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[CarrieM]

I just wanted to say hello to all you lovely, helpful ladies, and to ask for a bit of support regarding utrogestan.

I've been looking at this forum for over 12 months and I've picked up tips to approach my doctor with as she was clueless about hrt but very willing to help me.

I'm 54 and not had a period for 3 years. I've tried several HRT options, Femseven conti, Estradot in varying strengths with utrogestan, and also Livial, but not found the right option for me yet. I'm currently trying utrogestan for the 3rd time, plus an estrogen patch 75mcg. I was "lucky" enough to be referred to hospital for scans/ biopsy due to post menopausal bleeding, so had chance to speak to the menopause specialist, who is a nurse specialist rather than a doctor, but seems helpful. I asked about taking utrogestan vaginally and was told I can't do this. However, after all I've read on here, and also independent research, I decided to take it this way anyway. I'm taking it on a continuous basis but only just over a week into it. Even though I've read a lot about taking it vaginally, I am scared as I'm doing it against advice. This might seem a really silly comment, but I'm worried about where the remnants of the capsule end up ....I never see any residue from it ( eek - too much info??)

I still seem to be getting side effects even though I'm taking it vaginally. I do really want to get this to work though, and I need to persevere with it. Soooo - not sure what the point of my rambling post is, maybe just to get a few supportive comments from other ladies on a similar journey ......

Carrie xx

[Hurdity]

Hi CarrieM

 

Sorry you've been having problems finding the right HRT to suit you. What has been the problem with the various types? How far post-menopausal were you when you started HRT? Sometimes if women start HRT post-menopause and are given continuous combined HRT the side effects due to continuous progestogens can be problematic and give rise to continuous side effects. Although from the bleeding point of view ( lack of it) conti HRT is ideal, if it turns out that adverse side effects don't settle so that the negative effects outweigh the benefits - I can understand women giving up! In these circumstances some women opt to remain on a cyclical HRT which gives a withdrawal bleed - and some (such as myself) with the consent of my doctor (GP), take the progesterone on a long cycle which further minimises the exposure to progesterone.

Your nurse specialist was going strictly by the book when suggesting you could not take Utrogestan vaginally. OK it is not licensed to be used in this way for HRT but heaven knows why since the same preparation is used vaginally for fertility without problem, and it is also used on the continent in this way. Research has shown that more actually gets to the uterus when used vaginally than orally and therefore it is more effective at the same dose. I don't normally recommend going against licensed regimes/self-medication but in this case it is backed up by research. There is a thread utrogestan/estrogel support or similar where I have quoted abstracts from some of the papers, and many gynaes also prescribe it to be used in this way. If you are really concerned then you could do a £25 e-mail consultation with Dr Currie to show to your doctor/nurse (facility on the home page of the main website).

Many women also who take it vaginally prefer not to do this continuously for obvious reasons and especially if in a relationship. Also sometimes the side effects seem to accumulate over time and become relentless - necessitating a break from it! A longer cycle (but the same dose and duration of progesterone) is ideal but definitely would need the approval of your doctor and monitoring of the uterus lining to check it is not overthickening - but it might be possible to consider increasing the cycle to 5 weeks for example? A shorter duration of prog (as part of a cyclical regime) can sometimes be done safely - eg reducing to 10 days - under supervision.

Re the side effects - I use 200 mg vaginally and yes I experience side effects but I prefer to endure these for the benefits of oestrogen only the rest of the time. I also make sure I use plenty of local oestrogen (Vagifem) especially in the week leading up to my progesterone cycle - with the idea that this will minimise systemic absorption of progesterone in the same way that it does for oestrogen - but I have no evidence that this is the case!

I have been using 50 mcg patches since aged just under 54 in late peri-menopause, along with progesterone of some sort for over 10 years now, and I am so pleased that I have done. I found that 50 mcg patches worked straight away, but apart from a few months on low dose continuous oestrogen - have remained on a cycle all that time.

I hope this has given you something to think about - and please do not worry. Hoping you manage to get the right combination this time

Hurdity x

[CarrieM]

Hi Hurdity

When I started HRT I was just over 18 months period free, but for a couple of years prior to that I'd only had periods every 10 months or so.

I initially started on Femseven conti and cut the patches in half for the first few weeks. I felt relief from the flushes within a few days & the only side effect I noticed initially was a slightly low mood but I felt this eased over time. However after about 6 weeks I started getting severe vaginal itching, which I also suffered with in the few years before when my periods were erratic, but just in the week or 10 days before my period came. I assume this must be some reaction to progesterone. I put up with it, and used some of the self help methods found on this forum, as the patches were doing me good in other ways. But after about a year the flushes/ night sweats started to come back so I started to experiment with other types - utrogestan, livial. Livial did nothing for me so I didn't last long on it,although maybe I should have persevered. Taking utrogestan orally was a total pain, I can't go that long without eating in an evening and it made me miserable trying.

