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[Babspiglet]

Hello ladies, I wonder if those with experience/knowledge could help with this. I’m two weeks into a regime with a starter dose of half a 25mcg Evorel patch with 100mg continuous dose of Utrogestan. The low dose oestrogen is  because I usually get side effects (and found even Vagifem difficult to tolerate). I will increase the patch to 25mcg in a couple of weeks and progress from there. I’m 58, three years post-menopausal so should start low anyway. I’ve realised that the Utrogestan dose is probably too much for me at the moment in relation to the oestrogen and is making me a bit groggy and a bit low. My meno-specialist has already agreed that I can switch to taking the Utrogestan vaginally to mitigate against side effects. I was wondering if I could take it alternate nights or even less frequently while still on this baby dose-and maybe even on 25mcg-so that the good effect of the oestrogen could be felt sooner and spur me on? I’d only do what was considered safe and sensible.  Thanks for any advice you can offer. 

[Hurdity]

Hi Babspiglet

Your post got missed - and I'm not sure if you've had an answer yet?

Although the licensed dose is for 100 mg daily when taken continuously ( or days 1-25 of 28 day cycle), this is for the oral dose. When i wrote to the previous manufacturers about 10 years ago they sent me the french info which said that if used vaginally the same dose should be used. However there is research from small trials that when taken vaginally a lower dose may be needed ( on average) to protect the womb as more of the progesterone goes to where it is needed. One of the studies did in fact trial alternate day vaginal progesterone dosing and found that the womb was protected when paired with low to medium doses of oestrogen.

Also Dr Louise Newson also does suggest this sometimes to her patients and in fact says as such on her website - though this is off licence and will very much depend on the individual women and the oestrogen dosage.

As you are on a low oestrogen dose then it may well be that you will be fine on alternate day vaginal progesterone but this should really be done in consultation with your GP or menopause speciliast who may suggest a scan if necessary. A warning that it might not be working would be any form of spotting or bleeding altough this is to be expected during the first 6 months of continuous HRT anyway.

I did a compilation of the studies into vaginal progresterone which i have both bumped and updated periodically and will try to do so for you so that you can read about it yourself.

Hope this helps and let us know how you get on

Hurdity x

[Babspiglet]

Hi Hurdity, I’m enormously grateful for your very thorough response. I think my query was too specific to get many replies initially! I had intuitively worked out that I probably could take Utrogestan on alternate nights vaginally and this regime seems to be the one to settle for, with monitoring. I will run it by the specialist. The information in the clinical studies which you have provided is really helpful and provides a lot of reassurance. I’ve just started applying the full 25 mcg Evorel patch so hopefully that and your suggestion will help to strike the right balance and not lead to a ‘progesterone dominant’ situation. Thanks once again for all your support and I’ll let you know how I get on. x