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[Artmouse]

Hi all,

I've recently started taking Evorel 50 with 100mg of Utrogestan daily.  The instructions with the Utrogestan were to take it every evening.  I seem to be reading that some people take it for 25 days then have a break though, I'm not sure why this is and whether I should be doing it?  My GP didn't really explain anything (I'm not sure whether she knows much about HRT to be honest) and it's such a mission to get an appointment that I thought I'd see what other people on this regime tend to do or if anyone knows about it. 

Have only been on it for a week and a half and so far so good, no funny side effects yet fingers crossed...

[Hurdity]

Hi Artmouse

It is strange that the licensed regime is for 25 out of 28 days and the thinking is probably that if there is any lining that had built up during this time, then the 3 days off would allow a small bleed. In practice many women take it continuously without a break and their docs are happy for this to happen. However if you experience spotting on this every day regime then the 25/28 dosing might be preferable. The problem with the 100 mg dose is that itls "one-size-fits-all" dose so no difference is given for high or low doses of oestrogen - whereas in practice the amount of progestogen need to protect the womb is dependent on the dose of oestrogen.

Good luck let us know how you get on

Hurdity x

[Artmouse]

Thanks   So the progesterone is to stop the lining building up?  Sorry, I really have no idea and the doctor didn't explain anything at all.  I was also wondering how you would know whether your periods had stopped naturally if you were taking this.  Confused.com!

[Hurdity]

Hi Artmouse

You are only supposed to take it 25 days out of 28 if you are post-menopausal - although the 3 days break may work also if you are late peri? If you are still getting periods every 2 or 3 months or so then you should be on the 200 mg x 12 days per 28 days dose. The instructions should say this - there are different dosing regimes for peri and post menopausal women.

Those women who start HRT before they reach menopause ( like many of us) never quite know when they reach menopause because of the artificial cycle. The only way to find out is to stop all HRT and if you don't bleed for 12 months then you are post - but there is no need to know this!

Yes progesterone stops the lining building up if it's given at the right dose for the amount of oestrogen. If it is given cyclically ( ie as above for half the month) then it is designed to alter the lining that has built up while taking the oestrogen, and then it is shed once you stop the progesterone.

Does that clear up the confusion? I hope so!

Hurdity x

[Artmouse]

Hi there,

Feeling confused.com still!

I'm now on Evorel 75 with 100mg of Utrogestan.  Went for my '3 months on HRT' review and  GP advised that I only need to take the Utrogestan 14 days on and then 14 days off!  Tried doing this and got a headache about 2 days after stopping the Utrogestan - this might have been coincidental but not sure.  Told GP who said 'that shouldn't happen' but wasn't really sure so she has referred me to Gynaecology, and the appt. has come through for Dec...  I'm still getting headaches.  Having had a chest infection a few weeks back I'm now not sure if it's the HRT causing them or just after effects of infection.  Still not sure how I should be taking the Utro. and feeling confused and anxious.  It's probably a good thing that I have an appointment coming up but OMG! 

[Hurdity]

Not sure what you are still confused about? If you are peri-menopausal ( ie had not been without a natural period for 12 months before starting HRT) then you take it cyclically which is 200 mg x 12 days but I can see that if this does not control your bleeding or if on a higher dose of oestrogen some docs may suggest a slightly longer dose - as in your case ie 14 days.

As I mentioned before the continuous combined dosage officially is 25 days out of 28 x 100 mg - but because you stop for 3 days this can work for women in late peri perhaps so some docs also prescribe this even if not post-menopausal.

If you are post-menopausal then you can take it every day ie 100 mg but sometimes this does not control the bleeding on medium/high doses of oestrogen so a higher dose is needed or vaginal use can be recommended off licence.

A withdrawal headache just after stopping the progesterone is normal - it's due to progesterone withdrawal and just like many women experience during their fertile years when menstruating normally.  You should get a bleed shortly afterwards or around the same time. However a headache for this reason should clear pretty quickly so that once you are on oestrogen only and have had your bleed you should feel OK. In your case it might be a combination of both - your infection and the cycle.

