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[Bo]

Hello everyone i am new to this group/forum and have been reading many posts which have been very helpful. I haven't been able to find anything on this specific question though:

I am 55, 3 years post-menopause. Have Hashimoto's since August 2015 - on 62.5 mg of Levothyroxine and one natural dessicated thyroid tablet every day, and have been stable on this for some months now. I started BHRT (Oestrodose 2 pumps per day and Utrogestan 100mg one a day x 25 days) on the 8th July. I wanted this because after 4 years, my flushes showed no sign of easing or stopping. It took the oestrogen about 3 weeks to get to maximum effect (which has still not eradicated my flushes but they are much better). Within 5 days of starting both, i started to have side-effects which i think are from the progesterone. I didn't do well on prog cream before, so there's a clue. I also had PMS most cycles too. I took the prog for only 15 days, then stopped for a week. I didn't have a bleed, and went to the GP with my concerns about the side-effects. He said to continue for 3 months and see how i got on. However, i have been taking the prog again since 8th August and have had enough of...very sore boobs, 'flat' emotion (mostly that, with some mild anxiety & irritability), loss of enjoyment in my sport, some brain fog, lethargy, quite bad back/shoulder/neck pain, lank hair.
So, yesterday i decided to 'take' the prog vaginally (i had asked my GP about this and he said he couldn't sanction it but knew he couldn't stop me trying). I have read in the forum that generally we do not need as high a dose as when taken orally. My question is: what are the general guidelines on dosage when used this way? And a second question...how are the uterine scans carried out? Ultrasound?
Thank you 

[Bo]

Before my post drops off the first page...can anyone help with my questions? Or point me in another direction where i can research further? Thank you 

[Hurdity]

Hi Bo

 

There are so many new members and new posts that if a member doesn't visit for a few days - it's almost impossible to keep up! Sorry!

There are lots of threads on this - maybe the best one being the Estrogel and Utrogestan support thread - which has lots of pages! https://www.menopausematters.co.uk/forum/index.php/topic,23372.0.html. I suggest you put your feet up ( if you can!) and have a read as I expect that will tell you all you need to know!

I am sure your side effects are due to continuous oral progesterone - I have never taken it orally and never continuously due to side effects.

In a nutshell:

Utro is not licensed for vag use as part of HRT in UK - but there is a 200 mg vag preparation for fertility.

HRT Utro used to be available in 200 mg capsules but they were discontinued ( which leads to some docs mis-prescribing doses!)

Both of these capsules are exactly the same - ie the oral and the vag ones!

Elsewhere in Europe ( I know about France) vag use is given as an alternative to oral use if there are side effects - but the dose given was similar - just an alternative route.

Some limited research ( you'll find the papers in that thread) demonstrated that used vaginally approx half the dose was effective in protecting the uterus compared to oral use. However the research is limited - and will depend on individual women, whether there are any pathological issues with womb ( fibroids, endometriosis etc), as well as the dose of oestrogen and cycle length.

Some private gynaes ( and a few knowledgeable nhs docs) are happy to prescribe Utro for vag use in prog intolerant women. In practice many women actually just take it upon themselves to use it this way.

Therefore there is no standard recommendation/dose for vag use so if you were going to reduce the dose or cycle length this needs to have the approval of your doc to monitor how your endometrium responds to your individualised regime - eg  by regular scanning until you know what to expect.

That was a bit of a big nut!!!

Hope this helps

Hurdity x

[Mary G]

Bo, I am progesterone intolerant and take 100mg Utrogestan vaginally for 7 days every 5 or 6 weeks.  I am on a super low dose because I have such a severe problem but I do have regular uterine ultrasound scans and this dose if fine for me and gives me good thinning and clearance.  The scan consists of a probe which goes inside the vagina and checks womb lining measurement, ovaries, bladder plus other things like fibroids and it is very worthwhile. 

So my advice is if in doubt, take a lower dose of Utrogestan and have regular scans which are good for your overall health anyway.

It really is ridiculous that Utrogestan still isn't licensed for vaginal use in the UK when it is practically everywhere else. 

[Hurdity]

I agree it is ridiculous that it is not licensed for vaginal use - but there does not seem to be a problem with this provided there is sufficient dose/duration to protect the lining.

Just because Bo has said she doesn't get on with taking Utrogestan orally on a continuous basis, does not mean she is an extreme case of progesterone intolerance that warrants the short cycle you are advocating Mary G.

Once again I will add Dr Currie's post on this matter:

Just to confirm, while Professor Studd is very experienced and extremely knowledgeable, his regimens are not always in line with current recommendations, particularly around use of progesterone.
As always with providing menopause advice, this should be individualised and flexibility should be applied, as long as there is a clear understanding of national and international recommendations. Some women are intolerant of progestogen and progesterone and so it is appropriate to adjust the regimens, as long as it has been fully explained and discussed.
Best wishes
Heather

Bo - the first thing to do is to try it vaginally and also perhaps to discuss with your doctor changing to a cycle and having a withdrawal bleed if this is what you would prefer?

Hurdity x

[weathergirl]

Prometrium/Utrogestan is not licensed in the U.S. for vaginal use either.  In fact, my practitioner (she's GYN/OB) told me the reason I cannot get Crinone (I asked and wanted it!) is because they no longer use it as a vaginal progesterone - specifically when treating progesterone deficiencies in pregnancy.  She said women taking progesterone for pregnancy issues are now also given Prometrium orally as opposed to vaginally, by most doctors in the U.S. because results from oral administration are better for the intended effect (in pregnancy).   

With all the women who experience oral progesterone difficulties, it seems a so lousy that there have been NO extensive or rigorous, well-designed studies of the use of natural progesterone vaginally.  Or do they just not care and expect us to take the gels orally and be done with it?   Really a shame. 

[Bo]

Thank you SO much for your replies everyone.

I was originally put on Utro 100mg for 25 days out of 30. The idea being that i would have a withdrawal bleed (i didn't when i stopped after just 15 days but GP said that's not unusual when first starting on any hrt, or indeed hormonal contraceptives).

I saw the posts on here which said that Utro 200mg is used vaginally for fertility problems. I then researched online to find the excipients/capsule content and saw that they are almost identical - one has sunflower oil in the capsule, the other peanut oil - so i figured it wasn't going to cause any harm. I will continue this 'cycle' (up to day 25) using the Utro vaginally and then go back to GP to tell him what i am doing and see what he thinks of reducing the amount of days i have to 'take' it. I will also ask about scans - they sound like ultrasound scans.

Also today, i decided to try splitting the Oestrodose, er, doses  - one pump twice a day, 12 hours apart, instead of two pumps once a day - to see how i get on with that.

Thanks again everyone, i really appreciate it. What a fab resource 

[Cassie]

I use 100mg for 12 days a mth with a yearly scan. Would rather have a withdrawal bleed than use it continuously.