Hi there all
Last time this subject was discssed in detail I updated the summary of studies into vaginal use of micronised progesterone but have no idea where the thread would be (maybe Jenna you would remember - amazing!!!) so here are the additional studies:
The impact of micronized progesterone on the endometrium: a systematic review.Stute P1, Neulen J2, Wildt L3.
Climacteric. 2016 Aug;19(4):316-28
"AbstractPostmenopausal women with an intact uterus using estrogen therapy should receive a progestogen for endometrial protection. International guidelines on menopausal hormone therapy (MHT) do not specify on progestogen type, dosage, route of application and duration of safe use. At the same time, the debate on bioidentical hormones including micronized progesterone increases. Based on a systematic literature review on micronized progesterone for endometrial protection, an international expert panel's recommendations on MHT containing micronized progesterone are as follows: (1) oral micronized progesterone provides endometrial protection if applied sequentially for 12-14 days/month at 200 mg/day for up to 5 years; (2) vaginal micronized progesterone may provide endometrial protection if applied sequentially for at least 10 days/month at 4% (45 mg/day) or every other day at 100 mg/day for up to 3-5 years (off-label use); (3) transdermal micronized progesterone does not provide endometrial protection."
https://www.ahcmedia.com/articles/134766-endometrial-protection-which-progestogen-is-bestEndometrial Protection: Which Progestogen Is Best?By Jeffrey T. Jensen, MD, MPH
Leon Speroff Professor and Vice Chair for Research, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
March 1, 2015
Extract“The commercially available 4% vaginal progesterone gel (Crinone®) has been evaluated for endometrial protection in combination with transdermal estradiol. This product delivers 45 mg/day, and no cases of endometrial proliferation were observed in a small study involving 35 subjects. However, this is not approved for HRT and is quite expensive.â€
https://humrep.oxfordjournals.org/content/15/suppl_1/149.full.pdfVaginal progesterone in menopause: Crinone® 4% in cyclical and constant combined regimens D.de Ziegler124, R.Ferriani3 , L.A.M.Moraes3 , and C.Bulletti4
Human Reproduction, Vol. 15, (Suppl. 1), pp. 149-158, 2000
"Compliance with hormone replacement therapy (HRT) is notoriously low despite ample documentation of clinical efficacy. The two major reasons given by women who discontinue HRT are uterine bleeding and side-effects. The recent development of a controlled and sustained vaginal progesterone gel allowed single daily application and made prolonged use such as for menopause possible. Here we report our clinical experience with two therapeutic options for HRT using natural progesterone administered vaginally. A first group of 69 menopausal women received the sustained release vaginal progesterone gel, Crinone® 4% (45 mg daily) from days 1-10 of each calendar month with oestrogens taken continuously. A second group of 67 women received Crinone 4% twice weekly in conjunction with continuous oestrogen therapy. Endometrial thickness was evaluated before and after 6 months of treatment. Histological verification was obtained in all cases of abnormal bleeding. At 6 months, 63 out of 69 (91.9%) women receiving progesterone cyclically experienced predictable withdrawal bleeding. The vast majority, 54 (80.6%) of 67 women receiving Crinone in constant combined association with oestrogen therapy, remained amenorrhoeic throughout 6 months of therapy. AH cases of abnormal bleeding were biopsied and no hyperplasia was seen. Our results indicate that both regimens using the sustained release vaginal progesterone gel controlled bleeding in HRT. Combined with the lower incidence of side-effects characteristic of vaginal progesterone, both vaginal progesterone regimens have the potential of improving HRT compliance."
I think the 45 mg dose referred to in the studies and in the Australian review is Crinone gel - which is a idifferent way of delivering the progesterone so can possibly be used at seemingly lower doses.
Re CLKD's comment about vaginal absorption (of micronised progesterone) studies have shown that systemic absorption is in fact higher than with oral use, with higher systemic levels of oestrogen (therefore most likely, higher doses) but not lower, but the metabolites are different - so you could feel worse on vag Utro depending on what it is you are reacting to.
It seems also that most of the work on vag vs oral use has been carried out on low-medium doses of transdermal oestrogen - specifically patches of 25 mcg - 50 mcg per day. Therefore any variation from recommended doses may not achieve full protection of the endometrium, and increase the likelihood and frequency of spotting and bleeding.
Bo - I used alternate day vag Prog with Cyclogest (200 mg) capsules for a few months back in 2011, but was only on 25 mcg per day - and this worked fine for me. However I increased patch to 50 mcg and then discoevered utrogestan subsequently so dwent back to cyclical use.
For you it will be a toss up between achieving complete control of flushes and sweats ( by increasing oestrogen to 75 mcg), or complete control of bleeding/endometrial thickness - by maintaining oestrogen at 62.5 but limiting the prog. If you are under the Chelsea and Westminster menopause clinic and Panay's team then presumably you can experiment and you will be monitored?
Re the cyclical regime - Night_Owl I beleive is under the same team and is also highly prog intolerant (I'm sure she won;t mind my saying as she has posted in the past frequently on here) and she is on a long cycle (but very low oestrogen dose) monitored reguarly through scans. I understand your not wanting a short burst of high dose though - I do 200 mg x 12 days every 6-8 weeks and dread it - although sometimes it is not so bad for some of the time - just a bit foggier than usual.
I do my thing of loading the vag tissues with oestrogen for a week beforehand ( daily Vagifem) and keep on frequently during the utro course, in the (hopefully not misguided) hope that it minimises systemic absorption through the vag tissues.
I am very happy on 62.5 mcg - but as we always say on here "We are all different" !!
This is a ridiculously long post - but a subject I am closely interested in - so I hope some of it is useful
Hurdity x
PS while typing it I see Rhiner has posted and my local GP (gynae specialist) also suggested "stripping" the lining (she used these words) annually with a synthetic progestogen for one of the cycles just to ensure it completely thinned - if you are on a regime that is unlicensed. I did take norethisterone one year for this purpose but have been remiss in going back and asking for it again!
PPS Thanks for posting that Aus review matildamouse - had forgotten about that one...
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Topic: using utrogestan vaginally every other day (Read 10306 times)