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[Furyan]

Hi ladies

Quick question about increasing oestrogen please…

Trial #5 on HRT had me on Utrogestan 100mg orally every 2 days alongside what was initially a low dose Biest cream (estradiol/estriol 0.5mg each). Taking 2mg testosterone daily. This was in the context of going back to square one owing to discovering that insulin resistance had returned with a vengeance thanks to post-M (water and weight retention getting out of control).

Long story short: plan was to stay on this til my 3 month review, however I quickly realised I had to increase the estradiol component, which I did over a 2 week period by adding Estrogel to the compounded cream. Each increase has been better - but not quite. I’ve just ditched the Biest in favour of taking around 3.5 pumps Estrogel in two divided doses AND taking the Utro vaginally every 2 days due to low mood creeping in with oral.

I’m thinking I may have to increase to 4 pumps to eliminate those few remaining symptoms. My questions:
1. Over what period of time do people think is ok to increase oestrogen? They say 3 months but I can’t cope with hot flushes keeping me awake and joint pain, which get better with the increase
2. Finding the morning dose is ok but seems to be wearing off before I’m ready for bed. Is this common for gel? Or should I consider going on a patch for more continuous dose? If I do go for a patch, has anyone ever topped up their patch with gel? Going back on metformin for insulin resistance has been great for stopping weight gain, but also made me realise I need more oestrogen than I thought (used to think it was that causing all my problems).

Hope that makes sense. Any thoughts/experiences appreciated, thank you

[Stella2]

Hi Furyan,
I am sure that more knowledgeable ladies will be in touch but in the meantime my experience of increasing was such that my GP suggested an increase in patches straight away, not gradually. I am not sure if that's the best practice.
I replaced gel with patches due to suggestion that I may receive a more even dose. You can cut estrogen patch so if you need a bit more or less you can do it that way. I think Davina uses a patch and tops it up with the gel, try to Google her routine.
From my experience I started bleeding when I increased my patch from 50 to 65, not even full 75 what my GP prescribed, so it is important to double the Utrogestan dose when above 50 for some ladies.  I am not sure if that's equivalent to 4 pumps but it worth checking. Again, we are all so different so not everyone needs such a high dose of Utrogestan. I could never cope with taking it ever other day, I had to take it daily.
All the best

[Stella2]

I just found the link where you can check different estrogen prescriptions https://www.womens-health-concern.org/wp-content/uploads/2022/11/27-WHC-FACTSHEET-HRT-Doses-NOV2022-A.pdf

I forgot to mention that although my GP suggested immediate change to a higher dose of estrogen I decided to do it gradually.

[Furyan]

Hi Furyan,
I am sure that more knowledgeable ladies will be in touch but in the meantime my experience of increasing was such that my GP suggested an increase in patches straight away, not gradually. I am not sure if that's the best practice.
I replaced gel with patches due to suggestion that I may receive a more even dose. You can cut estrogen patch so if you need a bit more or less you can do it that way. I think Davina uses a patch and tops it up with the gel, try to Google her routine.
From my experience I started bleeding when I increased my patch from 50 to 65, not even full 75 what my GP prescribed, so it is important to double the Utrogestan dose when above 50 for some ladies.  I am not sure if that's equivalent to 4 pumps but it worth checking. Again, we are all so different so not everyone needs such a high dose of Utrogestan. I could never cope with taking it ever other day, I had to take it daily.
All the best

Hi Stella - thanks for sharing that. I was thinking exactly that with the idea of returning to a patch i.e. more even dose. And four pumps is equivalent to 100 patch. A friend of mine shared that she’s on a 100 patch yet taking utro vaginally every day for only 14 days. But as you say, there are some ladies who need to take it whichever way every day. As I’ve increased to 3.5 pumps, I’m thinking I should increase the utro slightly until my review. May be 2 days on/1 day off I dunno. I just don’t want my mood to start slipping low if I take every day that’s all. x

[Furyan]

I just found the link where you can check different estrogen prescriptions https://www.womens-health-concern.org/wp-content/uploads/2022/11/27-WHC-FACTSHEET-HRT-Doses-NOV2022-A.pdf

I forgot to mention that although my GP suggested immediate change to a higher dose of estrogen I decided to do it gradually.

