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[HopeAlone]

I'm new to hrt but have learned lots from this site by reading posts. I would like to ask your advice as I'm not quite sure of the answer for this .
I'm perimeno and just started femseven sequi but I don't seem to be able to get them to stick properly. Tried all the advice I read on here but still having problems. Anyway I was thinking of asking my doctor for estradot 50 and utrogestan. I know the utrogestan is 200 for days 15 - 27. My question  is if I decide to try it vaginaly is it still 200 or would I need to lower dose to 100 ?
Thank you x

[Dancinggirl]

I'm not the expert on this but I think many women use just 100mg when using Utro vaginally - this is not licensed here in the UK but private gynaes do OK this.  Your GP probably won't agree to you using Utro vaginally.  Hopefully Hurdity will be along to advice but I think she still uses 200mg for 10-12 days vaginally. You could try Provera and have the full dose orally for 10-12 each month? Dg x

[Mary G]

If you are on a 50mcg patch and taking Utrogestan vaginally every month for nearly 2 weeks then I think 100mg is easily enough. 

[Hurdity]

Hi HopeAlone

The advice is generally to start with the licensed dose and take it from there depending on how your womb behaves. No-one can say categorically that a particular dose "is easily enough" although it could be. It depends on your own womb lining, where you are in peri-menopause, whether you have fibroids or other (common) abnormalities of the womb and also how thick your lining is when you start the regime.

If you read the estrogel and utrogestan support thread (very long) in this section ( maybe a few pages back....) there is a lot of information on there about utrogestan and links to research - where some studies are quoted that show that less is necessary when used vaginally.

Personally I would start with the licensed dose - which is 200 mg Days 15-26 inclusive (ie only 12 days not 13!) and see how you get on.

Yes Dancinggirl is right in what I use (well remembered!) - but I am taking it on a longer cycle ( with the docs approval) as I am in my 60's and well post-menopause, and wasn't getting a bleed with a monthly cycle.

Hurdity x

[HopeAlone]

Thanks for getting back to me ladies.
I suppose I could try the utro orally first but my main concern is it seems to cause a lot of ladies to feel sedated. It could be good for my anxiety but I don't want to feel comatosed. I will have a look at that thread properly as I have a few more days before seeing my doctor who by the way is very supportive of this site.
Is estradot in supply at the moment as I read there was some problems ? X

[Mary G]

HopeAlone, the progesterone debate comes up time and time again on here. 

The only way to be 100% certain you are getting the right dose of progesterone is to have a uterine scan, everything else is guesswork to a large extent and no doctor can tell just by talking to you from the other side of a desk.  The NHS licensed dose is a 'catch all' dose which tries to cater for worst case scenario because routine uterine scans are not offered on the NHS. Most women will be OK with a lower dose of progesterone but some will not and of course there will be women who take the maximum (licensed) dose and still have problems with lining build up.  It is not an exact science or a one size fits all situation.  You will not know until you have tried the progesterone and established how well you tolerate it and preferably had a scan to make sure everything is OK.  Many women don't have any problems with progesterone but if you find that you do, the only way to make HRT work for you is to reduce the progesterone dose and have scans - a far better option than either suffering or giving up on HRT completely.

I am progesterone intolerance and was prescribed 3 pumps of Oestrogel every day and 100mg vaginal Utrogestan for 7 days each month (although I ended up taking even less than that under supervision) and I have never had a problem with lining build up but of course some women might.

If the other patches didn't stick, have you considered Oestrogel?  You simply rub it on your skin, it is very flexible and easy to adjust the dose up or down.

[Hurdity]

Hi again HopeAlone

Sorry I didn't make make myself clear. By starting with the licensed dose - I meant just that - the dose ( ie 200 mg vs 100 mg initially and decreasing under supervision depending on various things I mentioned) - not the route of delivery and of course it is fine to use it vaginally even from the start because there is no increased risk to your womb lining and in fact most would suggest a reduced risk through vaginal use. I have never taken it orally and would never do so due to the potential side effects from the metabolic by-products after going through the liver.

There are problems with Estradot supply although for me it is always there - it is just rationed so my 3 month supply prescription is given out month by month. It has always worked brilliantly for me since I started in late peri-menopause. As Mary G says - gel is an alternative transdermal method if the patches are not suitable for whatever reason and it is a matter of preference as well as absorption.

Hurdity x

[Katia]

Utrogestan is a love it or hate it. You have to try it.  It made me comatose and not in a good way. Even my eyes looked foggy. The progesterones that seem to agree with me are the third generation ones: desegestrel, gestodene and norestimate. Unfortunately none of these are yet available in HRT. There are some other progesterone if utro doesn't agree with you.

