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[Hurdity]

juwi - how much Sandrena are you taking? The dose has to be high in order to suppress the cycle and in women who start HRT while still having fairly regular cycles - yes their cycle is a "powerful force" as Elisabethrose put it - so bleeding at the "wrong" time is often likely. Average dose HRT is not sufficient to suppress cycles of regularly menstruating women and those in very early peri-menopause, so it is good to try to synchronise with your own cycle.

That being said some women start to get flushes and sweats while in the late reproductive stage and start HRT. Then their cycles get shorter ( as part of the late repro stage - just before peri-menopause proper) - so this may well be their natural cycle rather than an early bleed due to some failure of the HRT.

Early bleeds as Dancinggirl says can also be due to insufficient progesterone or if it is unstable - especially with oral HRT and oral progesterone which you are taking.

I would definitely look to using it vaginally (at the licensed dose that you have been prescribed) to give yourself a more stable dose - and see what happens then. Unfortunately with vaginal progesterone it is more difficult to continue using it once you are bleeding so the aim would be to get as many days as possible of the licensed amount before you start. I would be interested to see how your cycle behaves if you do this. You do not need to consult with the gynae to use it vaginally if you are not varying the dose (unless you particularly feel you need to) but obviously you would want to mention at your next appt. We know it is prescribed by gynaes for this use and is likely to get more prog into the system rather than less so perfectly safe to do this unsupervised.

Incidentally ( and digressing a moment juwi!) - the question of medical expertise or not seems to come up from time to time on here.

So to clarify:

One of the forum "rules" found in the information for members here: http://www.menopausematters.co.uk/forum/index.php/topic,8308.0.html

"Members are kindly requested to give references (eg links) to any health/medical information they provide, when it is not personal experience. Personal experience is anything the person has undergone himself/herself."

"All members are, by default, considered to be non-medical professionals".

None of us need to declare our background or qualifications as we are all equal in this respect in the sense that we post based variously on our knowledge but also on our experience, opinion and judgement and can advise accordingly.  If the advice is based on things read from the scientific or medical literature or medical/reputable websites - then this is usually referenced. Some members have degrees, medical or scientific background or even the occasional research doctorate - but others have no such education/qualifications but are extremely well read and/or well informed about menopause and HRT (amongst other things) through knowledge and experience and their posts are equally valid. We don't know and have no need to know anyone's background unless they feel they want to declare it but it gives them no superiority.

However there are also many cases as we have found where doctors have made mistakes so our knowledge saves some members from continuing with the wrong treatment. So in some cases some of us actually do know better than some doctors on specific things relating to menopause and HRT and that is not said in arrogance, but as fact - as many of you have seen from posts on here ( about GPs prescriptions and lack of basic knowledge about menopause and HRT). The other thing is sometimes opinions differ even amongst the expert gynaes because our knowledge on some of this is imperfect and we all react as individuals - simply not enough is known about everything!

Juwi - in view of some of the comments I just wanted to clarify that!

Hurdity x

[Elizabethrose]

Oh Juwi, how confusing this thread must have been for you, especially as your question was quite easily answered.

You're very sensible: stick with Nick's advice; he knows what he is doing.  When in peri our cycles are ever changing so it's almost impossible to marry up HRT with our own cycles: Nick explained this to me early on. He is also aware that sometimes very high levels of HRT are required in order to suppress a natural cycle and that that is still sometimes unsuccessful. He knows what he is doing and I feel sure will manage your treatment well.

It's really early days for you and I'm hoping this treatment will be a huge success. I wish you well.

[GypsyRoseLee]

Prof Studd told me that taking 200mg of Utro for 12 days a month was 'nonsense'. It's fine if you aren't intolerant, but Hell on Earth if you are.

He started me on just 100mg of Utro for 7 days a month. And he made absolutely no mention of me needing scans, despite me being on 4 pumps.

Similarly with the meno GP I saw yesterday. She told me to only use 100mg of Utro for seven days only once every THREE months! Blimey! She said I would be perfectly fine because I am still making some of my own progesterone. She also said that I wouldn't need scans for the same reason.

I was very surprised, but very pleased that she told me this would be a good regime for someone as intolerant as me.

[Mary G]

Bravo Professor Studd!!!  Of course 200mg Utrogestan for 12 days is nonsense.  Take this scenario, 1st to 12th of the month you take Utrogestan, then allow 5-6 days until your period starts, then you have a period for 5 days.  That takes you to about day about day 22 meaning you only have about one free week before you have to start the whole process again.  It's completely unworkable for most women and doomed to failure.  Even if you are not intolerant to progesterone, you are unlikely to feel very good on that lot and would probably be very disappointed with the results.  I am post menopause with virtually no progesterone at all and yet I have proved that I can get good clearance/thinning on a fraction of that dose.

GRL, as you so rightly point out, Professor Studd does not make uterine scans a condition of using this regime and the reason his regime is so successful is because he uses flexible HRT products and doesn't pump women full of unnecessary progesterone which not only makes them feel dreadful but undermines all the benefits of the oestrogen.  This makes even less sense when you consider that all the risks associated with HRT are in the progesterone component.

Anyone can prescribe Oestrogel and Utrogestan but they will not necessarily prescribe it at the right doses that work.

The NHS need to review their progesterone licenced doses as a matter of urgency and Menomale, nobody actually knows why the NHS do not licence Utrogestan to be used vaginally, it is complete stupidity because it works far better when used in that way and you can take less of it.

