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[jasper]

Hi, am I right in understanding that the 2.5mg Nomegestrol acetate - synthetic progestin that was in the Zoely i tried is stronger than 100mg utrogestan?

Thanks alot

[Hurdity]

You can't compare the different progestogens in all the different preparations as they behave differently in the body. In HRT the dose given is calculated so as to protect the endometrium (womb lining) from over-stimulation from the added oestrogen - and the extent to which it does this varies with the different progestogens used and their doses, so comparing the doses between the different types is irrelevant. In the Birth Control Pill the dose not only helps protect the endometrium but also helps work to prevent ovulation/conception, as I understand, so again cannot be compared with HRT progestogens and their doses.

Also women react differently to the different progestogens too - in terms of side effects.

Hurdity x

[jasper]

Thanks Hurdity,
Yes realise they are doing v different things, I was just confused by the massive difference in dosages 2.5mg vs 100mg when I thought the bcp was stronger?

[wombat62]

Hi

Interesting as I'm having to swap regime as combined patch no longer available . So separate oestrogen patch and daily progesterone pill. When I compared the quantities the pill is contraception strength and appears to be twice as much as in the patch, I think it's the same type. Doc says I can cut pill in half plus I'm not sure I want all that progesterone! If I didn't cut it in half is that amount dangerous in post?

Also if I forget to take pill would it be disastrous as not used to taking one daily for several years!

[Hurdity]

jasper - progesterone is unique in its dosage compared to all the synthetic progestogens because it is so unstable as a compound. It is micronised to improve its availability but nevertheless it breaks down quickly in the body - much is lost through digestion in the gut and metabolised by the liver and so the synthetic progestogens can be given in far smaller doses. I don't know how the strength compares because it depends what effect you want to compare eg effect on endometrium for example? Many of the adverse side effects form utrogestan (dizziness, sedation, depressive effect) are due to the oral metabolites, so I've read, which are not present when it is taken vaginally - although the large doses do still have some negative effects in some women. The synthetic progestogens vary in their mode of action and affinity to receptors etc and hence can have different side effects from progesterone itself, so it's a question of finding a type and dose that suits you.

wombat - I'm not sure what you are asking - perhaps you can be more specific? Which combi patch is no longer available - there are only two, Femseven and Evorel and to my knowledge both are still available - but perhaps this is very new news?

Hurdity x

[wombat62]

Hi Hurdity

The combined patch I'm on in Oz which is Estalis is having supply problems so doc has had to swap me to another regime of oestrogen patch and progesterone pill.

When I checked the progesterone pills they are for contraception and are a much higher dose than in the patch which is why doc said to cut in half if I wanted to. My concern is that if you took the full pill what would be the consequences of a higher dose of progesterone than actually needed?

My other query is around if you missed a pill what would be the result? Maybe not too much of a concern as no longer needed as post!

Sorry if I wasn't clear!

[Hurdity]

No probs - tell me the type of progestogen and dose in each and I will have a look - you can't really compare the amount in a patch as in a pill. It has to be much higher in any pill due to the amount lost in digestion. If the doc has said OK then presumably it is!

If you took too high a dose of progestogen you could get side effects if you were sensitive, and long term it could lead to overthinning of the endometrium which can cause spotting/bleeding. Not in the short term. If you forgot a pill then you could also end up getting random spotting or bleeding as the progestogen levels would fluctuate.

Hurdity x

[dahliagirl]

As Hurdity says, it is very difficult to compare doses of progestogen with each other, because they all works slightly differently and the amount you have to take to get an effective dose through the liver varies.

It is also really difficult to compare across preparations as HRT and BCP and others tend to use different progestogens.

Norithisterone and levenorgestrel are useful as they are both widely used.  I came up with:

COC is the highest by far.  The progestogen, along with the oestrogen makes your body think that it has already ovulated from day 7, so it stops the production of FSH and oestrogen etc.

HRT is the next highest - this regulates uterus lining

POP is fairly low - it makes changes to the lining/cervix etc which make it unfavourable to sperm and pregnancy but does not stop ovulation and you tend to have fairly normal periods.

Newer POP like cerazette and other generic versions are higher dose which gives a longer window to take it, and sometimes prevent ovulation as well.  They are a different type of progestogen from other preparations so it is very difficult to compare. I have seen in some places that it contains equivalent progestogen as in HRT, but there is no licence for this (in the UK - not sure about OZ) - only for contraceptive purposes.  (On their own they can stop periods, or result in irregular or constant bleeding)

[wombat62]

Thanks ladies, I'll check the amounts when I'm home. I'm pretty sure both contain Norithisterone which I've not had a problem with.

I'm assuming it's a POP as it said there was the three hour window.

I used to be on Cerazette which was great as it had the 12 hour window which was good for travelling but isn't available here.

[wombat62]

Hi Hurdity

Here are the amounts of Norethisterone:

Patch: 140ug/day 2.7mg patch (50ug oestradil)
Tablet: 350 microgrammes (ug) and will be having a 75ug oestradil patch with it.

Hopefully it will be ok to split the tablet in half, I don't really want to take any more progesterone than I have to.

According to Dana sounds like the combo patch supply might have resumed by the time my next prescription renewal is due!

Thanks