Thank you

[Stella2]

It is so difficult with Utrogestan. I have been taking 200 daily due to breakthrough bleedings and that was difficult. Now I am back on 100 and hope this will be enough. I am lucky to be able to take it daily.
Hope you will be able to find the best dose for you 

[Furyan]

It is so difficult with Utrogestan. I have been taking 200 daily due to breakthrough bleedings and that was difficult. Now I am back on 100 and hope this will be enough. I am lucky to be able to take it daily.
Hope you will be able to find the best dose for you 

Thanks Stella, yes it is hard! Since posting this, I went back to 100mg Utro every night as I didn’t feel every other day was enough and was leading to increased fluid retention again. That’s with between 2 1/2 to 3 pumps Estrogel. Just less than a week in and it seems ok but I’m closely watching my motivation and mood.

Sounds good that you’re back on 100, so let’s hope this is a longer-term thing for you! I said on another thread that I’m open to exploring alternative ways to take it or go for another micronised progesterone altogether, if this doesn’t work out.

[Furyan]

It is so difficult with Utrogestan. I have been taking 200 daily due to breakthrough bleedings and that was difficult. Now I am back on 100 and hope this will be enough. I am lucky to be able to take it daily.
Hope you will be able to find the best dose for you 

Thanks Stella, yes it is hard! Since posting this, I went back to 100mg Utro every night as I didn’t feel every other day was enough and was leading to increased fluid retention again. That’s with between 2 1/2 to 3 pumps Estrogel. Just less than a week in and it seems ok but I’m closely watching my motivation and mood.

Sounds good that you’re back on 100, so let’s hope this is a longer-term thing for you! I said on another thread that I’m open to exploring alternative ways to take it or go for another micronised progesterone altogether, if this doesn’t work out.

Hi Stella - I just posted on another thread about getting a bleed as soon as I upped my estrogel to 3.5 pumps. This may be temporary as I went back to ‘square 1’ with my HRT and this could be the initial breakthrough bleeding bla bla - however, I’m now intrigued that, if it should come to it, I might benefit from more progesterone to balance the oestrogen. I have since decreased my oestrogen due to the bleed, but not sure I can stay this low til my consultant review. My question is, did you experience any side effects with 200mg utro continuous, as I didn’t even consider you could go higher on a continuous regime. x

[Stella2]

Hi Furyan,
Sorry to hear you had a bleed, it must be due to upping your gel. Always good to check with a your consultant when you see them. I was not great on 200 that was prescribed to my by a gynecologist when I had a scan due to bleeding. Initially it was Ok, but later I became very tired and a bit depressed. But i think this is because I was on a low patch. The gynecologist said that I can stay on a high Utrogestan dose indefinitely as it would help to keep the womb lining thin, however GP said that not many women can  cope on such a high dose continuously. Again, there's no harm in taking it just it might affect your mood and energy levels if you are on low estrogen. I think that it is recommended that, if you are above medium dose of estrogen what is 50 patch, you should be prescribed 200 Utrogestan. And in that case it would not affect you badly. There is also vaginal progesterone that can be taken instead of Utrogestan should you have issues. That one comes in 200 mg pessaries. X

[Stella2]

Hi Furyan,
I just saw what you posted on other thread, just to mention that I started bleeding after i switched from oral to vaginal Utrogestan so I wonder if this might also be the reason for your bleed. I went back to oral  as I wasn't sure if vaginal worked properly. X

[Furyan]

Hi Furyan,
I just saw what you posted on other thread, just to mention that I started bleeding after i switched from oral to vaginal Utrogestan so I wonder if this might also be the reason for your bleed. I went back to oral  as I wasn't sure if vaginal worked properly. X

Hi Stella - thanks for sharing your regime. I’m taking my Utro orally and, having read yours and the lady’s post on the other thread, I’m kinda encouraged to try 200mg because I’m desperate to up my oestrogen to 3.5 pumps again. Thought of waiting it out til my review but don’t think my joints and zits breakout will hold out lol. In fact, a friend suggested alternate between 200 and 100 every night, which might be a gentler way to test the water. Reading your experience, I’ll be on the lookout for the moods though. Really appreciate you sharing  :)x

[Stella2]

That sounds like a good idea. Keep us posted x