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[Loubylou]

So after not agreeing with utrogestan as it made be bloat, awake at night and awful wind I was given a vaginal bio identical pessary called Lutigest.

I was asked to take it for 12 days 100mg. I was worried because it is a big tablet but also because of previous side effects with rapid weight gain and emotions.

So, I have been taking it for 14 days now. I am now losing weight instead of putting it on. I feel a lot calmer. People have been telling me I look good. I was only supposed to take it for 12 days but I want to carry on and take it for 21 and then have 7 day break. Is that ok?? My natural progesterone levels are practically zero through early menopause and I thought that If was taking the pill as hrt as I have done before I would be taking 21 days combined estro and progest anyway. What do you think?

I also have 50 estradot patch that I change twice a week.

So the lutigest is great! However, the discharge is a lot!! It is watery and thick white discharge due to the tablet breaking down. I'm single at the moment but in a relationship I'm not sure its good for a sex life.

[Dotty]

Hi I don't think many ladies have experience of this progesterone but I would do as your doctor prescribed. Or ask your doctor if you can change the length of time x

[Perinowpost]

I haven't heard of this progesterone Loubylou but as I'm prog intolerant I will watch with interest. Thanks for bringing it to our attention x

[Hurdity]

I thought this sounded familiar as I remember posting about it here:
https://www.menopausematters.co.uk/forum/index.php/topic,40628.msg643922.html#msg643922

... and this is what I said about it:

It would be interesting to see how it works in terms of sdie effects. May only comment would be if you compare the doses used in fertility treatment Lutigest is given 3 x per day ( ie 3 x 100mg = 300 mg), and vaginal Utrogestan the same frequency (ie 3 x 200 mg = 600 mg) ie twice as much implying that Lutogest is more concentrated - but maybe the formulation is such that more gets to the uterus easily - and hopefully fewer side effects!

We'd love to have a description of the tablet and how you get on with it!

racjen I've talked about dosing on another thread today in response to your comment - can't remember where now!

Hurdity x

Presumably there won't have been any trials looking at how much is needed to protect the endometrium if used as part of HRT but its dose for fertility is a guide - so if it's twice as concentrated (in terms of the formulation and how much is absorbed) compared with utrogestan then 100 mg for cyclical use sounds as though it could be about right.

 Progesterone levels are always low or very low during peri-menopause because when you are not ovulating you do not produce any - not in large quantities anyway.

It is unlikely to do you any harm if you continue to use it for 7 days longer than prescribed but with low doses of oestrogen and when you are post-menopausal - sometimes an excess of progesterone can overthin the endometrium. Why not try it for a but longer and see how you get on, and mention to your doc too?!

Hurdity x

[KiltedCupid]

Loubylou - not sure if you're still out there and come on the forum occasionally, but I'd love to know the outcome of your trial with Lutigest.

I hate hate hate Utro and had all the symptoms you describe plus more. I'm about to run out of fem7 conti patches so need to find an alternative prog. This might be of interest to other Scottish ladies too, as I believe there might be a ? over Utro prescribing here.

If anyone knows Loubylou please let me know.

[Clovie]

Loubylou - not sure if you're still out there and come on the forum occasionally, but I'd love to know the outcome of your trial with Lutigest.

I hate hate hate Utro and had all the symptoms you describe plus more. I'm about to run out of fem7 conti patches so need to find an alternative prog. This might be of interest to other Scottish ladies too, as I believe there might be a ? over Utro prescribing here.

If anyone knows Loubylou please let me know.

Also in Scotland, also interested 

[KiltedCupid]

It's an interesting one. Hopefully the drums will beat and Loubylou will reply.

[bear]

Hi girls,

Here's a recent review of the clinical efficacy of vaginal progesterone for luteal phase support that includes Utrogestan (capsules), Lutigest (vaginal tablets, also marketed as Lutinus and Endometrin), Crinone (vaginal gel) and Cyclogest (pessaries). I know nobody here is interested in luteal phase support for reproduction purposes  , but the interesting part is about 'comfort and tolerability'.

https://reader.elsevier.com/reader/sd/pii/S1472648318300555'token=50A3283062E23F2E8F4815C44F54BA1F1FF983FE76C21059F0DD65DA7F5FB1DC54F30EC1A81641506F3F9AE8F2ECC6F0

'Where patient-reported outcomes such as comfort and tolerability were measured, some studies did show variability in terms of patient preference between the regimens. Five studies investigated patient preference and convenience (Bergh et al., 2012; Ludwig et al., 2002;Ng et al., 2003, 2007; Simunic et al., 2007). Four of the five studies included Crinone in one of the treatment arms, and all subsequently identified Crinone as the significantly preferred intervention, over Cyclogest (in one study) and Utrogestan Vaginal (in three studies)(allP<0.05) (Bergh et al., 2012; Ludwig et al., 2002; Ng et al., 2003; Simunic et al., 2007). The reasons stated for preference of Crinone included: ease of administration, convenience for daily use, lower incidence of leaking, discharge and interference with coitus. The fifth study presenting patient-reported outcomes compared Cyclogest with Endometrin and found a significantly greater number of patients reported difficulty with administration of Cyclogest over Endometrin(P= 0.002) (Ng et al., 2007).'

