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[Spangle1512]

Hi

I have been on HRT for 3 years now, but recently I’ve started noticing low mood and anxiety when taking utrogestan (200 mg for 2 weeks on, 2 weeks off as I’m still having periods).  My doctor suggested I use them vaginally instead so I started doing that on Saturday but since then I have really bad urinary frequency.  And I’m really confused about the doseage,  the doctor said to take the same dose vaginally ie 200mg for 14 days but the Louise Newson website says it should be half the dose.  Can anyone clarify for me.  Thanks.

[joziel]

Progesterone vaginally can have the opposite effect to estrogen up there - ie - it can make everything less controlled and more relaxed and more prone to leakage and needing to go to the toilet.

With the dosage, there is some controversy on that one. Newson still recommend half the dosage. Other BMS drs recommend the same dosage...

[sheila99]

How much oestrogen are you on? If a low/medium dose *probably* OK with half the dose, if a high dose better to stick to the full dose or have regular scans to make sure the lining isn't building up. But I'm not a doctor.

[Spangle1512]

I’m on a 50 patch

[Hurdity]

There is no real controversy on this - the licensed dose specified by the manufacturers is for the same dose to be used  vaginally as orally. This is correct.

That being said, there have been trials with SMALL numbers of women, showing that for low to medium doses of oestrogen, HALF the amount of progesterone can be used to give the same protection to the womb compared with oral delivery. Note the oestrogen doses - low to medium. This has not been tested on high doses if I recall correctly - in the same way that all doses of progersterone are dose dependent ie more prog needed for higher doses of oestrogen, yet most docs just prescribe the licensed dose ie 200 mg for cyclical and 100 mg for conti use.

The danger is therefore extrapolating this finding to cover ALL women and ALL doses of oestrogen including the higher doses of oestrogen that are often prescribed today especially by some private clinics. The BMS gives the correct view - has researched the literature and come up with recommendations based on the evidence available.

As sheila says though too, therefore, as you are on a medium dose of oestrogen, you may well be OK but my recommendation would be to take it as your doctor suggests - but 12 days per 28 day cycle unless there is a medical reason for you to take it for 14 days, as it is 12 days that is the licensed dose.

Start off with this and see how you get on re bleeding etc - if you end up having almost no bleed then perhpas venture into 100 mg vaginally.

By the way I always get urinary frequency when on the utro phase of my cycle - especially at night when I have to get up, whereas I don't normally provide I don't drink too much (of anything) in the evening.

Hope this helps

Hurdity x

[Spangle1512]

Thank you so much for such a thorough reply.  I’ve switched back to orally because the urinary frequency was so bad (like you it always increases pre period but it was every hour with the vaginal dose).  But from my next cycle I will reduce to 12 days per month and see how my mood is. 

[meno-mel]

Hi Spangle1512, I found this same thing when I started using utrogestan vaginally, I lost a lot of bladder control at the time and a few days afterwards when it still felt irritated.

I use vagirux and I found it seems cancelled out by using utrogestan in the same place at the same time.

So I'll start my utrogestan today, but I'll try it rectally this time. Utrogestan in the morning because it has me too wired for sleep if taken in the evenings, so vagirux in the evening.

I have permission from the menopause clinic to use utrogestan vaginally instead of orally because I get no depression that way and reduced digestive disturbance, but they said I must use the full oral dose even though it may well have double the relevant absorption to where it's needed.

It's all trial and error. They start you on the cheapest HRT then as you complain the cure is worse than the disease you gradually get better and better versions until you hopefully end up with something tolerable.

[Spangle1512]

Thank you Meno-Mel

Interesting you had the same thing with the bladder.  Did your depression with progesterone start instantly.  I was fine up until spring (having been on it 2.5 years.