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[soniad]

Good morning Ladies,

I am going to be increasing my Estradot dosage from 25 mcg to 37.5 mcg.

Currently I am taking 100 mg Utrogestan for 15 days. So far that has produced a 5 day bleed - not too heavy and not too light. It has been 5 weeks since I started this regime.

Should I increase to 200mg Utrogestan with the increase to 37.5 or leave it as it is?

What do most ladies do at this dosage?

Thanks

[CLKD]

  can't help, sorry but didn't want to leave you wondering - ring a Pharmacist?

[soniad]

Okay thanks CLKD

[Hurdity]

Hi soniad

The Pharmacist will tell you either to use the licensed dose or follow your doc's prescription I imagine. The licensed dose of utrogestan is 200 mg x 12 days per 28 for sequential HRT and 100 mg days 1-25 ( or every day) for continuous use - taken orally.

However this is given as a "one-size-fits-all" dose which is clearly only a guide since the amount of progesterone needed to protect the womb lining is not only dose dependent ( ie higher doses of oestrogen will generally need higher doses of progesterone and vice versa), but also varies from woman to woman.

In addition to this women who experience side effects such as dizziness and headaches from oral use - are licensed to take it vaginally in France and mainland Europe - but at the same dose as for oral use, even though limited studies have suggested that more is absorbed into the uterus and system through vaginal use....

So - how long is a piece of string?! You were on a low dose of oestrogen with half the licensed oral dose of utrogestan - and you had a medium bleed. On avergae this may well be sufficient (given the above ie low oestrogen dose). As you have only been on it for 5 weeks it's too early to tell long term whether it would keep your endometrium thin - and also partly depends on what happened beforehand ie what your periods were doing and whether you were on a different HRT before this? Also depends on your individual reaction to it - as to how much is absorbed eventually after digestion/metabolism.

What has your doc said or doesn't s/he know? If you deviate from the licensed dose - then the only way you will know whether it is doing the job is partly from your bleed but only really by having an endometrial scan. Unfortunately this is not routinely offered on NHS except for unscheduled bleeding.

I have always erred on the side of caution although I am on a longer cycle and use utro vaginally - so my cycle is 6-7 weeks and 11-12 days of utro 200 mg vaginally - for 50 mcg patch. When I temporarily reduced my dose to 37.5 mcg f or 3 months I did continue with the same utro dose but then as I said I am on a long cycle (with the agreement of my GP).

Sorry this doesn't help much! You may well be fine on 100mg as with 25 mcg - but if you do continue with this I would review (with your doc) after a few months as you don't want to end up with a thickened lining.

Good luck and hope you are feeling generally better on your HRT regime!

Hurdity x

[soniad]

Thank you for this excellent info Hurdity!

So - how long is a piece of string?! You were on a low dose of oestrogen with half the licensed oral dose of Utrogestan - and you had a medium bleed. On avergae this may well be sufficient (given the above ie low oestrogen dose). As you have only been on it for 5 weeks it's too early to tell long term whether it would keep your endometrium thin - and also partly depends on what happened beforehand ie what your periods were doing and whether you were on a different HRT before this? Also depends on your individual reaction to it - as to how much is absorbed eventually after digestion/metabolism.

My periods before I started the HRT were exactly like the one I had while on the HRT - 5 days in duration.

I live in Australia so a different medicare system - but my Doctor is kind of taking my lead on this one - she had never even heard of Utrogestan.

My gut feeling is that if I go up a dose on Estradot I will probably go up to 200mg Ustrogestan. So far I haven't had any side effects on the 100mg and don't want to rock the boat. I was hoping to get away with staying on 100 mg but I also want to play it safe in terms of endometrial health.

Ah.....decisions decisions!

Thanks again

x

[Hurdity]

Hi again soniad - I really meant cycle frequency - because this is an indication of where in menopause you are if you haven't been on BCP or POP? You're managing to get Utrogestan now in Australia? We have several members from there and I understood it wasn't available although I think someone said it had just become available - if so no wonder docs may not have heard of it. Plenty haven't heard of it here in UK and it's been around for 5 years or so I think!

Hurdity x

[soniad]

Hi Hurdity,

Before starting hrt I was still getting regular periods. They came avey 24-25 days and lasted about 5 days. So I am def. Perimenopause.