Some women like me prefer to remain with a cycle even when post-menopausal - I am mid 60's and take Utrogestan vaginally 200 mg x 12 days every 6-8 weeks with estradot patch ( 50 mcg + a little bit). Those who have been on HRT for some time and don't know where they are in menopause, can be offered continuous combined (no bleed) HRT at age 54 to see if this works - but it is not essential.

Does this clarify? Hope your headaches clear soon.

Hurdity x

[Artmouse]

Thanks.  I am confused because I have been told by my GP that along with my Evorel 75 patch I should:

1. Take 100mg continuously
2. No, no need for that, take 100mg 14 days on, 14 days off

The official guidance for 100mg is take for 25 days out of 28 so maybe I should be taking it this way?

I'm 53 and peri-meno, i.e. had a period less than 12 months b4 starting HRT.

Basically I'm worried because I'm getting headaches and nausea and don't know how I should be taking this stuff. 

[Mary G]

Artmouse, I'm not surprised you are confused, as you pointed out, you have been told two different things.

There are various ways of using this regime and how you use it largely depends on whether you still want/need to have periods and how well you tolerate Utrogestan.  A lot of women on here take 100mg for 10 or 12 days so there are various doses.  Some post menopause women take Utrogestan everyday to avoid bleeds completely. 

I am on a different HRT regime now but I used to take 100mg Utrogestan vaginally for 7 days as per the Professor Studd regime.  Even that was too much for me (it caused silent migraines) and I ended up taking less than that but I do have regular scans and this was enough for me.  As you have no doubt read on here, this is not the same as the NHS licensed dose. 

I used to get headaches with Utrogestan so it could be a side effect.  If you use it vaginally you can get the same results with much less of it and it also has fewer side effects like breast pain and nausea.

I hope that helps.

[Artmouse]

Thanks Mary, that does help!  Especially hearing about getting headaches on Utrogestan. 

[Hurdity]

Hi again Artmouse

I also get headaches now and again on utrogestan but I understood from your comments that you got a headache AFTER stopping utrogestan which is due to progesterone withdrawal. I hope they have eased now - but if still continuing in the absence of taking utrogestan - then must be due to some other cause.

Just to re-iterate that if you are peri-menopausal the licensed dose is 200 mg x 12 days. As Mary G says this can be varied - but only under supervision of your doctor - but sounds like your GP doesn't seem to know this. Surprising because the info is on this website and readily available to medics (and laypeople) on the web!

If you can - best to start with the licensed dose and take it from there. The withdrawal headache -  may unfortunately happen each cycle - although it didn't with me, just sometimes. I now ease my way on and off the progesterone phase by spreading the first and last dose over two days ie 100 mg x 2 days 200 mg x 10 days then 100 mg x two days - which seems to help avoid the sudden fluctuations.

If you are getting headaches and nausea WHILE you are taking the utrogestan then taking it vaginally will help to prevent the nausea and should help to minimise the headaches too because oral use produces many more side effects due to the metabolic breakdown products (going through the liver).

Hope this helps

Hurdity x

[Artmouse]

Hi there,

Thanks    I did get a headache after stopping the Utrogestan so decided to ignore the doctor's 14 days on, 14 days off instruction and just keep taking it continuously until I can see the Gynaecology dept. in Dec.  Then the headaches/nausea came back again anyway!  Also noticed that when I stopped it my terrible insomnia came back within about a day.  Think I have just got very stressed about it all.  Silly really.  I have a demanding full time job and worry incessantly when symptoms come up in case it means I'll need time off.  My partner has lost his job so I can't afford to lose mine as have had a bit too much absence some of which I think has been due to Menopause stuff.

Just wish doctors were more helpful and able to give clear guidance!  How hard can it be?