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[Fairywoods]

Hi,

I have been on Oestrogel/Utrogestan for 3 months now.  2 pumps plus 12 days of 200 Utro.  The first two months I took the Utro orally but it made me extremely tired.  The third month, I tried 200 Utro vaginally for 12 nights.  I was still tired but not so bad, but by about day 6 of the Utro I felt incredibly low, depressed, tearful and emotional, not like me at all.  The really weird thing was that these low depressions would happen in the afternoon not all day long.

My question is, would it be safe to reduce the Utro to 100 for 12 nights to see if this helps with the tiredness and depression?  Or would that mean I would then need to have scans to check my womb lining?

I went to my GP today but she has never prescribed Utro for vaginal use and said she wouldn't be happy with me taking a reduced dose.  She said she could change me to a different non body identical HRT and also said that "usually HRT is easy".  So I felt like I was making a fuss or imagining things, especially as last time I saw her she told me she had never heard that Utro made patients tired.

I am wondering whether I need to see someone privately as I believe Dr Louise Newson may prescribe Utro at this reduced dose.  It says in Dr Newson's 'Easy HRT Prescribing Guide' that "Utrogestan can be given vaginally on alternate nights as continuous and one every night for 12-14 days each month as cyclical off license".  I'm assuming the "one every night" means 1 x 100mg capsule as she doesn't say the specific dose, although the rest of the section on Utrogestan talks about the 100mg capsules.  She doesn't say anything about scans though.

I'm not sure what to do, whether to try another month of 12 nights/200mg vaginally as licensed or reduce to 100mg vaginally.

Thanks for reading and for any advice.

[Ladybt28]

Ha Ha Fairywoods    GP said that "usually HRT is easy".   What planet does she live on or maybe she hasn't been listening to her patients cos I can't believe everyone sails through!!

I would say that if Louise Newsom talks about 1 every night she would be suggesting 100mg utrogestan as that is the unit they come in. Stellajane is right you need to see if it changes the bleed.  I have read here plenty of times about 1 x 100mg vaginally.  Personally I do 200mg and yes I do get tired and depressed but it's not as bad as when I started it first off.

I think you need to try and see and try for a scan at a later date.  Trust a GP to want to go "changing" cos it's easier for her - what she should be working on is how it is  "easier" for you to use, what you have been using!

[Hurdity]

I agree - reduce at your own risk. Any regime that is off-licence should be supervised by a doctor but it is unlikely that any doctor would agree to this ie monitor you with scans - although as Stellajane says you can arrange this yourself if you can afford it.

How old are you and whereabouts in menopause? Also what are your bleeds like on the current regime? If you are very late peri-menopause or post-meno then maybe you can stretch your cycle a little - make it a bit longer, if your bleeds are fairly light - so eg every calendar month rather than every 4 weeks, and then perhaps go to 5 weeks? The doc might be more willing to monitor you with this regime as you are still going with the same dose/duration.

As a matter of interest my reaction to utro varies each cycle and you might find the same? Sometimes I feel worse than others. Sometimes it builds up so I feel terrible the last few days, and others I feel worse to start with and then get used to it (foggy-headed fatigue) but can still function!

The other thing I do in my longer cycle is the week leading up to startung the vag utro I plump up the vag tissues with Vagifem with the idea that systemic absoprtion of the prog is reduced but I have no idea whether this is actually the case as I haven't read anything anywhere - but makes me feel better anyway  .

Hurdity x

[racjen]

I'm not recommending that you do this as, like everyone else, I don't want to be held responsible, but the guidelines I was given by Dr. Sarah Gray (who's a very well-respected menopause expert GP, she trained Louise Newson) was that the minimum she'd be happy with is 100mg vaginally for 10 days a month. That's with Evorel 100, which is equivalent to 4 pumps of Estrogel. Same advice from Mr. Tim Hillard who runs the Menopause Clinic in Poole Hospital. So if you're only on 2 pumps of gel I'd have thought you'd be quite safe with this.

[Fairywoods]

Thank you all for your replies, much appreciated.  I just felt really bad coming out of the GP appointment, I was expecting more advice but GP was running 40 mins late so maybe she just didn't have time.  Also I got the feeling that she hardly ever prescribes Utrogestan, she was looking up doses and prescribed me far too much for the next 3 months.  From what you say, I think I will give it another month with the 200 as it sounds like my experience may vary and the tiredness may diminish with time - I really don't feel good about going off license, I usually follow the rules!  I would rather not take any medication for menopause but on the plus side, it has really reduced my night sweats and solved vaginal dryness.

Hurdity - thanks for your advice - I'm 52 and think I was approaching menopause before I started HRT, very irregular periods sometimes 3 months apart.  Since taking HRT the first month I had a moderate bleed, 2nd month virtually nothing, 3rd month moderate.  So from what I understand I'm not over doing the Oestrogel (2 pumps) and the 200 Utro must be doing it's job.

The information from everyone on here and also on Dr Newson's website has been really helpful but I'm still a bit conflicted and in some ways I feel I should just get on with it and not rely on HRT.  But now I've started I'm worried I'll feel awful if I come off it and then have to start all over again.  I have read so much over the last few months trying to work out the best thing to do!

Thanks again for your replies, I think I just want to be 45 again before everything started changing!!

[Fairywoods]

Hi Racjen, thank you, I didn't see your reply, I must have been typing mine!

That's really interesting about the guidelines you were given by Dr Gray.  I just wish my GP would say it's ok but she didn't want me to go off license.  I'll see how I get on this month and then maybe reconsider.

Do you take Oestrogel/Utrogestan and what dose please, if you don't mind sharing.  And if you take a low dose of Utro do you have regular scans?  Thanks so much.

[racjen]

So far (for well over a year) I have been taking Utrogestan, supposed to be 100mg vaginally 10 days a month. But I never make it past 8 days - it makes me feel tired, very depressed, gives me stomach pain, insomnia etc. Not worried though as I always have a bleed similar to a normal to heavy period. So am thinking of changing to a synthetic progestin as these allow you to take a much lower dose. Thinking of trying Provera. I did try the Mirena but it made me feel so anxious I had to have it taken out after 4 days. So still a work in progress.

I must admit I am a bit more gung-ho than some on here about following doctors' advice to the letter - tend to trust my own instinct, in combination with medical advice. When I was diagnosed with breast cancer nearly 3 years ago, the surgeon advised me to have chemo first, to see if it would shrink the lump so that I didn't have to have a mastectomy. At the same time, the oncologist advised me quite strongly to have an immediate mastectomy, because the cancer was triple negative and therefore quite aggressive. So two completely opposing medical views of the same problem (I chose immediate mastectomy btw, and so far am still OK). We tend to think of medicine as an exact science, but it really isn't at all, a lot of it is about the personal bias of the dr involved.

[Fairywoods]

Racjen, thank you for replying.  I'm so sorry, it sounds like you have had a truly horrible time with breast cancer and mastectomy and that's quite shocking the two opposing medical views.  It's put my current trivial issues with HRT well into perspective.  I hope you get your HRT sorted, I shall look up Provera and bear it in mind if I continue to have problems with Utrogestan.

Thanks again, and sending you all good wishes on getting your HRT sorted now