Utrogestan is available in Aus but up until now only a select few doctors were authorised to prescribe it (luckily my doc was one of them) and you had to order it from a company in Perth.

But as of today, it is freely avalailable in Aus under the brand name Prometrium.

Yes we are very behind here. The only transdermal form of estradiol we have is patches.

[Hurdity]

Hi soniad - thanks for the info. If your periods are still very regular ie every 24-25 days then accoridng to the NICE Guidelines and the "official" designations here this is not yet peri-menopause but the late reproductive stage ie the ovaries are still working - although hormones begin to go awry (which varies from woman to woman)  - including dramatic hormone surges,  consequent mood swings and worsening pms, headaches etc (I can post a link to the stages if you like?). This stage can be difficult to treat with HRT because of this. A low dose can help women because it prevents the sudden dip at the end of the cycle and especially if oestrogen has reached a very high level mid cycle - which it can also do at this stage. Some people do loosely call the peri-menopause the time from which women begin to notice changes but it's a tricky one to categorise and pin-point exactly!

If you are having regular periods then you will be ovulating regularly and some gynaes (from what has been reported on here) do not give high doses of additional progesterone because the woman will be producing her own - which may be sufficient to shed all the lining. Therefore you may be OK for a while on the lower dose - but would need medical supervision - I think only specialist gynaes do it this way ie some not even prescribing prog initially. the tricky thing is then when do you add in extra because how do you know when you  are starting to skip cycles ( since HRT gives you an artificial cycle).

Sorry I'm rambling a bit and thinking aloud here as usual, but hope some of it is helpful and not confusing!

Hurdity x

[soniad]

Not rambling at all, I can understand what you're saying perfectly and your words are always incredibly helpful, Hurdity - thank you.

Yes, I know it is very tricky.

I am 49YO and my doctor says I am in Perimenopause. Prior to taking HRT I was having erratic sleep - mostly good but every now and then all of a sudden I'd wake in the early hours or find it hard to get to sleep (since age 46) but it was never at the same time every month . So there was no rhyme or reason to it, like there is with PMS (BTW I never had any PMS before this. Periods were evey 28 days like clockwork.)

Every 6 months or so over those 3-4 years I would have about 4-6 weeks of really crappy sleep. In hindsight I think the estrogen has been slowly declining over the years.

I am having medical supervision through this so I think I'll stay on 100mg and see if I get any breakthrough bleeding. Any sign of spotting/bleeding and I'll up the dose.

[Dana]

Hi Hurdity,

Before starting hrt I was still getting regular periods. They came avey 24-25 days and lasted about 5 days. So I am def. Perimenopause.

Utrogestan is available in Aus but up until now only a select few doctors were authorised to prescribe it (luckily my doc was one of them) and you had to order it from a company in Perth.

But as of today, it is freely avalailable in Aus under the brand name Prometrium.

Yes we are very behind here. The only transdermal form of estradiol we have is patches.

Sandrena gel is available. You can check what's available here on the AMS site. http://www.menopause.org.au/for-women/information-sheets/426-ams-guide-to-equivalent-hrt-doses

You can also check my previous post for more information on the availability of Prometrium. http://www.menopausematters.co.uk/forum/index.php/topic,32903.msg529235.html#msg529235

[soniad]

Oh thanks Dana,

I didn't know that!

Prometirum is easy - my chemist has just got that in.

Will keep the Sandrena in mind if I don't get on with the patches

[Dana]

What did you pay for the Prometrium? Chemist Warehouse didn't have a lot of information on it the other day, but they said it was $65 for 30 x 100mg, but I think they said the other day $38. Even at $38 that's expensive for just 30 capsules.

[soniad]

Hi Dana,

I'm picking mine up tomorrow. I'll let you know then.

The Utrogestan cost me $45.00 plus postage for 30 to order from Lawley direct in Perth.

So overall yeah, pretty expensive either way you look at it.

[Dana]

Lawley makes a good mark up on the cost. To be honest with you it would be cheaper to buy Utogestan from Goldpharma. It comes from Europe, but I used to get it, postage included, for around $32. You could also buy extra boxes and not pay any extra postage.

Anyway, hopefully they will add it to the PBS.

[soniad]

Yes I have discovered that.

Prometrium from my chemist cost me $45.00.