Hurdity, I asked my consultant about using utro vaginally when I was struggling with it and he said no that it wasn't licenced for use like that and couldn't be guaranteed to be safe. I even had a study from Europe on it, but he wouldn't budge.

[HopeAlone]

I think I understand now I can use the utrogestan 200 vaginaly for 12 nights or orally ?
We did talk about the gel at my last appointment and as my doctor has not prescribed it before I think she was quite keen lol. I would be her guinea pig. Is it better to start on a lower amount of pumps ?
I have a lot of time on my hands at the moment so I am doing a lot of reading on menopause and mood disorders as this is my main symptom along with the sweating. X

[Mary G]

HopeAlone, I think you could take 100mg Utrogestan vaginally or 200mg orally because you lose up to half of it in your digestive system.  My (German) gynaecologist always prescribes it vaginally but stresses that the capsule should be placed next to the cervix so try and find an old thrush applicator or similar.  It does work better when used vaginally and it also has fewer side effects.

I would definitely recommend Oestrogel if you can get hold of it.  2 pumps of gel is roughly the equivalent of a 50mcg patch or 1mg oral oestrogen.  I find 2 pumps of Oestrogel to be very effective and it was the only type of HRT that finally got rid of my endless sweating problem and all other menopause symptoms.  I split the dose and use 1 pump in the morning and 1 pump at night to keep the oestrogen levels even.  Like you, I found patches didn't stick properly and didn't deliver enough oestrogen into my system to get rid of the sweats.  Oral oestrogen didn't work for me either but obviously everyone is different. 

So give it a go!  I really hope this works out for you. 

[Dancinggirl]

It can be beneficial to start on just one pump of gel
Per day for the first couple of days. My gynae recommended this as it allows the body to adjust gradually. The body does store some oestrogen and I found 2 pumps per day too much. You can gradually increase over several weeks till you find the perfect amount to use each day to control the flushes. DG x

[HopeAlone]

Well ladies you have helped me make my decision I am going to ask for the gel and utrogestan. I will discuss the options of taking the utro with my doctor and see if she will allow me to try the vaginal route of 100mg if I struggle with the 200 orally.
She may need to look into it herself so will take it as prescribed until then .
I'm not using anything at the moment        ( last patch came unstuck) so will it be ok to start the gel straight away and start the utro at the weekend when I would of been applying the phase 2 patch of femseven?
Starting on 1 pump sounds good advice as well as splitting the dose when I increase to 2. I want to stay on a low as dose as needed as I've read lower may be needed in peri, can't remember where I read it or even if it's true.
I really hope it helps with my mood. I sort of feel unsettled and on edge. is it normal for your mood to fluctuate by the minute it seems.  I'm on maximum dose I think of AD so there's no room to manoeuvre there.
Thank you all for your help and advice x

[Dancinggirl]

Great Stuff Hopealone - you can suggest your GP looks at this site or perhaps better to print off the relevant info from this site to show them - can make things easier all round.  This site is linked to NHS Choices and is clinically led by a gynaecologist so the GP should be OK with all this.
I'm afraid the oral versus vaginal route may be a sticking point without specialist gynaecologist advice - vaginal route is licensed in other countries and is used for IVF in the UK, so why it isn't recommened for HRT is a mystery!!!!

Anyway, I'd try oral first - some like the positive effect on sleep but if you don't get on with this, you could experiment with vaginal.  I found the Utrogestan used vaginally irritated my ‘lady bits' while others find it brilliant - you see, we all different. Good luck. DG x

[HopeAlone]

Thanks DG
My doctor knows all about this site and Dr  Currie and knows I find all my information from here and is all for it.
I hope taking the oral route works as I don't think I have a problem with progesterone. I never had pms or pnd and took oral and depo contraception over the years no problem so I don't know if that is a positive sign.?
Is it true that progesterone is the first hormone to decline in the lead up to peri ? As I think this is when all.my problems started well before any change in my periods x

[Mary G]

HopeAlone, it is entirely up to you to decide how to take Utrogestan.  It is the same capsule for both oral and vaginal use so you don't need a different prescription.  For some weird reason the UK is the only place that doesn't license Utrogestan for vaginal use so it must be a fault in the system somewhere because there is no logical reason for it.  So don't let anyone tell you that Utrogestan cannot be used vaginally because it definitely can, the boxes I buy in Spain state it clearly.  I thought all drugs had to be approved for all EU member states by the EMA in Canary Wharf so it is odd that there are discrepancies. 

It sounds like you tolerate progesterone well so that is a positive sign.  I would start the gel immediately and you should feel your mood lift after a few days.

Good luck!