Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[skkb]

I'm happily taking my sandrena gel three times a week o.5mg plus micronor on the same three days, feeling good. Had my uterus scanned for thickening which was fine at under 5mm. Go to doc for general chat and he says now I have to take utrogestan for ten days each month and bleed!! I haven't had a bleed for 7 years, I'm 66. Will 10 days of utrogestan cause me to bleed?? Should I take it or continue as I am?? Confused yet again.

[CLKD]

  - my idea of HELL.  Give your GP a ring and ask, as your Scan has shown no problems, why you can't continue 'as normal'?

[skkb]

I took the scan results to show him......!!!!!

[Hurdity]

Hi skkb - good to hear from you! I am surprised the doctor has said this. Did he give a reason? Even if he thought your lining was too thick you could thin it  by taking more norethisterone which would do the job without bleeding ( if it has done so already) but you would have to be careful it didn't get too thin as this can also cause bleeding! Maybe he doesn't want you to be on continuous progestogen or a synthetic one at your age? Also that is far too much progesterone for the amount of oestrogen you are taking anyway (ie that much utrogestan). Um... sounds like he doesn't know what he is talking about. What dose of Sandrena are you on? I would phone up the docs and ask what the reason is and what is the objection to you continuing as you are.

Hurdity x

[Maryjane]

I would say " if it ain't broke , don't fix it " .

You have the results in front of you , I had a GP who said I needed to take progesterone every now and again when I was taking JUST two vagifem a week.

[skkb]

Thanks for your replies. Hurdity I take a 0.5mg sachet of sandrena on a Monday Wednesday and Friday only, and one 350microgramme micronor tablet on the same three days. I intend to have a mother scan early next year and see if the lining has changed. I don't think my doc is at all familiar with HRT and menopause and just "does what the book says". It's interesting that you say bleeding could occur if the lining becomes thin, I didn't know that. Do you know how thick the lining should be, mine was 4.7mm which she was happy with (under 5mm is acceptable) the utrogestan could give me horrid symptoms as, as you say, it would be far too high a does for the low does of estrogen im taking. Really not sure what next as going back to him won't help I doubt, he's about to retire anyway. Would a private gynaecologist help do you think?

[Hurdity]

Did this doc give you this regime in the first place - or maybe it was a private doc? Whichever - surely there is something in writing on your notes to say that this is OK? There really is absolutely no medical justification for saying that you should return to cyclical HRT and have a withdrawal bleed.  This is not the usual protocol for post-menopausal women. Even though your regime is a bit unorthodox, it is just your way of taking very low dose continuous combined HRT which works for you. My lining was similar when last scanned in the summer. I have read that 2 mm or below could be considered atrophied but it is unlikely that anyone on HRT would achieve this unless the dose of progesterone is very high so you don't need to worry about this. 

The only reason for changing to utrogestan would be to minimise any risk of taking synthetic progestogens for a long time post 60 - but I presume as long as you aware that there could be increased risk of breast cancer and the doc knows this you should be able to continue.  I mean you might want to try the Utrogestan - but the dose would be 100 mg  on the same days as you currently take the Micronor. This could increase the risk of spotting or bleeding, especially initially unless you used it vaginally.

I actually suggest you find another doc in the practice. You really don't need a private gynae at this point! You just need to be firm with your doctor (when is he retiring?) - so if you want to continue with the micronor, then ask him to prescribe it as before.

Hurdity x

[skkb]

Thanks Hurdity very inforrmative. I'm wondering whether to take the utrogestan 100mg on the same three days as  sandrena.......is the utrogestan safer than micronor?

[Hurdity]

The current view as I understand it is that long term it is better to take progesterone rather than a synthetic progestogen to minimise breast cancer risk especially if you are over 60 - although you are taking a very small dose, and apparently the evidence is still inconclusive. Also continuous combined HRT is associated with a slightly higher risk - although the absolute risk is very small.
http://www.menopausematters.co.uk/risks.php
http://www.menopausematters.co.uk/article-breast-cancer.php
http://wwwmenopausematters.blogspot.co.uk/2016/04/hrt-and-breast-cancer.html

I did read somewhere that Dr Currie describes progesterone as "breast-friendly" but I can't seem to find reference to this any more.

If you were to take it then yes I would take it the same 3 days - but as I said you may well have some spotting at least initially, and vaginally would be ideal although you might not want to do this long term.

Hurdity x

[skkb]

Many thanks. I have enough micronor for a while longer and not sure yet if doctor has cancelled the repeat prescription as he's given me utrogestan now. I may go back and ask to be referred again to the menopause clinic. I have a friend in the same situation I.e. Using estrogen on 3 days each week but NO progesterone as she doesn't want to bleed as the bleed is so bad in every way, the meno clinic consultant has agreed to this but only if she has an annual hysteroscopy to check the uterus, which she is happy to do but says it's painful. I also would do that if appropriate!!

[Mary G]

skkb, if you are happy with your current regime then why change it?  It takes a long time to get it right so before changing, I would put up a fight to stay as you are.  5mm is a good measurement if you are on continuous combined HRT and that is what mine was on that type of regime - it only goes down to 2mm immediately post bleed now because I am on a cyclical regime using very low dose Utrogestan. 

If you don't want periods and find yourself stuck with Utrogestan, you might find that a couple of 100mg capsules every week (used vaginally and spaced out by a few days) will keep you as your are now so you could try it on the understanding that you can revert back if micronor you decide you prefer it.  There is another member who takes 100mg Utrogestan twice or three times a week for a bleedfree regime. 

What you said about your friend is very interesting and it might have been you who mentioned this particular option on here before.  I also read somewhere (can't find it now) that oestrogen only with regular scans is an option in extreme cases of progesterone intolerance, usually while considering a hysterectomy, and I assume this is what your friend is doing except she has to have the hysteroscopy.

If in doubt, get a second opinion.

[skkb]

Thank you, really helpful. Could you clarify for me please.....is utrogestan progesterone or a synthetic progestogen and what is micronor? Which is better the progesterone or synthetic progestogen. Sorry if I'm being rather dense but I've got my knickers in a bit of a twist over this. What is the vaginal utrogestan as I know nothing about it. I don't want to bleed but want to safeguard the lining of my womb and will have a mother scan early in the new year.....many thanks

[Hurdity]

Hi there skkb

Utrogestan is micronised progesterone and is bio-identical with our own progesterone ie it is the same molecule as the one we make. It still has to be synthesised from raw materials as do all the progesterone available including the progesterone creams and bioidentcial hormone replacement therapy compounded creams. They all have to be made from plants as progesterone is not found in plants! Micronor is a synthetic progestogen - which consists of norethisterone, and is the "mini-pill". Norethisterone is a powerful synthetic progestogen for keeping the womb lining thin so is used for a lot of HRT as well as contraception although as such it is not on the licensed list to use as progestogen part of HRT ( no idea why - maybe to discourage the practise of prescribing separate oestrogen and prog?!!).

The same capsule that is sold for oral use is also used for vaginal use for fertility purposes - although now the only product available for HRT is 100 mg capsules which is very small whereas it is 200 mg for fertility. I presume the same results re endometrial protection can be obtained with vaginal use of 2 x 100 mg as 1 x 200 mg - ie sufficient gets to the uterus where it is needed.

You won't be able to tell if you will get a bit of bleeding or spotting with the Utrogestan because you are changing the prog.....

Hope this helps and good luck anyway -  the decision is yours!

Hurdity x:)

[skkb]

Many thanks Hurdity...so informative as ever, will perhaps speak to a different doctor before I change regime and also have another scan to see if the lining has changed at all. Thanks again.