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[juwi]

I'm on Sandrena/Utrogestan to suppress my cycle in order to deal with hormonal migraines.

My specialist prescribed Utrogestan from day 17- 26 (10 days). This is my first month and I'm on Day 7 of Utogestan and have started bleeding.

Do I continue taking the Utrogestan or do I stop and start counting today as Day 1? Or do I complete the course as instructed as count Day 1 as the day after the last Utrogestan?

Very confused and hoping someone here can help!

[Clovie]

I have never had an answer to this question from anyone medical, not even my meno specialist. I always bleed early, on about day 7 of utrogestan.

I had it suggested by someone on here that as I was still in peri with my own hormones that that was the reason, but I still don't know. In fact my own periods kicked back in after a short while on utrogestan and they are still regular.

So  I asked my meno specialist direct. I said 'if we take utrogestan to bring on a shedding of the lining, and I am a) either having my own shedding via unscheduled (natural) , or am starting the scheduled shedding early whilst taking utrogestan, can I stop the utrogestan at that point?'

She honestly didn't know.

Me,  now, when I use utrogestan if I start a heavy shedding around day 7 then 8 I don't bother with the rest of the tablets.
Every so often, every 4 months I'd say, I do continue with the rest of the course to the end, just to make sure I am shedding completely. (It never makes any difference to my flow so I presume rightly or wrongly once its started it's started, if you see what I mean)

[Dancinggirl]

It is common to start bleeding early when using Utro - it's not as powerful at controlling the bleeds as other progesterones and this can be one of the problems with this type of progesterone - you should use the full course of 10-12 days though, to ensure the womb lining sheds properly.  I kept getting breakthrough bleeding when using Utro - many use Utro vaginally because it can work better that way. DG x

[Clovie]

Just wondered Dancinggirl, if you're a medical professional with expertise in this area, when you say you SHOULD finish the course?
I'm working on the fact that the least utrogestan I can get away with and still achieve a full bleed  the better, given the recent tenuous progesterone link to breast cancer, plus not wanting to take medication in general that I don't need. Everyone is different. 

Interesting to note, when I was on the synthetic progesterones before I realised I was prog intolerant , before I used Utrogestan, I still bled early on the synthetic progesterones, so no different.

 edited to say, I re-read my question and it might come across as rude, just to say, not my intention!  genuinely wondering 

[Dancinggirl]

I'm certainly not a medical professional but we should all follow the instructions given with any medication unless told otherwise by a doctor.  I have been using HRT on and off for over 25 years and have tried just about everything there is to try to help meno symptoms.  I have had NHS and private treatment for meno symptoms as well. It just worries me that some put forward ideas that are off license.  Tinkering with HRT dosage could lead to problems e.g. build up in the womb lining, more chance of problematic bleeding plus the small increased risk of womb cancer. If regular scans were available on the NHS and women were really clued up about what they were doing, then things would be different.  Tailoring would be ideal - we are not in an ideal world.

The recent press about combined HRT did give us the impression that progesterone was the 'bad boy' when it comes to risk but it could just be the type of progesterone, the combination of oestrogen a progesterone together or other factors. They need to look into whether the Mirena is a better option in terms to BC risk.  I think they should look into the idea that it could women who suffer badly with meno symptoms (therefore need HRT) that are more prone to getting BC in the first place?? The study also doesn't look into lifestyle choices in relation to BC!!!!

I know there are many women who are under the specialist gynae who experiment with different doses so we should be very cautious in advising others to do this - we don't know their full medical history or why the doctor has prescribed a certain regime.

Better safe than sorry I say.  Dg xxx

[Clovie]

Oh dear. Perhaps you should re-read your reply as your reply comes across much more rude than my question it has to be said.
Sorry but your tone certainly implies you know better than others despite having no medical training, and your reply  definitely does come across as preachy.
Most women  do a lot of research as well you know  and given that a genuine qualified menopause specialist professional herself did not know the answer to my question and 'allowed' me to stop when I started a heavy bleed is good enough for me.

And I am quite aware of all the recent press thank you 

If you're implying I did this, think you'll find I did not say someone else should or should not do anything given that I am not a medical professional with special expertise in this area.  I think you'll find I gave my own experience and said what I do, unlike yourself, who  actually said what she SHOULD do. 
I'm sure even if other members DO, in an attempt to be helpful, advise doing something off license then I'd credit the reader with enough sense to make their own mind up if it's something to run by their GP - or not. We are all grown women here.


Juwi, good luck and hope others come on and give your their TAKE on your question! x 

[Dancinggirl]

So sorry if this came across as offensive. I didn't mean to offend at all and this really wasn't directed at you personally - I merely wanted to stress that we need to be careful not to advice others to go away from the licensed doses without the supervision of a specialist.

You are absolutely right - we share our experiences and others can follow our example if they think it is appropriate.
DG x

PS You simply picked up on ‘one word' - “SHOULD” - when I should probably have said COULD.  I was trying to be reassuring not tell juwi what she SHOULD do. 

[Clovie]

Ok, explains it now you've elaborated. Perhaps the use of could would have been better, yes. But thank you. No hard feelings 

[Lizab]

I had the same question during my first months of hrt. I found a website, which I won't search for and link to at the moment, that suggested stopping the progesterone and counting that first day of bleeding as cycle day 1. The idea was to line up the hormone with your natural cycle, and presumably doing that on the first month of it would get everything onto schedule. If I recall, the website seemed to be referring to cyclical progesterone only treatment, not estrogen and progesterone cyclically. Anyway, I tried this the first 2 months of my hrt, and I still bled on about day 8-9 of the 10 that I was prescibed. I felt awful and felt like I was cycling too quickly doing it that way. I further researched and did find some medical-ish source somewhere that said women typically bleed before finishing the course. Sorry I can't even begin to know where to find that link, as I only found it mentioned one place in days of searching. Given all that, I take mine the full 10 days, bleeding or not. Only once have I made it through all the days before starting a bleed.

