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[SaraUK]

Hi ladies, I’m confused about the utrogestan dosage. I’ve been on cyclic utrogestan orally 200mg 14 nights per month for 2 years with 2 pumps of Oestrogel.

Since January I’ve been told to up to 3 pumps of Oestrogel Then continuous utrogestan at 100mg per day, which didn’t improve my bladder issues and made me experience severe anxiety after 6 weeks. (Blood test showed 159 estadiol after 2 weeks of being on 3 pumps).

so I asked to up to 4 pumps. Dr said yes but I’ll have to double up my utrogestan dose.

So my question is, is that right, 4 pumps or more need double utrogestan dose?

I’m proving intolerant due to increased anxiety, so I’m stuck.

[Bandango42]

I believe with higher doses of oestrogen you need a higher dose of progesterone to ensure the lining is kept thin.

Having said that there are many women who take 100mg utrogestan continuously with higher doses of oestrogen. That was what I was prescribed 6 months ago. I opted to increase to 200mg continuously to control bleeding. BMS guidelines state for women on high doses of oestrogen, progesterone can be increased to either 300mg sequentially or 200mg continuously to control bleeding.

I guess do what you feel comfortable with, if you are progesterone intolerant, 200mg continuously may not suit.

[Penguin]

I recall people on here talking about a recent change in guidelines saying that higher doses needed more utrogestan. But gosh, 300mg, that's harsh and wouldn't be worth the suffering for me.

Have you tried using estrogen topically, like Vagifem, to help with bladder issues? I've seen a lot of women on here say that systemic hrt isn't enough, and they need vaginal as well.

Blood tests, especially in peri (are you in peri?) are notoriously unreliable and are just a snapshot of a given time. I did a month of private testing two years ago and my estrogen fluctuated on a daily basis in the luteal phase then, so they could have caught you on a bad day systemically when they did the test. But perhaps the vaginal estrogen would make more of a difference to your bladder if you feel okay apart from that?

Penguin

[sheila99]

They used to say that 100 utro daily or 200 x 12 days was sufficient for up to 4 pumps though I think they might have changed this recently. There are plenty of people on the original dose though. Your problem may not be lack of oestrogen but the continuous use of utrogestan. If your only issue is va you might be better reverting to your original dose and sequi regime and using topical oestrogen as well. Many people have to use both. Anxiety can be caused by both too little and too much oestrogen and also by utrogestan (and many other things too!).
  Did you have other uncontrolled symptoms on 2 pumps?

[SaraUK]

I recall people on here talking about a recent change in guidelines saying that higher doses needed more utrogestan. But gosh, 300mg, that's harsh and wouldn't be worth the suffering for me.

Have you tried using estrogen topically, like Vagifem, to help with bladder issues? I've seen a lot of women on here say that systemic hrt isn't enough, and they need vaginal as well.

Blood tests, especially in peri (are you in peri?) are notoriously unreliable and are just a snapshot of a given time. I did a month of private testing two years ago and my estrogen fluctuated on a daily basis in the luteal phase then, so they could have caught you on a bad day systemically when they did the test. But perhaps the vaginal estrogen would make more of a difference to your bladder if you feel okay apart from that?

Penguin

Yes I’ve been on vagirux every other day since May 2023 and daily since November. No change since November hence my worry. I even requested vagifem last month still no change.

[SaraUK]

They used to say that 100 utro daily or 200 x 12 days was sufficient for up to 4 pumps though I think they might have changed this recently. There are plenty of people on the original dose though. Your problem may not be lack of oestrogen but the continuous use of utrogestan. If your only issue is va you might be better reverting to your original dose and sequi regime and using topical oestrogen as well. Many people have to use both. Anxiety can be caused by both too little and too much oestrogen and also by utrogestan (and many other things too!).
  Did you have other uncontrolled symptoms on 2 pumps?

My bladder issues started last May. At first vagirux worked but when I went to twice daily it came back within 48 hours. I then did every other day for a few months which worked until November when I’ve had continuous daily bladder problems and external burning. I’ve used ovestin nightly for 3.5 months. Still no change.

I’ve come off utrogestan on a long 13 week cycle with provera for 2 weeks at 10mg in 11 weeks al to rule out progesterone intolerance due to horrendous panick attack on continuous at 6 weeks.

Still got bladder and external burning at 3 weeks in.

[Hurdity]

Hi ladies, I’m confused about the utrogestan dosage. I’ve been on cyclic utrogestan orally 200mg 14 nights per month for 2 years with 2 pumps of Oestrogel.

Since January I’ve been told to up to 3 pumps of Oestrogel Then continuous utrogestan at 100mg per day, which didn’t improve my bladder issues and made me experience severe anxiety after 6 weeks. (Blood test showed 159 estadiol after 2 weeks of being on 3 pumps).

so I asked to up to 4 pumps. Dr said yes but I’ll have to double up my utrogestan dose.

So my question is, is that right, 4 pumps or more need double utrogestan dose?

I’m proving intolerant due to increased anxiety, so I’m stuck.

My bladder issues started last May. At first vagirux worked but when I went to twice daily it came back within 48 hours. I then did every other day for a few months which worked until November when I’ve had continuous daily bladder problems and external burning. I’ve used ovestin nightly for 3.5 months. Still no change.

I’ve come off utrogestan on a long 13 week cycle with provera for 2 weeks at 10mg in 11 weeks al to rule out progesterone intolerance due to horrendous panick attack on continuous at 6 weeks.

Still got bladder and external burning at 3 weeks in.

Hi SaraUK - I'm not clear what you mean about your cycle? Do you mean you recently stopped Utrogestan altogether and started a long cycle of Provera for 2 weeks? But you said in your frist post on the thread that you've been discussing increased utrogestan?

For the record - the licensed dose of Utrogestan is 200 mg for 12 days per 28 day cycle or 100 mg days 1-25 (or continuously in practice). However no dose of oestrogen is given to match this progesterone dose.

The amount of progesterone required to protect the uterus from over-thickening through oestrogen stimulation is dose-dependent ie as a rule of thumb higher doses of oestrogen require higher doses of progesterone - on average - though obviously individual women will vary in their response.

The trials for utrogestan were carried out, as far as I understand, with low to medium doses of oestrogen as these were the standard doses for post-menopausal women that Utrogestan was seemingly, originally intended for. https://www.medicines.org.uk/emc/product/352/smpc#gref . More recently and especially in UK I think ( though I don't know) women are being prescribed higher doses of oestrogen but there has been no change to the licensed progesterone doses. If you look at the HRT menu on this website for example, eg at some of the tablet HRT which use norethisterone as the progestogen - when the oestrogen dose is doubled, so is the norethisterone dose.

Hence the guidelines from BMS have allowed for the fact that progesterone at the licensed dose may not control bleeding and have suggested increases as Bandango stated.

Re what your doctor said - if you do want to continue with utrogestan but are not able to tolerate 300 mg, then are you able to suggest to your doctor that you are scanned after a few cycles to check the lining, ie whether it is overthickening on the higher oestrogen dose when you are keeping to the same utrogestan dose? You would need a scan immediately after the withdrawal bleed. If you are still peri-menopausal then the lining will vary with your natural cycle as well.

The fact that your oestrogen levels seem low (notwithstanding the inaccuracy of spot testing of estradiol as Penguin says) could indicate that you're not absorbing and that your womb lining may not therefore be overthickening.

Also be guided by what your bleeds have been like?

Hurdity x