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[br350]

Can someone please comment on the use of oral progesterone capsules vaginally? I use Prometrium (utrogestin to UK users) and these are either pink 100mg gel caps, or yellow 200mg gel caps. 

The progesterone is suspended in peanut oil, the gel caps are meant to go through the stomach's digestive acids. How can these be ok for vaginal use? Since a great deal of the progesterone is destroyed in the process of digestion - but apparently this is still adequate for the intended purpose of uterine protection - I would assume using either of these strengths vaginally would be a major overload of progesterone (way more than is necessary.)

Secondly, how is a capsule designed for digestion supposed to work vaginally? Even if you pierce the gel cap and place it high up in the vaginal canal, how is it supposed to get OUT of the capsule? I'd think you'd need to put a very big hole in it or virtually squeeze the contents out (onto fingers?) and jam the gel up there. 

I'm just not getting this but hear women use it this way.    Aren't there specific vaginal progesterone preparations intended for vaginal only use? Someone help me wrap my mind around this.   

[Mary G]

I agree with Stellajane, it definitely works when used vaginally and the box I have contains the white capsules and states that it can be used either orally or vaginally.  I have never had any problems getting a good bleed with them, the only problem I have is the intolerance issue. 

[Hurdity]

I agree with the others.

We discussed this very issue recently because a pharmacist raised it with a member - ie re the stomach acids etc. I don't know why though because if it were inadvisable to, the intructions would say, and the French SPC state the alternative use as vaginal for exactly the same product.. Here is the thread: http://www.menopausematters.co.uk/forum/index.php/topic,30212.0.html . It may well be different for Prometrium in US - you may have different preparations of progesterone for fertility and for HRT, whereas it is the same in UK.

Hurdity x

[br350]

That may well be the case that the coating and manufacturing is different in the UK version.  Not sure. I'm going to call my pharmacist to inquire. Have heard of women here in the U.S. using the Prometrium gels (which are indeed in a peanut oil suspension - something to do with the micronization?) and although they report it works, some have vaginal irritation and other issues. Also, not sure how this would work with nightly insertion (for 12 days in a row) if one has a, ahem, active sex life??  I can see that causing some potential issues.  I'm quite curious. Thanks for the info ladies. 

[Kathleen]

Hello TovahFell and welcome to the forum.

I had a similar question recently, infact Hurdity posted a link to it in her reply. The person I spoke to may have been thinking of a US product so any information you can share with the forum would be great.

 BTW I know we women have a reputation for multitasking but having to be your own Pharmacist on top of everything else is really going some don't you think lol.

Wishing you well on your menopause journey.

K.

[GypsyRoseLee]

I was wondering, if you absorb the Utro vaginally what happens about sex? If you insert it at bedtime would you be okay to have sex the flowing morning, or should you leave it until the afternoon?

[Hurdity]

Hmm it is a difficult one and I can imagine more so for those younger members who probably indulge a lot more  ....however just to say that on occasion I've inserted one, then done the deed and it seemed to be OK. Alternatively you could insert it afterwards although may be less would get to the uterus because of ... er...other secretions going on! I've done that too without problem. Maybe different if post-meno though?

Here is some info from the SPC - this is for vag utro used for fertility:

Following vaginal administration, micronised progesterone is absorbed rapidly and achieves stable plasma levels in the range of 4-12 ng/ml, depending on the daily dose, with much less inter-subject variation than following oral administration.
http://www.medicines.org.uk/emc/medicine/28065/spc

This is for vag utro used for HRT (the translation from the French I have a copy of from the manufacturers):

After vaginal insertion, progesterone is rapidly absorbed by the vaginal mucosa, as shown by the increase in plasma progesterone levels from the first hour after administration.

Peak plasma progesterone concentrations are reached 2 to 6 hours after application and mean concentrations over 24 hours of 9.7 ng/ml are obtained after administration of 100 mg morning and evening. This mean recommended dosage therefore induces stable, physiological plasma concentrations of progesterone, similar to those observed during the luteal phase of a normal ovulatory menstrual cycle. The low between-individual variations in the progesterone levels make it possible to precisely predict the effect obtained with a standard dosage.

Therefore really no need to worry that much GypsyRoseLee I'm sure - next morning you'd be fine and maybe even as I have done in the past - thought not too often maybe?!! Have fun 

Hurdity x

[Tinkerbell]

I am glad this has been asked, I was too embarrassed to!
Have become more of a morning person, two teenagers in the house who don't get up early at weekends so no disruptions

[Hurdity]

Nothing is too embarrassing to ask on here - although sensitive topics like this are usually asked in private lives so that the whole internet world cannot read about our exploits 

Hurdity x

[Pollie]

Lucky you if you have a problem putting sex on hold for 12 days 

 

[Meeka]

I have found this to be a negativie of using it vaginally.   Also I tend to get a 'build up' of the melted capsules over the 7 day period.   After that time I have to douche it all out or I think it would be in there for a long time

[Trufflecat]

I do wonder how much it would affect your male partner to get repeated small doses of progesterone!

[Hurdity]

I hadn't thought about this so I looked it up and found this study:
http://www.hindawi.com/journals/ije/2015/685281/

Rather than paraprhase I'll just quote the abstract:

"Objective. To determine if sexual intercourse reduces absorption of vaginal progesterone gel in women and to determine if progesterone is absorbed by the male during intercourse. Study Design. Prospective, randomized, cross over, controlled study of 20 reproductive-aged women and their male sexual partners randomized to receive vaginal progesterone gel (Crinone 8% gel, Actavis Inc., USA) or placebo cream. Serum progesterone for both male and female partners were measured 10 hours after intercourse. One week later, subjects were crossed over to receive the opposite formulation. In the third week, women used progesterone gel at night and abstained from intercourse. Results. Serum progesterone was significantly reduced with vaginal progesterone gel + intercourse compared with vaginal progesterone gel + abstinence . Men absorbed significant progesterone during intercourse with a female partner using vaginal progesterone gel compared to placebo . Conclusion(s). Vaginal progesterone gel is reduced in women after intercourse which may decrease drug efficacy during luteal phase support. Because men absorb low levels of progesterone during intercourse, exposure could cause adverse effects such as decreased libido."

So basically there could be a minor effect on (male) libido - bearing in mind that the study was looking at the effect on fertility and the support of pregnancy, but used Crinone gel, not Utrogestan or micronised progesterone capsules. Interestingly it did show decreased serum levels of progesterone (in women) following intercourse after the gel was used - so this also informs our earlier discussion about what happens with sex and effectiveness! Just because serum levels of progesterone could be reduced though, doesn't mean to say that they would be insufficient to keep the endometrium thin, as that wasn't studied and wasn't the object of the study. I think the point is it could lead to variation in progesterone levels (if you intermeittently had sex while on the course of utro vaginally) so could lead to spotting/bleeding.

Hurdity x

[Trufflecat]

Very interesting! Thanks for looking that up

[Meeka]

Thanks for the info,  good to know it doesn't really hurt the males