[Elizabethrose]

Hello juwi

As a rule I don't respond to any HRT threads as I'm absolutely no expert and I wasn't successful using it. However, my specialists used a similar routine to try to manage my pure menstrual migraine.

I was being treated by Nick Panay and Claire Bellone along with Anne MacGregor. I was prescribed Estrodiol Gel and Crinone which is a vaginal  progesterone pessary. They too were trying to suppress my own cycles and I was instructed to use the gel for 28 days and then to use the pessaries on alternate days for the last 12 days of the 28 day cycle. I was told to ignore any bleeds and to finish the 28 day cycle before starting it again.

Our own cycles can sometimes just continue though, thus two periods a month. Sometimes this settles sometimes it doesn't. Sometimes dosage may be increased in a further attempt to suppress our natural cycles, this can work for some and not for others. It's all a bit trial and error it would seem especially as we are all so very different. For me this just didn't work: my own cycle is a powerful force and couldn't be suppressed and a GnRH analogue was the next possible course but it was decided it was probably too risky for my migraine. I'm experiencing a very long peri as these ovaries won't give up!

I really wish you luck, I hope it works for you. Pure menstrual migraine are a nightmare. It's suggested that you need to give it a minimum of three months to see whether it will work for you, then they may start playing with the dosages.

[juwi]

Thanks everyone for your responses!

Elizabethrose - I'm also under Dr Panay's care and it's lovely to hear from someone who suffers from menstrual migraines too (I mean that in  a good way). If HRT didn't work for you - may I ask what you're doing now to deal with the migraines?

I've  now heard back from the Dr's office and they have instructed me to finish the course of Utrogestan - regardless of the bleed. I'll give it the required few months and to see what happens.

[Elizabethrose]

Hi juwi

Menstrual migraines are horrible things and I really feel for you. This course of action is very often successful and I really hope all goes well for you. His peers know Nick as Mr HRT, you are in good hands!

I am a bit of an anomaly I'm afraid, I'm seriously reactive to hormone change and many things have been tried over the past 15 years to treat my migraine. I try to avoid describing my experience, as I have no wish to frighten anyone at the beginning of this journey. 

I'm now 57, still in peri though feel sure late stage now. Whilst I still have frequent migraine they are not the monsters they once were and all vomiting has stopped. I had some very dark days but things are definitely easier.

I was advised that I had to go into natural menopause so I've been desperately trying to hang on to my ovaries. It would seem that for the vast majority of women their pure menstrual migraine will ease if they reach menopause naturally as opposed to surgical or medical menopause. That's the route I've had to take.

I only now treat migraine acutely: I take Frovatriptan as early as possible but only when aura and prodrome have finished and the headache starts. I also use diclofenac sodium suppositories. Frovatriptan is apparently most successful at treating pure menstrual migraine as it has a long half-life and helps with the rebounds. It's the only triptan that worked for me and indeed the only med that has worked. The diclofenac suppositories are also brilliant as they avoid the stomach, which is in stasis, and definitely help alongside Frovatriptan.

Good luck to you, I wish you every success!!

[Mary G]

Clovie, I completely understand your desire to take the barest minimum when it comes to Utrogestan, I do exactly the same.  I am severely intolerant to all types of synthetic progesterone and to Utrogestan in high doses so I take 100mg (vaginally) for 7 days every 5 weeks and I can just about live with that but any more is completely out of the question.  I have regular scans to check my lining and it is normally 2mm post bleed so I know this dose is OK for me. 

The problem as I see it is twofold, the NHS, for some bizarre reason that nobody has ever been able to explain, does not licence Utrogestan to be used vaginally (I have found it to be more effective at clearance/thinning when used in this way) so their licenced doses have to allow for the fact that at least 50% of it gets lost in your digestive system when used orally.  Secondly, they have (probably) based their licenced dosage on worst case scenario so, in my opinion, it is over-prescribed.  For women who get on well with Utrogestan this is obviously not a problem but for those who don't, it can be a deal breaker and I fear many women end up ditching HRT altogether because they just can't tolerant the horrendous side effects caused by the high dosage.  There are other types of progesterone that can be used but they also have side effects and in my case, they are even worse than Utrogestan!

Therefore, it seems you have to either seek help privately and have a tailor made regime with a specialist or go the NHS route and ask your doctor if you can take less Utrogestan and have regular scans on the NHS.  If they refuse, you could offer to take responsibility yourself by paying for regular scans in the hope they will agree to work with you. 

It's not ideal I know but I can't see much alternative. 

[Dancinggirl]

juwi - if you are under Dr Panay's care then you are probably getting the best treatment available - he is one of the top gynaes. I would keep following their advice. 
I don't think you have told us your age or where you are in your meno journey?  These horrible hormone migraines are difficult to control and if you have only recently started this HRT regime it will take 3-6 months for your body to adjust and settle.
If I were you I'd keep doing what you have been prescribed and see how things go one the next 3 months.
DG x

[juwi]

Thanks Dancinggirl.

I'll definitely follow his advice and see how I'm doing in 3 months time when I have a follow up call with him.

I'm 41 and one month into Sandrena/Utrogestan. Early days!!