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[Ramona]

Hello,

I am posting here as I am a bit confused about my Utrogestan prescription. I've searched the forum for info and have found some really useful things but I wonder if anybody can comment on the following?

I have been taking Sandrena gel and Utrogestan for about six months now. I take 100mg Utrogestan daily, no break. I am 47 and perimenopausal (started symptoms about 3 years ago).

I have really good care via my GP and am an outpatient at the hospital menopause clinic. I couldn't tolerate any of the progesterone I was first offered (all of them gave me severe panic attacks) so I was given Utrogestan and gel combo end of 2018.

The Utrogestan is much better and I no longer get the panic attacks. However, since the new year my mood has been very low and I am tearful all the time. I am less able to make decisions, my mind is in a fog, and I get upset about everything however small. My partner commented that he has noticed my mental health deteriorating since that time, too.

I have a history of depression (and am on citalopram to help manage this) so I rang my GP today. He thinks the mood change this time could be the Utrogestan and has suggested I do a test and take Utrogestan for only half of each month and see if that makes a difference.

I agreed to do this but reading this forum and other info online it suggests that if Utrogestan is taken only part of the month that the does should be 200mg. My GP did not suggest any increase of dosage.

Has anybody else had similar issues or know whether the right dose might need to be 200?

I really appreciate you reading this long and rambling message. Reading it back it is symptomatic of my recent inability to make decisions on anything.

Thank you all and very best wishes

Ramona

[Ladybt28]

Hey Ramona - welcome - nice to have you aboard.  I think that the issue may be that your Sandrena gel is not high enough.  you don't say what dose you are on or what age you are? I have trouble with progesterone and cannot  take it continuously.
I too have a history of depression and had really bad brain fog.  Testosterone got rid of the brain fog for me but it doesn't work like that for everyone.  I am 57 and post meno. I am on 5 pumps (just increased it from 4) of gel which is considered very high, but it works for me.  If it was working before then I'm not sure it is the Utrogestan that's the problem.

Tell us about the sandrena dose?  I was off AD's for 4 years after 40 years on and recently had to have a short course back on Sertraline which I'm off again because all the meno symptoms (and boy did I have them ALL!) went with the right hrt regime but I was just left with a crippling bout of depression. Mine was since xmas too.

[Ramona]

Hello Ladybt28

Thank you so much for your helpful reply. I am so sorry you too have been suffering with a mix of menopausal symptoms and depression. But so glad the right HRT combination is having good effects for you. It can be so hard working out what is caused by the menopause and what is the lifelong depressive illness - they are getting so bound up together.

I hadn't considered the Sandrena being the issue but that is a good suggestion. I currently use a 1mg gel sachet a day; it was originally half that but that was not working at all. I am 47 and have had peri symptoms for about 3 years now. I think I will try a double dose this evening

Thanks again and hope your HRT mix continues to help you

Ramona

[Ladybt28]

What happens as we go through peri towards full menopause our bodies change again Ramona and the levels of hormones our own bodies produce deplete and so we need more "hormone replacement" to make up for it before they fizzle out altogether!  That is possibly why you need more gel from when you started and maybe will continue to have to up it as you go through to full meno.  We don't use Sandrena gel here, I use oestrogel but there are ladies here on the forum who use it and post about it.  Have a search and see if you can find out what the maximum dose for it is and keep that in mind.  Someone like Hurdity or a Sandrena lady might be along soon tell us the max dose?

Play around with it and see how it goes - good luck x

[sheila99]

Hi Ramona and welcome. As you're peri you should be on a cyclical hrt not a continuous one. I have no experience of sandrena  but I am on utro and take 200mg for 12 days per cycle. I'm also in peri. If you don't already take it vaginally that would be worth trying too. Taking it cyclically has the advantage that you can tell if you feel worse when you're on it. Many ladies have no problems with it but it makes me tired. As ladybt says it could also be that you need a higher dose of oestrogen.

[Ramona]

Thank you both so much. Your advice is really helpful and much appreciated.
I will try a combination of both suggestions - taking the Utrogestan in bursts and upping the dose of gel

All the very best

Leila

[Denise Didi]

It does seem strange all the different doses we are given. 200mg for days 17 -28. Try the NICE GUIDELINES  and see what it says

[Ladybt28]

Hi Denise Didi - the doses of Utrogestan depends on the cycle you are running and/or whether your are taking it continuously and/or combined with whether you are taking it orally or vaginally.

I take mine on a cycle vaginally and my gel and utro cycle is longer than that under NICE guidelines. Some consulant's run different cycles depending on their patients reactions to progesterone in general.  It's all about what each person can tolerate.
NICE guidelines for instance do not talk about using it vaginally only orally nor does the drug leaflet in the box in the UK talk about using it that way, and to use it that way in the UK is considered "off licence".  However, drug leaflet in Europe says for "vaginal use" and some meno Consultants know it can be used that way.

It is commented on the forum and elsewhere and with some consultants that 100mg is enough used vaginally because it is localised insertion and absorbed through the walls where it is needed, but 200mg is for oral use because when taken orally the drug potency is reduced by stomach acid and filtered through the liver before entering the blood stream.

[Hurdity]

Hi Ramona

Just to add - yes you should be taking 200 mg x 12 days per cycle if you change from continuous Utro to cyclical - this is the licensed dose. As Ladybt points out this can be varied under medical supervision by doc who knows you and your womb and is prepared to monitor you, and as she says many menopause clinics and private gynaes especially, can personalise the regime.

The Sandrena dose for one sachet is only 1 mg though whereas the standard dose for Oestrogel (also known Oestrodose on mainland Europe) is 1.5 mg (two pumps). I switched from patches to gel (Sandrena) for a while and was also on one sachet per day but because my symptoms returned I didn't do the increase as I had been happy on patches.

Personally I would increase slowly if you are going to - and use 1.5 sachets for a few weeks and see how you feel.

In your position though I would only change one thing at a time and if it were me I would start with going cyclical for the utrogestan - but entirely up to you which you go for first, of course!

Good luck and hope you feel better soon

Hurdity x

[Ramona]

Thank you all so much for taking the time to post (and sorry for my delay in replying). This is such a confusing time! I realise how little I know about my own body which is pretty shocking.

Thanks again and hope you are all faring well

Ramona