They are not meant to be cut!
I used cyclogest for the first 4 years or so of HRT - prescribed off-licence by my GP but I was prescribed 400 mg per day for 11 days per 28 day cycle. That was probably too much.
Also all progesterones are not created equal! 100 mg cyclogest does not necessarily equate to 100 mg utrogestan in terms of protection of the uterus. Are there specialists who are recommending cutting them in this way and using half a cyclogest per day in place of utrogestan?
If you look at the dose for luteal support for utrogestan and cyclogest, the dose for cyclogest is 800 mg per day and for utrogestan 600 mg day so as a very rough guide a third as much cyclogest would be needed - if uterine protection is comparable. This would be 130 mg per day for continuous use - obviously not possible but maybe possible to shave a bit off the cyclogest (?with a sharp potato peeler or sharp kitchen knife) - though without knwoing how and where the progesterone is distributed throughout the cyclogest pessary, it is difficult to say whether this woud affect total progesterone and absorption of whatever is left.
As for 1 quarter of a cyclogest - why?? It just is not designed for this.
I do understand that we are limited by the doses of progesterone available and in some cases, especially those taking LOW doses of oestrogen, a smaller dose of 50 mg may be better, but in the meantime this can be approximated by alternate day dosage of utrogestan or maybe every third day of cyclogest (in consultation with your doctor).
Back in 2011 I think it was I discussed with someone on here (unfortunately the posts have been archived so I can't find them) about how much cyclogest would be needed, and through various calculations came up with 200 mg cyclogest every third day for a 25 mcg oestrogen patch! At the time I was returning to HRT having stopped for 3 months and doc suggested lower dose. I did try this regime for about 6 months but because symptoms came back I then increased patch and started Utrogestan. A bit off the point but just to illustrate that it is not that straightfoward and care is needed as well as medical supervision in order to protect the womb. MY GP was happy with this and I had no brekathrough bleeding.
The BMS in their progestogens paper do equate the two but I haven't delved into the literature to see whether this is based on research trials (using Cyclogest) but on first look I don't think so, as it is not licensed for HRT. Maybe there is more information now?
Anyway those comments are meant to sound a note of caution and especially those on higher doses of oestrogen - cutting these cyclogest pessaries may be endangering your womb lining so do make sure you are under medical supervision
Hurdity x
Hi Hurdity - is there guidance specifically saying they shouldn’t be cut or who exactly has advised this? There are licensed professionals who advise they can be if needs must and if alternate day dosing hasn’t been recommended for whatever reason. The point being that different professionals advise different ways to take these pills. I don’t know if you are a medical professional working with women taking different types of regimes, but the views/ideas mentioned in this and other threads are evidently not just those of MM members but mostly have their foundation in what they’ve been told by medical professionals who are monitoring them - clearly differs widely. You ask why would anyone would cut a (200mg) Cyclogest into quarters. As I am one such, I’ll answer: I personally was on a low dose of oestrogen and Utrogestan 100mg every other day until I started bleeding continuously because I slightly upped the oestrogen. Equated to 50mg daily, but the difference for me is that my bleeding stopped on Cyclogest and I also figured I might benefit from daily, rather than alternate day, dosing. Utrogestan does not allow for this flexibility. As you said, not all progesterones are created equal, including that produced by our own bodies. Sometimes not even our own bodies respond ‘equally’ to the dosings depending on our hormonal profile and needs at the time. Any licensed professional worth their weight will have an evidence base from which to work from, but are usually flexible around this and advise their patients according to their needs. If that involves cutting a tablet into doses that the individual can tolerate then so be it. As long as women are working safely in partnership with their physician, I think we have to take a creative approach to how we take this and that
within safe parameters - the whole point of different HRT regimes is to offer flexible options to better suit the individual if ‘standard’ methods do not work for them.
After saying all that - I’ve just again lowered my oestrogen and can therefore cope happily on alternate day dosing of Utrogestan. But if, at any point, I need to increase my oestrogen again, I will once again consider Cyclogest cutting - with consultant blessing.