm so confused, is this a normal protocol? I would really appreciate some help. I'm 44 and peri. My mum went through an early meno and has osteoarthritis. I've started to suffer hot flashes and vaginal dryness but only had no periods for 6 months before being put on HRT.

[justaboutcoping]

Hi dands

My dose Utrogestan is the same as yours, although at the moment I'm only on 25mcg Estradot (and I'm not due to start my Utrogestan for a few days yet)

I was confused about when to take too but I checked with Dr Currie and she said the 12 days can really start on any day ( I haven't had a period for quite a while now either). So I will be taking from the 1st of the month for 12 days.

Don't know if that helps but I'm sure someone will be along later who can advise x

[Dancinggirl]

Hi and welcome dands - You are right to question this. The 3 day break is only for those using Utrogestan on a continuous basis in post menopause - I think your doctor is confused!!!! Do read the leaflet that comes with the Utrogestan as it should explain that you take the Utrogestan for 12 or 14 days in the second half of a 28 day cycle so there will be roughly 2 weeks when you don't use Utrogestan but you will get a bleed a couple of days after stopping the Utrogestan.  It always baffles me that doctors don't give a bit of time explaining how to take medication!!! I hope that helps.  Once you get into the routine of all this you wil find your fluchese etc, will get under control.  I have to say they have put you on a very big dose of oestrogen!!!! It might have been better to start on half that dose to see how you do.  Keep us posted. DG x

[dazned]

I was started first on hrt at 1 mg estrogen,think at age 44 thats about right  ,as its quite young.

[dands]

Thanks everyone.

justaboutcoping - I feel better that Dr Currie has given you the same advice. I'll take the Utrogestan as prescribed on Day 1-12. Are you perimenopausal?

I was told that the 100 mcg dose (which I too initially thought was high) was because of my age and to protect my bones due to my Mum having osteoarthritis.

The pharmacist gave me Cyclogest for this first prescription as she said there's a manufacturing problem with Utrogestan. Has anyone else heard the same?

[dands]

sorry was meant to write my Mum has osteoarthritis and osteoporosis

[Grumpymum]

Bit concerned to hear you were told there was a manufacturing problem with Utrogestan. Hope that is not the case for myself and a lot of other ladies on this site. I didn't have a problem with the last pack I had but I am only getting one month's supply at a time. Hope you get on alright with the substitute you have been given.

[Dancinggirl]

I googled Cyclogest and it's described as a 'natural progesterone' so maybe it's the same as Utrogestan but under a different name!!!???
dands - The big dose of oestrogen would probably be appropriate to prevent osteoporosis, particularly as your young age, however they perhaps could have done a DEXA scan first to see how your bones are as you may not need such a high dose.  There are many factors that cause osteoporosis  - lack of calcium in the diet, lack of sunshine ( therefore deficient in Vitamin D ) and also the hereditary influence. I would still have started on 50mg and then built up if need be. It will still be important to maintain some weigh baring exercise like brisk walking and make sure you get enough calcium and vitamin D to keep your bones healthy.
I assume you are going to use the Cyclogest for 12 days each month with a 16 day break which will include a withdrawal bleed?
I'm sure this regime will be fine once you get into it. Give things at least 3 months before reviewing things.

DG x

[Hurdity]

Re the 12 days - as already discussed if you are late peri and don't have a regular cycle it doesn't matter when you start but it is 12 days in the 28 day cycle. It doesn't matter how you number the days - it's just that the convention with a 28 cycle is for Day 1 to be the bleed so that's why utrogestan is prescribed from Day 15-26. If you are already taking oestrogen then if you want you can call the day you start the utrogestan as Day 15 so that you can work out when your bleed comes in relation to when predicted!

What dose Cyclogest have you been given? I used this for 4 years and I think when I first started utrogestan was not yet available - Cyclogest was the only progesterone.

For those who want to know this has been around for years as a natural progesterone for fertility - it comes as waxy pessaries which can also be used as suppositories. It isn't licensed for HRT although some gynaes ( and my gynae specialist GP) prescribed it for this purpose. The usual dose is twice as much as for Utrogestan so for a cycle you chould have been given twice the number of 200 mg capsules. I was prescribed 400 mg for 11 days per 28 day cycle. Mine came in 200 mg capsules so I used to put one up the front and one up the back  (interesting effect the next morning!). I did feel that this was too much progesterone but it seemed to produce a withdrawal bleed OK.

