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[Furyan]

Hi Furyan and discogirl, thank you very much for your replies, apologies I have not been back on in a couple of days to respond, my cat has been very ill and I have been back and forth to the vet and not online much.

When you cut them width ways, how do you ensure it is half? As even with measuring, the pessary is a different shape at each end (pointed at top and narrows down at the bottom) so I don't know if the two halves would be equal? Or do you think it doesn't matter too much as if you do each half on subsequent nights it adds up to the one complete one anyway? That is what I have got stuck on and why I was trying to cut length ways, though as you say that is tricky and not v successful!

Thanks again, it is just one more complication on this whole complicated menopause journey!!

Flossy - sorry to hear about your cat, it is a worry I know. Hoping for a speedy recovery x

[Hurdity]

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

[Kathleen]

Hello again ladies.

Hurdity - You make some very good points about the safety of Cyclogest. I saw an NHS consultant recently who was concerned that there hadn't been any studies on its use for HRT. He said that my regime may not be enough to protect the womb lining and I should use a pessary every night.

 I was happy to try this but Newson Health only provided enough for alternate use and when I asked them for more they said this wasn't necessary as the amount required for my prescription was correct.  In the past there have been some supply issues with Cyclogest so this may have been another reason why NH couldn't send me any more.

I haven't had any bleeding on this dose and my 1mg of  Sandrena gel is about the equivalent of a 50 mcg patch so not a particularly high Oestrogen dose.

It is a worry though and another example of the differences in prescribing between the NHS and private clinics.

Wishing you well and take care.

K.

[Mary G]

Kathleen, it sounds like you are taking the right dose of progesterone and not drowning out your oestrogen with too high a dose. 

I'm assuming you have regular uterine scans?  If so, there is no need to guess how much progesterone you need because you and your doctor can work it out for yourselves.  The point is, if you have regular scans you can afford to be flexible and take less progesterone because there is no guess work involved.

The NHS cannot afford to routinely scan women which is unfortunate because they are missing cancers other than uterine cancer that are picked up on transvaginal scans.  Therefore, the NHS over prescribe progesterone to cover themselves because they can't support women who deviate from the rigid NHS guidelines - I don't call talking to someone from the other side of a desk supervision, the only meaningful form of supervision is a proper transvaginal scan.

As we know, most private clinics (I'm sure Newson are similar) will not prescribe HRT until they can see a scan showing a post bleed womb lining measurement of less than 4mm or if on continuous HRT it must always be under 4mm.  5mm is normally considered to be the danger line in both cases but the private clinics are ultra cautious.  Some women have a problem keeping their womb lining at safe levels and they need constant supervision, obviously via scans.

[Hurdity]

The NHS cannot afford to routinely scan women which is unfortunate because they are missing cancers other than uterine cancer that are picked up on transvaginal scans.  Therefore, the NHS over prescribe progesterone to cover themselves because they can't support women who deviate from the rigid NHS guidelines -

I will take issue with this - although as we know, the NHS is far from perfect and the menopause treatment woefully underfunded, nevertheless awareness and treatment of menopause has moved on considerably in the past 10 years and many women and their more knowledgeable GPs as well as NHS menopause specialists happily work with women to give them individualised treatments based on their symptoms, which may deviate from the standard licensed doses and regimes - which is as it should be.

Of course the licensed treatments must provide progestogens at the doses required to prevent endometrial thickening for the majority of women - even so there will be some for whom even this is not sufficient. There is nowehere that says these doses must be adhered to come what may.

Hello again ladies.

Hurdity - You make some very good points about the safety of Cyclogest. I saw an NHS consultant recently who was concerned that there hadn't been any studies on its use for HRT. He said that my regime may not be enough to protect the womb lining and I should use a pessary every night.

 I was happy to try this but Newson Health only provided enough for alternate use and when I asked them for more they said this wasn't necessary as the amount required for my prescription was correct.  In the past there have been some supply issues with Cyclogest so this may have been another reason why NH couldn't send me any more.

I haven't had any bleeding on this dose and my 1mg of  Sandrena gel is about the equivalent of a 50 mcg patch so not a particularly high Oestrogen dose.

It is a worry though and another example of the differences in prescribing between the NHS and private clinics.

Wishing you well and take care.

K.

I can understand your concern and as Mary G says - presumably you will be having regular scans for peace of mind?

As I say regularly, (and this is in no way a criticism), this is not an option for many women due to cost and therefore we have to do the best we can within the system available to us, and encourage women to work with their doctors using whatever information they have, to individualise their treatment.

Hurdity x

[Kathleen]

Hello again ladies.

I have been with Newson Health since the end of 2019 and they have never arranged or helped to arrange a scan for me.  I have had investigations for bleeding but this has always been through the NHS. My last scan earlier this year showed no problems and a lining of 2mm.

I am sure that some private clinics do insist on scans etc but that has not been my experience with NH.

I think the consultant was worried that there is no research to prove that my regime is safe and that is why he suggested I use more Cyclogest to be on the safe side. As I explained this is a bit difficult because my GP doesn't prescribe it and NH do not think I need any more.  I am also a little worried that more Progesterone will impact my mood and I don't want to have to increase Oestrogen at the moment.

Perhaps I should arrange my own scans in the future if only for peace of mind!

Wishing you well ladies and take care.

K.

[Mary G]

Kathleen, I'm sorry, I wrongly assumed your NHS consultant had scanned you and given you a full health check/examination but it sounds like he was being generic and quoting the NHS line re progesterone.  If he is a gynaecologist/obstetrician he will not necessarily be an expert on HRT/menopause and it sounds like he's ripped up your HRT regime from behind a desk based on nothing, not even a scan.  I think that is dreadful.

If you had a scan earlier this year and it came out at 2mm then you are being put through a load of worry unnecessarily.  I would definitely do my own thing and arrange my own scan once a year for peace of mind.

[Furyan]

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.