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[Rosie500]

Hope this is a straightforward question! I feel I should be able to find the answer by searching etc but have failed so far.

Basically I started on oestrogel + utrogestan 3½ weeks ago (post menopausal aged 51) having previously done a month of Elleste Duet Conti 2mg - I know you are supposed to give it 3 months or so but I felt bad on the tablets; I am cautiously optimistic that the current regime will suit me as I feel a lot more even in mood. I am taking the utrogestan for days 1-25 of the cycle (I assume a cycle is 30 days or is it 28 days? Does it matter?!). My main question is why there is a break? Is it so I can bleed if I need to? Also I gather some women take 200mg for 12 days - again why/is it something I should consider ie is it better?

I am slowly working my way through the information on the forum and site - wow it's quite complicated and we all react so differently, no wonder a lot of GPs don't have a handle on it when they hardly see women for HRT these days. I know quite a few doctors socially and was talking to one who said he may be asked to prescribe HRT for one woman a year, if that, whereas 20 years ago he would regularly see women for HRT reviews etc so was much more clued up on the different options then.

What has struck me in my reading is how warm and supportive everyone is on here. If there was a prize for the nicest internet forum, MM would win it 

[CLKD]

Have a look at Member 'Hurdity' - you should be able to trace her responses (if she doesn't pop up with info.)

Make notes 

[jedigirl]

1-25 days on 100mg Utrogestan is generally for post menopause and the three days will give a bleed if necessary.
1-14 days on 200mg is if you still have periods allowing a better bleed.

[Hurdity]

.... and to add that some women prefer to continue with a cycle even though post-menopausal - because of the side effects of progesterone (of any sort) which some women are particularly sensitive to.

Yes the cycle is usually 28 days. I would try it with the 3 days break at first and see how you get on and whether you get a bleed. After a few months, if you don't get a bleed and you don't have side effects and you would prefer to take it all the time then many docs say that this is OK - but mention to your doc first.

What dose of oestrogel are you taking?

Hurdity x

[Rosie500]

Very good idea CLKD - my poor brain isn't what it was and I am struggling to get my head around all this hormonal stuff.

Thanks jedigirl and Hurdity, I think I am tolerating the utrogestan pretty well, but time will tell. I'm not sure how to tell if I'm sensitive to progesterone but maybe if I was I'd know by now judging by what I have read on here? I don't think my body likes norethisterone though. I just wondered if there was any reason to take it all the time or not and why the product leaflet says to take a short break if research shows that continuous oestrogen/progesterone is the thing to do for post menopausal women to protect against endometrial cancer. I don't have any particular desire to take it every day or not, just would like to know why/why not and what the purpose of the break is. I won't ask my GP as he had never heard of utrogestan before I asked him for it! He was happy to prescribe it for me based on information I collected from MM  and to be fair is very supportive. There was a female GP who had an interest in these things who probably got all the menopausal women but she has recently disappeared. There is a new lady GP coming soon who is a similar age to me so am hoping she might be more experienced about HRT.

I am using 2 pumps of oestrogel, did do 3 pumps for the first week then reduced it - I was a bit random I'm afraid; it turns out my GP had only written up 2 months supply (not very sure about dose/pack size) so I thought I'd change to 2 and increase it if it seemed necessary. I'd read older women might need a bit less than perimenopausal ones so thought 3 pumps might be overdoing it. I do feel better on it in general and like the idea of the flexibility of dose. I know it's early days but I am impatient and want to be me again!

Have I got the right or wrong impression that the dose of progesterone (ie 100 mg) is a bit of a guess/one size fits all thing and perhaps in the future it might be adjusted when more research has been done? Or is it finely tuned?!

Thanks!

[Hurdity]

Yes - it is a bit of a one-size fits all. I mean the licensed dose does not specify the dose of oestrogen to go with it or the maximum so I'm not sure how specialist gynaes deal with this. Also it all depends on absorption - especially when used orally. Some women need less and some need more, and also more may be needed with higher oestrogen dose, and less if Utro is used vaginally. As I said before I would have the 3 days break initially just to see if there is anything to shed - and probbably do it like this for a few months and see how you go. That will then give you an idea of how well it's working. Glad you seem to be tolerating it

Hurdity x

[Rosie500]

Thank you very much. I feel like I'm guessing quite a lot of the time (so many uncertainties) so thank goodness for this site 

[GypsyRoseLee]

And just to add to the mix, don't forget that Prof. Studd recommends just 100mg x 7 days per month!