Re the doc saying use for 12 days and 3 days break. Did the doc suggest you then had another 12 days? If so as others have said this is totally wrong!!

I agree with Dancinggirl re starting with 50 mcg as there are fewer side effects - would be good to be on 100 mcg eventually at your young age though. I was given 50 mcg but I was late peri and nearly 54. I sometimes wonder how I would have felt if the dose had been increased. Probably too late now at 62!

Hope it goes well for you.

Hurdity x

[justaboutcoping]

Hi Dands

I'm just over 50 , and was peri when I originally emailed Dr Currie last year, I'm prob late peri now as have only had one light bleed in the last 6mths and periods very irregular for about 18mths before that. Really really heavy for a while, and every couple of weeks, and then down to about 1 every 2-3mths, then nothing.

Because of that Dr Currie also said I could try 100 Utrogestan daily if I wanted to - she said why bleed if you don't need to.... (might just get a breakthrough bleed depending on what my cycle is doing)But I decided to go with the 12 days initially as wanted to be able to tell how the utrogestan was affecting me.

For various reasons and delays over a major op I've only just recently started HRT, 25mcg not having much effect for me so will give it a few more weeks but may have to up it. Hope that helps Dands. I pestered Dr Currie quite a bit  and she was great - I showed my GP her emails and she was happy to prescribe based on Dr Currie's advice

[dands]

Thank you all for your helpful replies.

I've used Cyclogest before during fertility treatments so I don't mind using it temporarily but would prefer the Utrogestan as I hate the mess Cyclogest creates (even if put in the back passage). The pharmacist in Boots said she would keep trying to order Utrogestan for me but that's what showed up on her screen. I've been given Cyclogest 200mg.

The doctor suggested 12 days of Utrogestan and then a 3 day break during which I would bleed. She also suggested cutting the first week of patches in half so I could get used to the dose. Now in fairness, she was in a big rush and I was a bit dazed but she said she would send a letter to my GP before I started. The letter stated:
Estradot 100mcg patch changed twice weekly and Utrogestan 200mg between day one and 12.

I had a DEXA in December which showed my bones were normal thank goodness. My cycle is still there (barely) but I think it was concern about the early menopause of my Mum, sisters and my Mum's osteoporosis that prompted the doctor to put me on HRT at the higher dose. I had started to get some sweats and vaginal dryness too.

I think I would prefer to mimic a natural cycle as much as possible so will take the Cyclogest starting on Day 15. Anything different and I'm likely to forget to take it.

[Dancinggirl]

dands - I think it wold be sensible to cut the patches in half for the first month to see how you feel - then if you try the full patch and don't feel good you know what is right for you. As you are peri meno and still getting periods - all be it erratically - the a sequi HRt regime would be best.  It may take a few months to bring your cycle under control but you should eventually get light monthly bleeds a couple of days after you finish the Utrogestan(progesterone) phase.  I'm not sure why your doctor told you to do a 3 day break after 12 days of progesterone for the first month?! Maybe it will get the cycle off properly from the start as your uterus will shed and you start fresh after that.
I think a 50mg patch is still considered good for bone protection. DG x

[Hurdity]

I'm interested that you have only been given 200 mg Cyclogest for endometrial protection - and this is presumably the pharmacist's decision. As I said my gynae GP ( who studied with Prof Studd) prescribed 400 mg. I see from the fertility info that the max utrogestan is 600 mg whereas for Cyclogest it is 800 mg - so not quite twice as much. I imagine if used vaginally you can get away with less as it goes straight to the uterus. I'm now wondering how I would now find it on 200 mg - if this is sufficient, although utrogestan seems to do the job. It is definitely messier than Utro!

Hurdity x

[dands]

Thinking back I was on 400mg Cyclogest for ivf. I suppose the pharmacist thought that 200mg of Cyclogest and 200mg of Utrogestan were much the same for HRT purposes.

I'll let you know how I get on as I start the (half) patch tomorrow.