The best I felt was in May this year when I used 2 of the 37.5 estradot patches plus utrogestan vaginally every other night.  However I then had some bleeding and was referred to the hospital, so that scared me and I came off everything for a few weeks, the flushes/sweats returning after about a week.
Regarding the femseven conti, when I said it just gave me slightly low mood initially but that eased, well my partner told me in the past week that since I started on that, I became nasty. I was absolutely mortified that I'd been like that for around a year! The meno specialist has suggested trying mirena coil but I'm reluctant to do that as it's twice the dose of the prog that's in femseven, which doesn't agree with me.
I would consider trying a cycle again, although I do prefer not having periods, plus I don't get migraines with conti hrt.
Before I went on hrt, apart from the physical symptoms of the menopause such as flushes, night sweats and joint pain, mentally I felt fantastic. I know from what I've read on this forum a lot of ladies suffer from mood/anxiety issues which HRT sorts out. So I was lucky in that respect.

Hope I've not put anyone to sleep with this long essay!!

Carrie xx

[Hurdity]

Thanks for the update. Haha CarrieM re the long essay - just look at mine!!! I find it hard to be brief as I just type as it comes into my head and I am a very talkative person!

As you felt well with the 75 mcg patches then it sounds like this is the right dose for you? What did the hospital say about the bleeding? Sometimes Utrogestan does not control the bleeding well although used vaginally it tends to work better. If you are using it every other night then maybe your progesterone levels are fluctuating too much - it has a very short life in the body which is why it is used in large doses and daily.

If it works for you and keep the lining thin ( need to have scans to check) and you are happy then that's great. I can understand about the migraines but have you tried using utro cyclically to see how you feel?

It is also recommended to use local oestrogen if you have any vaginal problems (some women need this as well as systemic oestrogen to keep things comfortable) althpough I'm never quite sure what happens when taking utro vaginally as well. When I'm on my Utro cycle I use the Vagifem in the morning - approx 12 hours apart from the  Utro.

Keep us updated as to how you get on?

Hurdity x

[CarrieM]

Hi there

When people use utrogestan cyclically, do they need less estrogen when they are using it alone, then more when the progesterone is being used?

When I had the scans and biopsy, the biopsy came back as " normal" and the scans showed lining at 4.3mm and 3 fibroids. They said all my lady bits looked very healthy. I've been told I can't have regular scans on the NHS just because I'm taking hrt.

I have found since I've been on the utrogestan that I'm not sleeping as well plus I need to get up in the night to the loo, which I didn't do before.

Im going to give it another month or so and see how I go on, then maybe switch to a cycle. That's if I can stand it that long, it was so easy sticking a patch on once a week then forgetting  about it, it's a pain using this utrogestan every night. Plus no local pharmacies could get the estradot so I was given evorel and they're as big as my bottom lol.

Do I need to post on another board if I have any questions or comments? Is there one for utrogestan users?

Carrie xx

[Hurdity]

Hi CarrieM

You can post anywhere at all but perhaps it's best in future if you have another question or comment, to post on All Things Menopause once you've finished introducing yourself as more members will look at that once they remember they've welcomed you! It's easier for those commenting if you stick to the same thread for the same topic and to update, otherwise those reading have to ferret back through old threads to find out what it was someone was waiting for! This one's fine here though

ANyway re the utrogestan - some members seem to find that it has fewer side effects if they temporarily increase their dose while taking the Utro (cyclically) although I've never tried this. I imagine that if the dose is high enough anyway the beneficial effects of the oestrogen might mask the negative utro effects for some?

Yes it has that effect on my bladder too - even though I sleep very deeply these days - it always makes me wake at the times I am taking it.

Haha re the Evorel - I can imagine! I had Evorel sequi for 3 months when I first started hRT and those were Evorel 50 - and they were big enough - the 75 mcg size must be mahoosive!! This is annoying re the Estradot  - seem to be in short supply and this is shocking for something that is widely used. One would think the pharmaceutical company would be wanting their profits and would step up production eh? Mine are rationed to monthly so keep having to go back to get the 2nd and 3rd month owing.

If you have any abnormal bleeding or spotting or unusual pelvic pains then you should be able to get a scan. I don't understand why uterine scans aren't part of the gynaecological screening tests we get - after all we have cervical smears and mammograms so why not womb scans? Yet another example of something that is not seen as necessary - and the implication that HRT is a luxury, maybe?

Do let us know how you get on and fingers crossed that things improve on this regime without too many side effects.

Hurdity x

[CarrieM]

Thanks Hurdity, I'm now thinking of an email consultation with doctor Currie so I can show it to my doctor.
I'm struggling with the utrogestan, not sleeping well and feeling exhausted. I do want to try and persevere for the full 25 days and see if I feel any different on the 3 day break.
If I go on a cycle, is it double the dose for half the month? Makes me think I'd feel twice as bad?
I'll post on one of the other boards next time if comments are more likely to be seen.
Thanks so much for all your comments, I am very grateful
Carrie xx