Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[AKatieD]

I find it daft that the standard dose of P is supposed to be the same for everyone. Am I missing something?

Most medicine dose is individualised - eg Oestrogen - as we all react differently.

We will also have our own different natural production of progesterone, which we don't test to establish before dosing. 

Some people cope fine with progesterone every day, or on alternate days, or for half the month, or twice a week, some not at all

Crinone was tested as effective at 45mg twice a week. GPs worry if you dont take at least 100mg Utrogestan per day. But both contain progesterone (not progestogen) so should have same effect when taken by same route (vaginally) and both can't be the "correct dose".

Some of us struggle with intolerance. Surely it suggests dosage needs to be individually tailored? Studies are needed to establish dosage as current system does not work for everyone?

[Mary G]

I agree, it's far too inflexible.   As far as the UK is concerned, I think the problem is that the NHS don't offer annual transvaginal scans so they over prescribe the progesterone component of HRT to cover themselves but that is not helpful for most women.  Overdosing on progesterone has ruined so many HRT regimes and is one of the main reasons for women giving up on HRT altogether.

That is why some women opt out and go privately because they get more choice with far greater flexibility.   For a number of years I used 100 mg Utrogestan (progesterone) for 7 days each month (sometimes even less than that) with a high dose of oestrogen and my womb lining was anyways well below the limit.  The fact is, everyone is different and another woman could take the same dose as me and have problems but the crucial point it, find out by having a scan, don't just guess and take more progesterone than you need for years on end.

I think the NHS need to review their guidelines for progesterone.

[Hurdity]

Hi AKatie D

Yes there have been insufficient studies into the dosage of progesterone needed to protect the womb - these have mostly been done for low to medium doses of oestrogen and not very high oestrogen doses nor very low ones.

Yes we all respond differently but many HRT products are combined oestrogen and progesterone so the dose has to be worked out that does the job on average.

With separate products for oestrogen and progesterone it is possdible to tweak the dose but only underspecialist help or within licensing guidelines.

So - taking Utrogestan - two regimes are given: 2 x 100 mg for 12 days per 28 day cycle or daily 100 mg for continupis regimes. This may well be too much for very low oestrogen doses and too little for higher doses.

Some work has been done regarding alternate day dosing for vaginal utrogestan (some small studies) showing that half the oral dose can be used if taken vaginally to protect the womb, when taking low to medium dosdes of oestrogen As far as I recall the studies not not include high oestrogen doses.

It is not possible to compare one type of progesterone with another becauase their mode of delovery is different - it is the amount that gets to the womb to protect it that is important . If 45 mg Crinone is sufficient to protect the womb in the same way as 100 mg eg daily use, then it may well be that an equivalent amount is absorbed systemically even though the total dose sounds and is less - if you see what I mean. There will be studies looking into how much is absorbed into the body but I don't have them to hand. There is a thread I bumped recently which looked into some of this - you should be able to tell by the title - something like: vaginal utrogestan some studies...

It's certainly not possible to test how much progesterone you need from testing - because that's not how it works. When we take it as part of HRT we are artificially providing what the ovaries no longer produce or perhaps in insufficient amounts. Protection of the endometrium (womb lining) is the prime purpose of taking progesterone as part of hRT and the doses have been worked out through trials. It is not desirable to work this out by trial and error for every woman - but dosages can be tweaked under medical supervision. If you have a menopause clinic near you perhaps you can ask for a referral from your GP?

I sympathise with your feelings regarding lack of choice - this is echoed by many of us.

Is there anything we can help you with eg with menopausal symptoms or hRT?

 

Hurdity x

[AKatieD]

Thanks, Hurdity.

No I don't need particular help, it is just exasperation at how annoyingly contradictory and unscientific HRT is! I am intolerant to Utrogestan, just started Crinone, but it is all just guesswork/ trial and error as to what will work and what dose is needed.

In comparing Crinone and Utrogestan I was  pointing out the vast difference in dosage that the two options would involve vaginally, given they both contain the same hormone and using the same route of administration, you would expect them to be straightforward to compare.

If 90mg of Crinone twice a week works (in fact the study used the 4% version not the 8% available here) that is a much lower dose than 100mg daily Utrogestan, so it seems there needs to be some work done to establish what is the necessary dose or progesterone level.

I come from a hypothyroid background, which being a hormone based problem, you might think would be similar. But with that there are plenty of great thyroid support groups who advise on how to optimise treatment and health through testing, advice on product selection and dosage.

We need a similar approach with HRT! 😀

[martha]

I have the opposite problem to most people on this forum.