I think this shows that they're just guesstimating? I do think in years to come that Utrogestan dose will be more specific to the patient. It really should be looked in to, as it is the progesterone which the majority of women really struggle with.

[Briony]

To add to the confusion, there are also (a few) ladies who still have periods but take 100mg from days 1 -25 . This is sometimes because they are fine taking Utrogestan but suffer once they stop (a bit like a drug withdrawal). I was one of those who had a horrible mental dip when I stopped it.

[Hurdity]

I do agree GypsyRoseLee - it should be possible for a woman to work out the best dose with her GP - but this is unlikely on NHS because it would involve having regular scans to check on the womb lining. It would be great if we could have these as part of our reproductive health in the same way as we have regular mammograms, after a certain age!

Re Prof Studd's recommendation - he originally proposed this but as a minimum for women with progesterone intolerance - but of course these would be women who are being seen and monitored by a specialist gynae and who would be scanned reguarly. Studd's own research from the 1970's show that the degree to which progestogens protect the uterus is dose/duration dependent and that a higher incidence of endometrial hyperplasia is likely to occur with use of a synthetic progestogen at the correct dose for 7 days per month as opposed to 12 days. I'm just mentioning this as it would be unwise for any woman reading this to decide to reduce her dose from the licensed amount on the basis of this.

Hurdity x

[Dancinggirl]

I would just like to support what Hurdity has said about taking progesterone.  The gynae I am seeing privately explained to me very clearly that, when using progesterone sequentially, it is very important to use progesterone for at least 12 days in a row to ensure that the womb lining sheds properly. 7 days is unlikely to produce a full bleed and this can then result in erratic and problematic bleeding. He also explained that it is quite rare to be really sensitive to all progesterones - it is more about finding the one that suits you best.  On the whole it is the withdrawal of progesterone ( when you stop taking it and go back to just oestrogen alone) that will result in more severe the symptoms e.g. headaches, cramps etc. I think it is low mood that can plague some women on certain progesterones - I certainly felt irritable on the synthetic progesterones.  I use Utrogestan continuously now and find it works well for me.   DG x

[Briony]

Feel a bit stupid asking this, but can you do any harm in taking too much progesterone? ie if a younger lady who still has periods opts to take 100mg (vaginally) for days 1-25 - apart from the possible issues with spotting -  can it do anything serious to the womb? 

I ask this as my GP is quite laid back, knows I try to read up on things, and will therefore go with what I request (within reason, of course). Sometimes I worry about the 'too little knowledge ...' thing with me! I really hated stopping Utro when on hrt, but was very content on it. I'd do it with 100mcg patches in order to suppress ovulation - this (suppressing ovulation with 100mcg patches) is the second line treatment for pms if the pill doesn't work - but it is assumed that this is accompanied by 200mg Utroegstan for12 days only, I guess?
B

[Hurdity]

It is unlikely to do any harm - if you have too much progesterone then theoretically this can lead to over-thinning and ulceration of the endometrium (therefore spotting) but this would be most likely to happen with women who are post-menopausal and not taking any oestrogen - for example perhaps if a Mirena coil was kept in after menopause unknowingly (ie not knowing menopause had been reached).  Maybe also with too high a progestogen dose compared to oestrogen (just thinking aloud here)? I believe I have read also that high dose of norethisterone can also do this over a long period of time - but only in the absence of oestrogen. In women who are in peri-menopause it shouldn't make any difference apart from controlling the bleeding.

In any case I don't think an overthinned endometrium is harmful in the same way that a thickened one is ie the latter can lead to womb cancer. I haven't looked up the long term consequences of over-thinned endometrium though!

Sorry that sounds a bit vague! I'm too tired to look it all up now!!!

Hurdity x

[Nina]

I hope not as that is what I do!

Meh. I gather that if I don't have spotting and feel good then there's no problem


<buries head in sand>

[Hurdity]

Sorry Nina - what is it that you do?! I was just trying to answer Briony's question but not intending to be alarmist - in fact the contrary I hope!!

Hurdity x