I suspect Utrogestan 100mg is not marketed in the UK for vaginal route because Lutigest 100mg vaginal tablets might still have some sort of commercial designation industrial property.

BeaR.

[Hurdity]

The key question re all the progesterones and their use as part of HRT is primarily their efficacy in protecting the endometrium and secondly, of course their tolerability, the chief part of which relates to their systemic absorption (at the doses needed for endometrial protection), as it is this aspect which seems to be most problematic for many women (the local irritability etc being minor).

Maybe as other HRT preparations are gradually phased out (if they are that is) then more research will be carried out into these other preparations at various doses so that we have more choice. Although not licensed for HRT Cyclogest has long been used for this purpose and there have been studies looking at Crinone and Cyclogest and the endometrium.

Hurdity x

[KiltedCupid]

BeaR - thanks for the info, really interesting. Just to clarify, it's the Crinone which ladies found most comfortable to use and with least side effects? Do you know if it's available, even off licence, for hrt use?

[Hurdity]

Crinone is theoretically available off-licence for HRT - if you do a search you should find members who have used it. I think Night_Owl is one - through NHS - but menopause specialists I think at the C and W. I don't think she got on with it - but I don't want to speak for her. From memory it used to be available at 4 % but now only at 8% which is too strong for many women re side effects. You can find it listed on our database of medicines.

https://www.medicines.org.uk/emc/product/1283/smpc

Iif you look at the studies I posted on the thread about vaginal utrogestan you will see the review of progesterone studies (the last one I posted) which includes reviews about Crinone. Also there was a paper specifically about this one:

"Endometrial Protection: Which Progestogen Is Best? 2015
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

https://www.ahcmedia.com/articles/134766-endometrial-protection-which-progestogen-is-best

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.”

Maybe start another thread specifically about Crinone (or post on an old thread if there is one!) so that interested members can find information easily?

Hurdity x

[bear]

BeaR - thanks for the info, really interesting. Just to clarify, it's the Crinone which ladies found most comfortable to use and with least side effects? Do you know if it's available, even off licence, for hrt use?

Hi KiltedCupid,

CRINONE ® was produced by Juniper Pharma Services, a former UK company which was developing an intravaginal ring with bio-identical progesterone and bio-identical estradiol for HRT.

https://seekingalpha.com/filing/3930569

Page 9 under Hormone Replacement Therapy.

‘Our Solution – JNP-0201

We believe that JNP-0201, our combination estrogen and progesterone IVR product candidate, has the potential to offer patients multiple benefits as compared with currently available therapies, including: integrated administration of natural progesterone and natural estrogen; improved patient compliance; improved side effect profile; and continuous local vaginal delivery of natural hormones, while eliminating the need for daily administration.'

Unfortunately Juniper has been acquired by Catalent in July 2018. 'Catalent will continue to support Juniper's CRINONE® (progesterone gel) franchise marketed by Merck KGaA outside of the U.S. Juniper's Intravaginal Ring development pipeline was previously licensed to Daré Bioscience, and Catalent will not be involved in the further development of this program.'

Fortunately, Daré Bioscience seems to be initiating DARE-HRTI (Intra Vaginal Ring, combination bio-identical estradiol + bio-identical progesterone) phase 1 this year in Australia.

https://darebioscience.com/pipeline/

Let's hope they succeed!

BeaR.

PS. Yes, according to that study, the subjects found Crinone was the most comfortable and yes, I think it's available off licence for HRT, but it's very expensive and the dose (90mg) is not significantly different from Utrogestan (100mg), but it might suit those women who have intolerance to Utrogestan's inactive ingredients (sunflower oil and soya lecithin).

[KiltedCupid]

Oh BeaR - that ring sounds awesome! Good detective work.

Would you please update the forum if you come across any updates on it, I know I'd be interested.

Yes, I suspected the thorn in the side of Crinone would be £££'s. No harm in asking gp though - shy kids get no sweets, as they say.

[bear]

Of course, KiltedCupid  and keep us updated on your GP's reaction when you ask for posh Crinone 

BeaR.

[KiltedCupid]

Of course, KiltedCupid  and keep us updated on your GP's reaction when you ask for posh Crinone 

BeaR.

Will do. I'll ask for Crinone or Lutigest and see what happens.