I need a higher dose of utrogeston too help me with my insomnia. I am 58 and take two pumps of oestrogel and 200mg oral utrogeston every day. That dose has been magical in giving me normal refreshing sleep.

My problem is that this is not the standard dose, which is 100mg od in the postmenopausal woman. I have tried twice to reduce the dose back to 100mg and my unrelenting insomnia returns. I am worried that when I ask for a repeat prescription my GP will not prescribe me that dose because it is not the standard dose in the BNF.

I did increase the dose from 100mg to 200mg without consulting with me GP. Progesterone is a relaxing hormone so I thought I would try and increase. The effect was magical. I had endured three months of NO sleep, or if I was a asleep it was very light sleep with terrifing anxiety dreams. As soon as I doubled the utrogeston I had my first good night's sleep, and it has continued unbroken, but as soon as i drop the dose back down, within 2-3 days the insomnia is back. I have practised all the sleep hygiene measures going. I have even changed my double bed for a superking. This is after 33 years of marriage. The bed is so big that we can wave to eachother from the sides, but it is a hike to get together, but at least we can both starfish without touching.

I feel that the problem is chemical, and lies in my brain. It makes it impossible to relax . I do all the relaxation exercises but a few minutes later I realise that I have mucular tension in all muscles but particular my eye muscles and I have to consciously relax them again. My brain is wide awake as soon as my head hits the pillow. I have pronounced tinnitis. Yet when I take 200mg utrogeston every day, none of this happens and I am back to my normal self.

[sheila99]

Have you tried increasing oestrogen? I have insomnia when my oestrogen levels are too low.

[pollywollydoodle]

I have the opposite problem to most people on this forum.

I need a higher dose of utrogeston too help me with my insomnia. I am 58 and take two pumps of oestrogel and 200mg oral utrogeston every day. That dose has been magical in giving me normal refreshing sleep.

My problem is that this is not the standard dose, which is 100mg od in the postmenopausal woman. I have tried twice to reduce the dose back to 100mg and my unrelenting insomnia returns. I am worried that when I ask for a repeat prescription my GP will not prescribe me that dose because it is not the standard dose in the BNF.

I did increase the dose from 100mg to 200mg without consulting with me GP. Progesterone is a relaxing hormone so I thought I would try and increase. The effect was magical. I had endured three months of NO sleep, or if I was a asleep it was very light sleep with terrifing anxiety dreams. As soon as I doubled the utrogeston I had my first good night's sleep, and it has continued unbroken, but as soon as i drop the dose back down, within 2-3 days the insomnia is back. I have practised all the sleep hygiene measures going. I have even changed my double bed for a superking. This is after 33 years of marriage. The bed is so big that we can wave to eachother from the sides, but it is a hike to get together, but at least we can both starfish without touching.

I feel that the problem is chemical, and lies in my brain. It makes it impossible to relax . I do all the relaxation exercises but a few minutes later I realise that I have mucular tension in all muscles but particular my eye muscles and I have to consciously relax them again. My brain is wide awake as soon as my head hits the pillow. I have pronounced tinnitis. Yet when I take 200mg utrogeston every day, none of this happens and I am back to my normal self.

It is chemical, or at least hormonal - you're pumping out adrenaline at the wrong time of day. The adrenaline surges could be because your oestrogen dose isn't high enough/is too high, but if you feel comfortable on that dose in terms of other meno symptoms, leave it and continue with the progesterone. Another option is progesterone cream - you could continue with the 100mg utro and add a pump of cream, usually dosed at 20/25mg per pump. The cream definitely works for me and there may be other women on 'alternative' section who have the same results. Do you still have sweats/adrenaline surges at other times of day?

[pollywollydoodle]

Thanks, Hurdity.

No I don't need particular help, it is just exasperation at how annoyingly contradictory and unscientific HRT is! I am intolerant to Utrogestan, just started Crinone, but it is all just guesswork/ trial and error as to what will work and what dose is needed.

In comparing Crinone and Utrogestan I was  pointing out the vast difference in dosage that the two options would involve vaginally, given they both contain the same hormone and using the same route of administration, you would expect them to be straightforward to compare.

If 90mg of Crinone twice a week works (in fact the study used the 4% version not the 8% available here) that is a much lower dose than 100mg daily Utrogestan, so it seems there needs to be some work done to establish what is the necessary dose or progesterone level.

I come from a hypothyroid background, which being a hormone based problem, you might think would be similar. But with that there are plenty of great thyroid support groups who advise on how to optimise treatment and health through testing, advice on product selection and dosage.

