Post meno utrogestan

[SlobDylan]

I wonder if the collective wisdom here can help me answer a few questions.

I am 48, post meno (by about 3/4 years) and recently went to doc to “negotiate” (my female doctor’s phrase) going onto hrt. After a 3 month stint on Tibolone I asked to try body identical hrt and have been prescribed Oestrogel (2 pumps per day) and Utrogestan 100, one to be taken daily.

Q1: is it ok to take the Utrogestan daily? Many people here seem to take it only on certain days per month.

Q2: I’ve only been taking the new stuff a week, but I seem to be extremely irritable. Could there be a connection?

Q3: I was initially prescribed the Tibolone for libido, and I understand it has positive effects on bone etc. But I can’t find any info directly comparing the effects of Tibolone to the other types of hrt. Is Tibolone an effective form of hrt across the board? I think I have formed the impression that I was slightly ‘fobbed off’ in the first instance.

Thank you so much for any advice or insights. 💐

If you had an early menopause ( before 45) there ought not to be any negotiation around HRT. NICE advises it is used for all women with an early menopause and some experts regard 'early' as before 47 (although everything online is stuck at the 45 yr cut-off.)

1. Like all progestogens, Utrogestan can be taken to give you a continuous regime - which means you use both hormones daily. OR it can be taken sequentially - for 12 days a cycle (usually 28 days.) These are the options for ALL HRT whether it's a patch, pill or two separate products. You need progestogen if you still have a womb .

2 . Possibly. Feeling tired is more of a common side effect.

1. Tibolone is not 'normal' HRT - it is a steroid with estrogen-like effects. It is a synthetic product and part of its mix is that is has androgenic properties. You can easily read up about it online.

(Sorry if this is sounding like a lecture.)

It's used for women who want a no-bleed type of HRT, like a continuous regime. It can also be used with women who have endometriosis as it doesn't stimulate the womb lining.

It is linked to some side effects longer term - these keep changing as new research comes along- but in the past it was thought to have a higher risk of stroke. www.gov.uk/drug-safety-update/tibolone-benefit-risk-balance

You really need to give your new HRT 3 months before giving up or swapping. There is no reason to carry on with the continuous regime if you feel that daily Utrogestan is an issue. You could swap to sequi regime, using it for 12 days per 4 weeks / calendar month.

Guidelines are that you should be on HRT until 50, if you have had a early menopause, you shouldn’t have to negotiate that, your GP is lacking in knowledge.
If you are post meno you can take utrogestan every day to give a no bleed HRT.
I hated utrogestan, it gave me awful nightmares, I got hardly any sleep and I couldn’t function in the day as I felt so doped up even though I was using it vaginally.
I use the Mirena now instead with Estrogel.

Are you swallowing the capsules? Using them vaginally reduces the side effects - or seems to in my case anyway.

@FirstGirlonMars

Interestingly, I have started using them vaginally after years orally, and find the absorption is so much higher that they a) make me incredibly hot at night b) I sleep less well , which seems ironic, and c) have more vivid dreams.

I do feel a bit dopey when I wake up but after a few hours it's passed.

I'm on long cycle though and couldn't cope with cyclical 4-weekly cycles at my age.

Guidelines are that you should be on HRT until 50, At least, as a minimum. After that there are no cut off points. It's an annual review to discuss pros and cons, and if you want you can use it for life.

Thank you all, that’s really really helpful.

@jinglinghellsbells (great name btw) thanks for that link, I will go and read up.

My doc gave me the impression that I will have to report sufficient “improvement” in symptoms to justify being given it. She also thinks the definition of early meno is before 45. But I didn’t go to her until recently, so she is a bit “one eyebrow” about my self diagnosed time frame.

@firstgirlonmars that’s interesting, I didn’t know I could take them any other way. Can I use the same capsules?

Sleep’s not too bad, actually, but forgetfulness, complete lack of get-up- and-go, zero libido, poor energy levels, weight gain, are all major players! I have a 7 year old DS as well, so I need my energy! Now and for many years to come. (So I went from late pregnancy into early meno with barely a pause. I think BF-I get for 3 years covered my symptoms. But it all adds to my long-term concerns about bone loss etc).

Sorry, am rambling! Thanks for all replies

Yes, same capsules can be used orally, vaginally or even anally if you're so inclined. I believe (Jingling will know?) that they are not licensed as such in the UK, but pretty much everywhere else in Europe they are (I live abroad, my gynaecologist says there's no difference which method of delivery you use, they are all fine). Possibly different modes of delivery might suit different people?

You can insert them wherever, or swallow them. In the UK they are only licensed for oral use but most private drs suggest using them whichever way suits you best.
Which ever route, take at night as they can make you sleepy.