[juwi]

A lot of food for thought there!! Thanks ladies!

Hurdity - I'm on 2mg of Sanrdrena a day and 100 of Utrogestan from day 17-26!

I'm just completing one month now and have not had a migraine this month except on the first day of Sandrena. Fingers crossed it remains like this!

[Hurdity]

I see juwi - 2 mg won't actually prevent ovulation and suppress your natural cycle (as far as I know - and the fact that you bled early suggests this also) but will prevent the extreme oestrogen dip at the end of the cycle - which I presume is what your specialist is aiming for? Great news re the migraines! I was sure mine were due to the progesterone withdrawal but perhaps also due to the oestrogen dip all along!

Many G I have said many times Prof Studd himself has done research which shows that women are at greater risk of endometrial hyperplasia when using progesterone for 7 days per month compared to 10 days, and this is greater than when used for 12 days. He has also changed the advice on his website which said that if women used progesterone for 7 days only per month there needed to be a lower threshold for endometrial sampling indicating greater vigilance due to the potential for endometrial thickening. I can only assume he is monitoring his own patients carefully. You have never commented on this and yet keep repeating that it's OK.

I quite agree that there needs to be more research on a more dose dependent approach to progestogens in general ( not just utrogestan but all of them) using evidence based trials, and in particular licensing vaginal use. However vaginal use on the continent is still given at the same dose as oral progesterone - I have a copy of the French SPC which the previous company which supplied it, sent to me.

In haste GtG!

Hurdity x

[GypsyRoseLee]

Hurdity

Prof Studd has never mentioned scans to me.

The GP who I saw yesterday, specialises in the Menopause and she has advised me to only use Utro every three months, and still just 100mg for 7 days. When I asked her about the risk of my womb lining building up she said it won't because I am still producing my own progesterone (proven by me still having my own cycle and periods).

Maybe it's more important to use Utro once you are post meno when you aren't producing any progesterone?

[Mary G]

GRL, that's right, to my knowledge, Professor Studd has never made uterine scans a condition of using the 7 day 100mg Utrogestan regime.  As far as I know, this is irrespective of whether women are peri or post menopause.

Have any of Professor Studd's patients on MM ever been told they have to have scans as a condition of using this particular regime?  Obviously it is a good idea to do so but it is not a condition of use.

[Hurdity]

GypsyRoseLee - I am sure it may be a different scenario for some women who are having regular periods - but equally I am sure it depends on the individual and the dosage of additional oestrogen given - as to whether the lining is kept thin.

Mary G - Prof Studd's prescription of 7 days prog per month is not the standard prescription and by his own account is reserved for those whom he treats with either reproductive depression and/or progesterone intolerance or both.

Here is what he says at various places on his website:

http://www.studd.co.uk/dep_women.php
"As women with PMS respond well to oestrogens but are often intolerant to progestogens and it is therefore common-place for us to reduce the orthodox 13 day course of progestogen to 10 or 7 days starting, for convenience, on the first day of every calendar month. Thus, the menstrual cycle is reset".

"If women become depressed with 10 to 12 days of progestogen, it may be necessary to halve the dose, decrease the duration or change the progestogen used.(35) It is our policy to routinely shorten the duration of progestogen in women with hormone responsive depression because adverse side-effects with any gestogen are almost invariable. We would therefore use transdermal oestrogens either 100 mcgs or 200 mcgs of an oestradiol patch or a 50 mg oestradiol implant and then we would reset the menstrual bleeding by prescribing Norethisterone 5 mgs for the first 7 days of each calendar month. This will produce a regular bleed on about day 10 or 11 of each calendar month.

If heavy periods occur, (and they usually do not), to extend the duration of progestogen to the more orthodox 12 days."

Section on pms

http://www.studd.co.uk/dep_treatment.php

"The problem is the progestogen as these women are often progestogen intolerant. Progestogen should be used in the lowest dose and the shortest duration necessary to prevent endometrial hyperplasia or the return of PMS type symptoms if the women are progestogen intolerant.
......
The patients will need progestogen to prevent endometrial hyperplasia and irregular bleeding, but because of the progestogen intolerance found in these women, a smaller dose of shorter duration is recommended, usually in the form of 2.5 mgs of Norethisterone or 100 mgs of Utrogestan for the first seven days of each calendar month; this will produce a regular withdrawal bleed on about day ten of each calendar month. "

http://www.studd.co.uk/depression_nov2013.php

"Patients with a uterus who are having transdermal oestrogens for mood swings and depression should have monthly progestogen to protect the endometrium. Unfortunately these women with PMS are usually progestogen intolerant and even a low dose of a low potency progestogen for only seven days (the orthodox duration is fourteen days) may produce a minor reoccurrence of PMS type symptoms."

juwi -  as you can see threads often digress a little as different points are made and variously challenged - this is the way things go. It doesn't read as confusing to me - just separate points - about general principles - as well as advice given specific to your situation! I hope you find this interesting and helpful. . I hope you remain migraine free - or at least that they become rare!

Hurdity x

[GypsyRoseLee]

That was interesting to read Hurdity. I assume it's only the women who are severely progesterone intolerant that he puts on the very low Utro dose? But, I guess most women who see him are intolerant else they would be okay with their HRT?

He just kept telling me that it was 'very good' that I barely had any withdrawal bleeding. Didn't seem concerned at all.