We need a similar approach with HRT! 😀

Wholeheartedly agree AKatieD - my intolerance of these sledgehammer doses of prog/progestin was so pronounced that I discussed a hysterectomy with my GP and she referred me to gynaecologist for further discussion. It was removing large chunks of my life whichever way I tried it, it wasn't just whilst using it, it was at least a week afterwards too. What's interesting, and seems to track for those women who try, is that a 50mg dose of usp progesterone whether as alt night vaginal utro or compounded prog, is beneficial and without issues. I'm not using standard HRT anymore for a variety of reasons, but I find around 20-30mg of topical progesterone really useful, no sedation, no bloating, no brain fog, no black moods, in fact quite the reverse, I feel really good. Obviously, this dose isn't suitable to use alongside oestrogen hrt, but it has proved to me that it was the dose and not the prog itself that caused all the problems.

As ever, it comes down to cost, and I understand that this type of reduced dosing requires bi-annual scans to ensure there's no issues, and the poor old NHS is being hammered from every direction, unable to provide that level of screening for women who are otherwise 'well', hence the one size fits all doses. I've no idea how many women are suffering in silence with these doses vs. the number who are absolutely fine with them, but one thing I have noticed is the new generation of menopausees are just not willing to put up with it, and it's a good thing, raising awareness and pushing for change needs to happen so maybe it's your generation alongside the 'money pause' media types who will make that change. I hope so.

[AKatieD]

Indeed, you are right, polywollydoodle. 

Unfortunately as usual with NHS, it is being shortsighted costwise as if the studies/ scanning was available there could be a corresponding reduction in
- wasted meds if women are taking too much,
- wasted g.p. time from trying to sort out problematic progesterone intolerance and long term health problems if don't take HRT
- saving in other long term health costs if women live more healthily

As you suggest, because it is being so widely promoted now, perhaps manufacturers and NHS will see point in putting money into HRT to improve treatments.

[martha]

I have no other menopausal symptoms. No hot flushes or night sweats. I have no anxiety or panic attacks during the day.

I am loathe to increase my oestrogen dose as I worry that it will be one more thing I have to maintain. My body seems to like homeostasis and it seems to get dependent on things and does not like any change. If I stop medication I often get adrenaline surges. It happened when I stopped amlodipine.

I think I am going to try and stay on two doses of oestrogel and 200mg of utrogeston as I know that combination works.

[pepperminty]

Yep the progesterone dose in Femosten is the same for the low and medium HRT tablet.

I think they really need to trial more types of progesterone doses and types to give more choice. and monitor wombs more regularly. Unfortunately the model is cure not prevention.

So short sighted in the long run.

PMXX

[pollywollydoodle]

AKatieD - the issues around slim choice on preparations and doses needs to be highlighted pan media, that's the only way manufacturers will take notice, Pharma only worry when the demand dries up and that's not likely, so lack of choice needs to be highlighted, preferably by a 'sleb'.

[pollywollydoodle]

I have no other menopausal symptoms. No hot flushes or night sweats. I have no anxiety or panic attacks during the day.

I am loathe to increase my oestrogen dose as I worry that it will be one more thing I have to maintain. My body seems to like homeostasis and it seems to get dependent on things and does not like any change. If I stop medication I often get adrenaline surges. It happened when I stopped amlodipine.

I think I am going to try and stay on two doses of oestrogel and 200mg of utrogeston as I know that combination works.

It really sounds like you've found your perfect dose, it would be really unreasonable for your GP to refuse to work with that. I'm sure there must be other women who need 200 daily to remain well. Maybe do a search online and take any evidence to your next appointment.

[sheila99]

As well as the difficulty getting testosterone only because there is no product licensed for women in the UK.

[pollywollydoodle]

Yep the progesterone dose in Femosten is the same for the low and medium HRT tablet.

I think they really need to trial more types of progesterone doses and types to give more choice. and monitor wombs more regularly. Unfortunately the model is cure not prevention.

So short sighted in the long run.

PMXX

Pepperminty - if you do a search for progesterone/progestin, there are dozens of types available, it seems shoddy that only a few have been selected for use in hrt. There are dozens of progestins available in different doses and routes for birth control so I don't see why that couldn't be tweaked for hrt. There's also a vaginal ring "Progering" used in African and South American countries for birth control amongst breastfeeding mothers, it releases 10mg per day of progesterone directly to the uterus, this is something that could definitely be modified for hrt use. Crinone is another progesterone prep that we don't here much about but I believe it has sustained release and could therefor be less powerful in its effects than utro. There needs to be more demand, employers are losing out from sick days, the NHS is losing out from repeated GP and clinic appointments, it's surprising things haven't changed, the so-called 'gold standard' is anything but that for many women and the risk from progestin over progesterone is exaggerated. We need more options.