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[MicheleMaBelle]

Hi cor- and if you take the utrogestan vaginally and at 100 mg for the recommended 25-28 days no need for scans unless there is continuous suspicious bleeding ( although breakthrough bleeding can be common)
If you take it sequentially for 12-14  days at 200 mg, no need for scans either ( see above)

Anything other than these prescribed guidelines should be done under medical supervision and requires back up scans. Please don't try and self medicate your own dosage.

You don't seem to be having many adverse effects to the utrogestan so why don't you take it vaginally, at the prescribed dose each day whilst reducing your oestrogen dose.
If you do start to experience side effects, you could then try taking it sequentially and see how you go with this.
Different things work for different folk. I could be telling you to come off it based on my experiences but I'm not going to as I appreciate that it works better for some folks and others and that tweaking is quite often required. So, don't go chasing after hares- you'll know if it feels right or not. It's easy to be swayed by others but you need to do what's right for you. X

[Cblimey]

Thanks Michelemabelle.  I'm going to speak to my GP about vaginal utrogestan.

[MicheleMaBelle]

It's the same stuff Cor- you just shove it up!
It's not licensed for HRT usage in the UK this way ( it is for IVF) but gynaecologists' have no hesitation using it this way. By all means tell your GP that this is what you're doing but I don't think you need to ask her if it's ok.
Trust me- I'm not a doctor! X

[Cblimey]

Oh, I see.    Thanks for saving me a visit to the doctors!

[Freckles]

Cblimey-
Vaginal Utrogestan (pessary type) is not current available here either on the NHS or privately; it's only the oral type.
I tried taking it orally as prescribed  but found taking it vaginally  (using a pessary dispenser- I use the one they give you with Canestan for thrush)  last thing at night and getting it as high as possible to the cervix really worked for me.
Mary G  here on MM suggested that to me ages ago.
I  found I get more effective results and certainly less, in  fact minimal, negative side effects, as it hasn't got to be processed by your stomach, liver, etc.
Also it's approved for vaginal use by my friendly expert medical Professor Gynaecologist , as I checked with him!
Prof Studd said that plenty of women find this method of application more effective than orally
I don't have regular monitoring/uterus scans as I get a decent monthly "scant bleed" using Utrogestan this way.
Why they don't make it in pessary form now, I don't know.
Certainly breast tenderness, depression, PMS symptoms  can be a symptom of excess progesterone e.g. see
http://www.studd.co.uk/bioidentical_hormones.php
But of course, one size doesn't fit all, so read around properly and make an informed choice based on clinical evidence, and not just the often quoted NHS "guidelines" (which some NHS medics seem to ignore by raising, sometimes it seems on an ad hoc basis both the dosage and length of time for taking Utrogestan for such long periods each month given the posts on MM).
You won't get regular uterine scans on the NHS on HRT ( or even one)  unless there is clear clinical evidence of "issues" but even then it seems to be a postcode lottery.  Privately they cost about £100 a time.  I haven't needed one as I get a regular and decent bleed on my prescription.
May that's why the "orthodox" treatment regime  is recommended to avoid costs to the NHS re scans and adjusting treatment.
I personally couldn't handle the "orthodox" treatment of 200 mg for 14 days a month, so half the dosage for half the time really works for me. Been on it  (plus Estrogel  and testosterone (Testim) gel for nearly a year and it's been life changing for me.
Good luck in your research!
Freckles xx


   

[Cblimey]

Thanks for all the info Freckles and the link. I'm sure I've got a pessary dispenser somewhere.......  It's great to hear that your treatment has been life changing.

[Freckles]

You are welcome- give it a go for a couple of months with a pessary dispenser and see if there is a difference for you.
Deffo use last thing at night, after going to the loo, and put as high as possible to the cervix.
And also do some reading!
One size doesn't not fit all re HRT and there is no "absolute truth"- NICE "guidelines" are just that "guidelines" and sometimes the information in them are ignored by health professionals.
It's what works  effectively for you at the lowest possible level of HRT intervention and minimising related side effects that matters, not an overall inflexible adherence to a general prescriptive dictat.
Good luck!
Freckles xx

[MicheleMaBelle]

Hello-  I'm not advocating that the NHS guidelines are right or wrong. They presumably have a safety net built in there, regardless of the reasons for doing so. Many women take HRT in its prescribed form with little or few side effects so they can't all be wrong.

