If you use Estrogel & Utrogestan...

[NickyNora]

Did you experience break through bleeding if you changed how you used the Utrogestan?

Consultant told me to use stop using the Utrogestan every month & to use it every 12 weeks for 7 days. (I really struggle with progesterones)

12th week is next week, I've started to bleed today.

Could this be because i hace used just Estrogel for too long?
Could it be a period?
I'm postmenopausal, 15 months since my last period.

Any advice?

Could this be because i hace used just Estrogel for too long?

Yes most probably. Unlikely but not impossible that it's a period after 15 months.

A 12 week cycle with just 7 days is pushing things a bit. I did do long cycle on Norethisterone- used it for 10 days every 10 weeks- but it's stronger than Utrogestan at controlling the lining.

I'd have assumed you would either do 7 days a month, 7 days every 2 months, or 10-12 days every 3 months. To reduce to 7 days AND go 12 weeks is right at the end of what is safe. Is your consultant good and a meno specialist? (You can PM me names if it helps.)

I currently use if for 10 days every 6-8 weeks. After 8 weeks the bleed is quite heavy .

I'm flooding this afternoon & in agony.

Hes a lead Consultant Gynecologist at a North London NHS hospital.

I'm not overly confident but to be honest I've lost all confidence in doctors in recent years.

I was very surprised at the idea of 12 weeks, he said its a very common practice.

I will only use it for 8 weeks after this & see how I get on.

Thankyou for replying.

Long cycle as long as 12 months is more commonly used with women in peri who are still having their own periods.

I don't think you will find anyone who knows about meno offering 3 months / 7 days Utrogestan. There is a risk of hyperplasia.

This is way beyond the licensed dose of 12 days per 28 day cycle.

Some women use 7 days per month, but if the cycle is longer it's usually 10-12 days Utro and if you go as long as 3 months you need to report unscheduled bleeds so they can scan you to see if you have a thick lining.

Thankyou QueenoftheNights.

I was discharged from the menopause clinic.

I remembered reading about the risk of hyperplasia & thats that's why I questioned the dose.

Honestly Mumsnet & Menopause Matters has been more helpful than all the doctors I've seen in the last 13 months!

There is (or was) an HRT called Tridestra which is a long cycle HRT in tablet form, but it still used progstogen for 14 days each long cycle of 12 weeks.

The research /guides show that the minimum amount in a long cycle should be 10 days in 84 days (12 weeks) as the absolute minimum for uterine protection.

Obviously the longer the cycle, the heavier the bleed tends to be. I notice a difference between 6 and 8 weeks when I do either.

Even the pioneer of the 7 day regime (John Studd) now often advises 10 days of prog per calendar month due to incidence of hyperplasia in some women. I am amazed at this dosage of 7 days per 3 months - no wonder you're flooding!

What dose of Utro do you use on these 7 days and do you take it orally or vaginally? Vaginally will give more protection than orally.

You also haven't said what dose oestrogel you use - the amount of thickening ( and therefore dose of progestogen, and amount of bleeding) is dose dependent. More oestrogen = thicker lining = more progesterone needed to shed the lining = more bleeding - on average, that is (each woman will respond differently).

Thanks Bellaciao & QueenoftheNights

I use 4 pumps of Estrogel every day. 1 pump of Tostran, twice a week.
200g of Utrogestan vaginally.

I'm ignoring my doctors advice & will use the Utrogestan for 10 days this cycle.

I just hope i can tolerate it. I'm on day 3 & can feel my mood shifting. I hate progesterone, it will be the reason i stop HRT. My periods stopped at 43 & I'm only just 45. If i was older, I'd have given up on HRT by now

From now on I plan to use the Utrogestan for 10 days every 8 weeks.

Funnily enough I got an appointment sent to me today for a different Doctor at the same hospital even though I was discharged in September.
I'm still bleeding & feel drained.

why not consider the Mirena? At 45 you need longish term HRT.
I cannot believe you were told 7 days / 12 weeks when you use 4 pumps! That's crazy, you are using 3mgs estrogen daily which is a high dose.

Your lining will be thick and that's why it's shedding on its own.

No wonder you feel drained.

No I cant stand the thought of a Mirena. The consultant offered to insert it under G.A but its the risks of bleeding & depression that worry me.

I feel like all i do is rub gels, take tablets & still feel rubbish!

Nearly 9 months on this particular combination & although i feel better then i did, i most certainly don't feel 'normal'.

I'm exhausted. Headaches. Zero labido. Joint pain. Dry skin, eyes. Vaginal dryness & still moody!

Lost 16 lbs by removing sugar & processed foods. No caffeine, alcohol & exercise at least 2/4 times a week.
Maybe its time for A.D as tbe thought of being as i am for the rest of my life is awful.

I know it's easy for me to say but for someone your age the coil might be the answer. Bleeding is usually just light spotting. Depression? Not all women have that- lots of women find it wonderful.
Not tempted to try it for 3 months? can always be removed.

No i can't risk feeling worse then i do. I am only jusr coping using the Estrogel. Thats partly why i wanted the regime the last doctor suggested to work. I don't feel like other women do on HRT. Its not given me my life back.

