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[michelleu]

Please help ladies.

I am 49  ,  and have just this month started sandrena gel 0.5mg daily and am about to start Utrogesten in two days time 200 mg  for 12 days . I think i have frightened myself by reading too much  about side effects of utrogesten . Please could any help wiith the following queries.

1. Can i take the capsules vaginally even though they say take orally or is this a different type  of capsule altogether and will this reduce the side effects

2.  Should i just start with 100 mg instead has only taking a small amount 0.5 of estrodiol.  I know it is about getting the right  hormones in the right amount but my Dr  really does not seem to know anything about  this subject .

Finally why if these hormones are natural do the instructions scare  so much with increased risk in  breast cancer and blot clots etc. I am wondering should i even have started these  i just want to  feel better ie moods mainly  and feeling depressed at certain times of month  . All the information makes me feel like taking these hormones bring even worse side efffects and if  so what is the point . Please can someone try and clarify and i reading too  many negatives  or should i wait until my symptoms are worse or i am in proper menopause rather than peri I know i am asking for answers when there is probably not any  right or wrong but  i wish i had a Dr who could at least know a little about this subject .  i would sincerely appreciate any help

[Dancinggirl]

Hi and welcome to MM michelleu
I'm afraid you just have to ignore all the scary stuff in the leaflet - BC will happen if it happens - there is still much confusion about what actually causes most cancers but being over weight or drinking alcohol brings far higher risk for BC than HRT. If you read the leaflet for Ibuprofen you would really think twice about taking it - the pharmaceutical companies have to cover their arses.

I have tried most HRT types and combinations and of all of them I found Utrogestan the most problematic in terms of side effects.  However there are many women who absolutely love it and do extremely well.  Utrogestan is considered the least risky in terms of BC though and finding the right HRT is going to be trial and error.

On the continent vaginal use of Utro is preferred and I believe 100mg (so one capsule per night for 10-12 days each month) is probably enough when using a low dose of oestrogen. Hopefully someone will be along to confirm this.

If you are trying to control low mood then a range of strategies need to be put in place - not just HRT.  Most progesterones can bring some low mood and PMT type symptoms - Utrogestan can make one feel sedated, although using it vaginally does reduce this for some women.

There is no doubt that if you are under 50 and suffering with flushes and night sweats then HRT is absolutely the right treatment.  However getting your diet and exercise regime the best you can is also vital. Make sure you are getting enough vital nutrients e.g. Vitamin D, Omega 3, Magnesium, calcium etc. - being low in these nutrients will result in low mood and fatigue.  Getting enough appropriate exercise is also important - lots of brisk walking or/and swimming is ideal.
Hopefully someone will be along to advice about Utrogestan - do a search as you will find lots of info on this site.
DG x

[Mary G]

michelleu, firstly, don't be frightened by other peoples' experiences, they are all different.  I am severely intolerant to all forms of synthetic progesterone and high doses of Utrogestan but that doesn't mean that you or anybody else is. 

The whole point of this forum is for people to tell others of their experiences both good and bad, get help from others and obviously to offer useful advice when they can so please don't worry!

My advice would be to take 100mg vaginally because 200mg is a high dose aimed at oral use and I doubt you need that much if you are on a low dose of gel.   You don't need a different tablet for vaginal use, it's all the same stuff and it's only the UK boxes that don't state 'vaginal and oral use'.  For some bizarre reason that nobody has ever been able to explain, the NHS don't licence Utrogestan to be used vaginally even though most other countries do - I buy my Utrogestan in Spain and my gynaecologist (who is German) always prescribes 100mg vaginally. 

If you do take Utrogestan orally, up to 50% of it will get lost in your digestive system whereas using it vaginally means most of it hits the spot so you can take less of it and get the same results.  I take 100mg for 7 days every 5 weeks or so and always have good clearance and thinning on that dose but I have regular scans to make sure and you might want to consider that option too.

Lastly, don't allow Project Fear (HRT scaremongering) to scare you off HRT, it is outdated rubbish.  Oestrogen only HRT carries no cancer risk at all and combined HRT only has a slightly increased risk - some experts now believe that oestrogen only HRT DECREASES BREAST CANCER RISK.  Utrogestan is a micronised progesterone but it is my understanding that the discredited studies all used synthetic progesterone and it was certainly in high doses on much older women who started taking HRT for the first time when they were 10 years post menopause. 

The latest study is equally flawed with poor data and not nearly enough information about the products/doses they used but basically they are trying to tell everyone that HRT is dangerous because an extra 3 women per 1000 'might' get breast cancer - good luck with trying to sell that one. 

The benefits of oestrogen hugely outweigh the negatives so why not go ahead and take it and look forward to feeling much better.  If for any reason you don't get on with Utrogestan, there are other forms of progesterone you can try or you could lower the dose slightly.

Good luck.

[Hurdity]

Hi there michelleu

Just to say I agree with the others - and yes it is the same stuff. I have only ever used it vaginally. In fact though the French instructions that I have actually give the same dose for vagonal as for oral use although as Mary G says much gets lost to digestion in this way. A limited amount of research suggests that on average half the dose can be used for vaginal delivery vs oral use - although this is off licence.

Yes you are starting with a very small amount of gel so with your doc's approval you should be able to take a smaller amount of utrogestan if using it vaginally. It does also depend on where you are in menopause, what your cycle has been doing recently, how heavy your periods are and whether you have fibroids, polyps or endometriosis so it's not a "one-size fits all". Personally I would err on the side of caution to start with and take it for the licensed amount of time ( 12 days) x 100 mg vaginally. Then see how you feel after two or three months and what sort of bleed you get.

Despite your saying that your doc doesn't know much about HRT, it sounds like s/he is playing ball re giving you the bio-identical hormones ie those that are the same as produced in our body - estradiol and progesterone.

In the months (or even years) leading up to peri-menopause, before periods begin to become irregular and when they sometimes shorten, many women experience worsening pms symptoms and moods as hormonal changes begin to occur even when the ovaries are still functioning. Some women do find that a low dose oestrogen at this point really does help.

The advantage of taking a slightly higher dose of progesterone than perhaps you need at this stage, if you are happy on it, is that it can help limit the heavy bleeding common in peri-menopause and especially if you have anovulatory cycles (ovulation does not occur, and the womb lining builds up until ovulation happens and a period comes).

As the others have said - don't look for problems and go into it with an open mind and positive outlook - you can't avoid menopause but these treatments are designed to mitigate the worst effects and help you to feel better overall.

Good luck and let us know what you decide and how you get on

Hurdity x