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[Nicola Winter]

Is there a minimum break requirement for peri ladies taking Uterogestan? The day I stop uterogestan I bleed heavily until I take it again. 2 weeks heavy bleeding is just unbearable. I get run down, mouth ulcers etc. Can I just break for 2 or 3 days or does it have to be 2 full weeks?

[Nas]

Maybe take it continously instead, not sure.
2 weeks bleeding must be horrendous for you and you shouldn’t bleed for that long really. Maybe a different progesterone would be better.  🌸

[joziel]

If you're still bleeding that heavily it's likely that if you took it continuously you would just get breakthrough bleeding all the cycle instead.

You might want to try a Mirena coil? That is known to be really effective for reducing bleeding to almost nothing and provides the progesterone for HRT too, so you just need the estrogen.

[Nicola Winter]

The doctor said I can't do continuous because I'm peri and I had a Mirena before and reacted badly. I'm not sure what else to do. I asked the doctor if it might help to reduce the oestrogel and she said she didn't think so but to be honest, I don't think she really knew  🤷‍♀️

[joziel]

You probably need to try a different progesterone. Eg the Evorel Sequi or the Femseven Sequi patches both use different progesterones. (I think levonorgestrel and norethisterone off the top of my head...)

It is known that some women have bleeding issues on the body identical utrogestan. Probably this will happen less when you are menopausal so you could try switching back to body identical in many years time if that's important to you....

[McPeri]

Hi Nicola - how many pumps of oestrogel are you on? You can take utrogestan continuously at any point, but often people who are not ready for it will bleed. However, if you were on a low enough dose of oestrogel (e.g. up to 2 pumps) you might not.

You could always try it and see how you get on. The heavy bleeding suggests you might struggle with bleeding while on continuous utrogestan but you won't know until you try. If you think about it, things like the Mirena and the pill can stop bleeding continuously so there is nothing inherently wrong in a no-bleed regime. It is more about whether or not it will work for you.

Alternatively, you could try a continuous regime of a progestin like Provera to see if you tolerate that. The Mirena seems to be best for stopping heavy bleeding but, like you, many of us just can't cope with the synthetic progestins (as good as they are).

Also, how do you take the utrogestan? More tends to be absorbed where it is needed (uterus) when taken vaginally. You could try it that way on a continuous regime and see if it stops the bleeding or, at least, reduces it to a more manageable level. If you are nervous about no break at all, it can be taken with a 3-day break only. But do some research and ask your GP to do the same - they are getting paid for it.

If your GP is a bit in the dark, it would be good to see a menopause specialist who can give the GP options that are known to be effective.

Also, might be good if they checked your blood levels for iron, B12, Vit D, etc, if not already done.

[Nicola Winter]

I was on 2 but the doctor has said go to 3 to improve libido. I'm just thinking could I do 200mg of uterogestan and take 100mg orally and the other 100mg vaginally and try that for 15 days? I've only been taking 100mg orally. I started vaginally but it's hard to take that way when I keep bleeding 🤦‍♀️

[McPeri]

Hi Nicola, from what you have said, you are on a moderate amount of oestrogel so nothing to cause worry there.

I don't think taking one tablet orally and one vaginally will make much difference because the one you take orally will lose a lot of its effect going through your digestive system. Utrogestan is usually more consistent and better absorbed taken vaginally, if that suits someone.

The usual dose on a cyclical regime is 200mg per night orally for 2 weeks (or 12 days but 2 weeks easier to remember).

200mg orally is equivalent to 100mg vaginally according to Newson Health, and the research does bear this out. If it were me, I would use 100mg vaginally for the 15 days and see what happens while you are taking it, and when you stop taking it (should get a withdrawal bleed). This way you are actually increasing the amount of oestrogen you have been taking to date (100mg orally).

If vaginally doesn't suit, move to the prescribed cyclical dose of 200mg orally for 2 weeks.

Some women who have problems with breakthrough bleeding take 200mg vaginally for 2 weeks to increase the progesterone. You should discuss this with your doctor.

[McPeri]

Sorry - just realised I said you would be increasing the oestrogen (end of para 4) Progesterone is what I meant!  ;
Meno brain at play.

[sheila99]

According to the manufacturer the dose is 200mg x 12 days however you take it. I would try 200mg vaginally and see if it makes a difference. You could ask for a scan to see how thick the lining is just after your bleed and to rule out anything else such as fibroids.

[Hurdity]

Hi there

I agree with sheila 99 - try vaginally at the licensed dose first - though no harm in doing this for 14 days - for a few cycles and see what happens to your bleeds.

Do you know where you are in menopause ie what were your cycles like before staryting HRT?

Otherwise the option is either to increase the duration - which could be up to 25 days per 28 day cycle ( of 200 mg vaginally) though depending on how strong your cycle is you may get breakthrough bleeding - or increasing the dose for the 14 days eg to 300 mg.

The BMS do not recommend halving the vaginal dose and nor do the manufacturers.

Also thumbs up to the advice for your doc to check out if other causes of the heavy bleeding - important for these not to be potentially overlooked.

Hurdity x