Some women are progesterone intolerant and the progesterone part undoubtedly causes issues- however, if less than the prescribed guidelines / doses are given, this should be done under medical supervision and an understanding that there MAY be additional risks. Not everyone can afford the luxury of private consultations and scans. I've been fortunate enough to be able to do this so far, but where do you draw the line? It's a sad state of affairs but the truth is that we are all different and what works for some, doesn't work for others. And sadly, HRT just doesn't work for some women.

Also, I can't see anywhere that it's the progesterone causing issues in this case. There is no mention of  low mood/ depression etc so what I'm trying to say is subject to some tweaking on the oestrogen part, there should be no need at this point to go and make too many changes.

As freckles has said, you just need to be as informed as possible, be prepared to make tweaks as necessary and be aware of any additional risks if you go off road.

Good luck x

[Hurdity]

Hi Hurdity, Freckles and Salad. 

Thank you for taking the time to give such detailed responses. I really appreciate all the info.

For now I've decided to lower my oestrogen by cutting up the patches so I'll get approx. 50mcg. I'll see how this affects my breast pain.  Salad you mentioned breast size - I'm not sure if mine are bigger but they certainly feel heavier.  When I roll over at night the pain wakes me up. I already sleep wearing a bra but I'm now on the hunt for a more supportive design.  I didn't mention before but I had a breast tumour removed in my 20s that thankfully turned out to be benign, so I'm particularly sensitive to changes in that area.

As for the Utrogestan I'm going to keep reading and researching before I change from the 100mg capsules.  I don't like processing those hormones through my gut (I've also had a number of tumours removed from my large intestine) so I'm definitely looking for an alternative.

Should my GP be checking the health of my womb now that I'm on HRT?  Do you have regular monitoring?

Sorry to hear about your breast (and gut) tumours Cblimey but pleased to hear that your breast ones were benign. However I can see why you might be a bit anxious given your history. The connection between HRT and breast cancer is still uncertain and controversial though, and causality not established, although there is some increased risk (of BC through prolonged use of HRT). It does appear that progestogens play an important part but that any increased risk may depend on type and duration of progestogen used. In addition the absolute risk is small, and other lifestyle factors (body weight, alcohol consumption, exercise for example) are thought to play as important, if not more important a part.

This being the case, if you do decide to continue with 25/28 Utrogestan you should be vigilant about changes to your breasts - which I am sure you are given your history, and attend relevant screenings as advised. Progesterone (as opposed to synthetic progestogens) has been described informally as "breast friendly" as a result of some research studies (sorry don't have these to hand). You might eventually decide in consultation with your specialist to consider using progesterone cyclically for this reason - but time for that later!

You can read more about breast cancer risk here:
https://www.menopausematters.co.uk/risks.php
http://wwwmenopausematters.blogspot.co.uk/2016/04/
https://www.menopausematters.co.uk/newsitem.php?recordID=176/Breast-cancer-mortality-and-use-of-HRT
https://www.menopausematters.co.uk/newsitem.php?recordID=175/RCOG-BMS-response-to-Breast-Cancer-Now-Generations-Study-on-HRT-use-and-breast-cancer-risk

I realise you did not ask about breast cancer risk but since you mention your previous tumours and current breast pain, I thought I should also mention the current thinking. As Michelemabelle says though - especially as you have only just started using HRT and much of the concern relates to long term use of HRT, perhaps just tweaking at this point is all you need

I hope your adverse side effects settle soon and you reap the benefits of HRT as many of us do

Hurdity x

[Cblimey]

Thanks Freckles, Michelemabelle and Hurdity.

I've got lots of reading to do!

[Hurdity]

You're very welcome Cblimey - it's always good to be as well-informed as you can. Knowledge is power!!

Hurdity x