I am a single parent of 4dc, youngest is 4. I need to function!

I really struggled with the combined Pill. Tried it in my teens, 20s & 30s.
I tried The POP in my early 40s & I became really depressed.
Then started HRT... Femoston was awful, i was so aggressive & angry.
I had really severe postnatal depression 4 times.
Depo provera in my teens & 20s made me suicidal. I never made the link with progesterone until i started HRT.

I don't trust that the doctors would remove the coil if things got too bad.

I've seen about 8 GPs, 2 specialist GPs & 2 Gynecologists in the last 14 months trying to find a HRT solution.

Hopefully the long cycle will improve things. Also I know blood tests are inaccurate but might give an indication of whether you are absorbing the gel sufficiently well - not every woman does. perhpas you need a higher dose or if not absorbing - a trial of patches?

Bloods tests in the summer showed i was absorbing the gel well. I am very careful about applying it.

I'm on 4 pumps, not sure the dose can be increased.

I have psoriasis & am allergic to adhesives so can't even tolerate a plaster, so i originally used HRT tablets.

Thankfully my psoriasis isn't too bad atm but patches really aren't an option.

One doctor suggested i go on The Pill but the consultant disagreed due to the blood test results.

Nicky, poor you. I'm in a similar situation, period stopped at 41, started on Estrogel (2 pumps a day, not sure why) and had mirena fitted at 42, now 44. Have had no problems with Mirena at all. Few cramps the day after it was inserted and nothing since. Maybe you should think about it? Good luck.

I'm also on 4 pumps a day Estrogel and testosterone gel. I feel FANTASTIC on both until the 7 days a month of Utrogestan when I feel utterly horrible. It's like Jekyll and Hyde with moods, anxiety, zero libido, I basically hate my husband, it threatens my marriage every month and lasts 10 days until I have a bleed.

I have been going to Studd clinic and we are currently trying Utrogestan for 7 days every second month, with annual scan to check womb lining isn't too thick. In theory this will reduce the hell from 10 days a month to 10 days every second month.

I tried Mirena and it did not suit me at all as I'm so horribly sensitive to progesterone.

I am not perimenopausal yet at 43 but I went to Studd clinic to try and tackle my hideous lifelong PMS. It may be that my experience isn't relevant to what you're experiencing, but when I hear of women who are very progesterone-intolerant like me I have to at least say hello! Too many of us are fobbed off with antidepressants (which I tried for a year and which just removed my libido completely and numbed my emotions, but didn't tackle the cyclical nature of my depression at all).

I wish you the best of luck. There's a lot of trial and error involved.

@hippospot I'm surprised Studd is suggesting only 7 days on alternate months especially with that amount of gel.

I read on Menopause Matters forum that he no longer suggested 7 days after someone [on that forum?] was found to have hyperplasia on that dose (don't quote me in case it's not true, but I'm 90% sure that was the outcome for this woman.)

7 days is, I've been told, the minimum for a month and if you are using 4 pumps and going 2 months, that's pushing it a bit re. safety.

Has it not been suggested that you try using the Utrogestan vaginally in order to reduce side effects? More is absorbed into the system but as it's not going directly through the liver, the metabolites which can cause side effects are reduced.

@QueenoftheNights thanks for your reply. I am already using the Utrogestan vaginally. It still has severe effects on my mood.

I sometimes feel like my options are hysterectomy or divorce.

I am going back to the Studd clinic in a month and will query the safety of the dose I'm on.

I'm not on the MMatters forum but read it now and then. If you want to scroll through the posts you might find it- think the subject heading was 'hyperplasia' or similar.

TBH if you aren't happy with him and are going privately anyway, I'd change consultants for another opinion.

[quote QueenoftheNights]**@hippospot I'm surprised Studd is suggesting only 7 days on alternate months especially with that amount of gel.

I read on Menopause Matters forum that he no longer suggested 7 days after someone [on that forum?] was found to have hyperplasia on that dose (don't quote me in case it's not true, but I'm 90% sure that was the outcome for this woman.)

7 days is, I've been told, the minimum for a month and if you are using 4 pumps and going 2 months, that's pushing it a bit re. safety.

Has it not been suggested that you try using the Utrogestan vaginally in order to reduce side effects? More is absorbed into the system but as it's not going directly through the liver, the metabolites which can cause side effects are reduced.[/quote]
How did you get on @hippospot

@Thepathofleastresistance Thanks for asking.

Last year I had a total hysterectomy. I now take only oestrogen (Estrogel) and testosterone. It was a long recovery but it has massively improved my quality of life and probably saved my marriage. My lovely DH was not planning to leave, I am being a bit facetious, but my PMS (PMDD I think) made life really hard for us both for nearly half the month, every month.

I feel really well now, physically and mentally.

I went private as there's no way I could have got a hysterectomy on the NHS for PMDD.

I am sorry you feel like that. I also feel like that… it is hard. How are you feeling now ? Did you go back to the clinic ? And what doses are you on now?
if you are taking ultragestan vaginally how much are you taking? Other doctors say that ultragestan has more absorption viginally so they say the dose can be cut 1 tablet 100mg every night.