Migrating from oral HRT to gel/progesterone, a couple of questions

[slidingdrawers]

I've been on Femoston 2/10mg for just over a year and it's not been working as well as it was.

GP has prescribed me gel (2 pumps) plus progesterone (Utrogestan) at night for days 15-26 of my of cycle.

So my current oral cycle is 28 days. I presume I start the gel on day 1 when I end my current oral pack? Also, with progesterone on days 15-26, am I now in a 26 day cycle or still 28?

It's much easier to use Utrogestan on the same day each month. That's what I was advised.

So, work around a date such as the 1st of each month or the 15th.
It works as a monthly cycle because once you have taken the Utrogestan you will bleed 2-3 days later, making the whole cycle more like 30 days ( a complete month.)

Start the new regime when you end your pack of pills, but if you want to delay a day or two it won't make any difference.

Thank you. Starting on the same date will work well for me, rather than having to recalculating a new date every month.

That’s what I have been advised to do as well. I have been told take the utrogestan on days 1-12 of every month rather than trying to remember dates of my cycle...

I was told it’s important to take it BASED on your cycle! I have to take it on day 14, day one being the first day of my period...😩 soooo confusing, also have no clue when I can start my gel either, do I wait until I take the utrogestan? May have to call Newson again 🤦🏻‍♀️

@pinkrabbits39

I was told it’s important to take it BASED on your cycle! I have to take it on day 14, day one being the first day of my period...😩 soooo confusing, also have no clue when I can start my gel either, do I wait until I take the utrogestan? May have to call Newson again 🤦🏻‍♀️

If you have really regular cycles then that might work. For women who don't, it's not workable :)

If you have paid for advice from NC didn't they tell you when to start the gel? (You should start it any time.)

I take mine from the 1st to the 14th as advised but now I seem to have two periods a month, one based on my existing cycle and one in the utrogestron! I'm about six months in 🤷🏻‍♀️.

I started the gel on day one of my period and then started the utrogestan on 1st March as I have been told to take it on 1st-12th of every month as my periods aren’t regular.

@HelloDaisy @JinglingHellsBells
Thank you
So been in touch with Newson and I’m starting my gel tomorrow...🤞🏻
Stupid question and I really can’t bother them again, they’ll block me soon! When it comes to utrogestan, I’m due my first 2 tablets on 28th March for 2 weeks - that makes my last one 10th April, do I count the 2 weeks break from the 10th or 11th April then please?

Excellent, so pleased you have contacted them. I went to The Female Health Clinic as it is near me and they’ve not blocked me yet despite constant email questions so you should be fine!

I don’t know the answer to your question though as I take mine from the 1st-12th of every month. Doctor advised me to do that so that I will know when to start and stop easily each month. Sorry I can’t help.

@HelloDaisy I’ll email her, you’re right, she’s been lovely. So you and @TabbyStar are on a 2 week on and 2 week off regime the same? It’s just when you were told to start that’s different... so you may end up with your normal cycle bleed and then a utrogeston bleed, guessing regardless of when you bleed you keep up the same schedule of taking them? My calendar is going to be busy plotting it all until I get into a rhythm!

I was just told to take them for the first 14 days of every month (which fitted when I was prescribed). No idea whether it will settle down or not - I was already on a fairly short 21-25 week cycle since perimenopause, so maybe the whole thing will always be erratic. I feel like I should know this really. I was prescribed privately originally but now through my GP, I'm expecting to get a GP review at some point though I was told there was no one in the surgery who specialised in menopause.

Mine probably did sort of link with my cycle although I had been every 3 weeks until waiting to start hrt as it was then 5 weeks which coincided with 1st of each month. It does seem to be in tune though as I stopped utrogestan on 12th March and period came this week so will see what happens next month!

Should I alternate which arm I apply the oestrogel too?

I apply to both at the same time but no idea if that’s right really! I am on one pump so squirt it onto my hand and then divide to spread it on.

I was wondering if you are supposed to alternate between arms and thighs - always some queries going on 😁

There's a lot of flexibility with the gel/utrogeston combination. I tried at least 3 different regimes on the advice of my consultant, all very different but none of them suited me so I'm now on patches which is a huge improvement.

I'd still rather be on the oral tablets though

@HelloDaisy

I apply to both at the same time but no idea if that’s right really! I am on one pump so squirt it onto my hand and then divide to spread it on.

I was wondering if you are supposed to alternate between arms and thighs - always some queries going on 😁

It makes no difference whatsoever as long as it's on your arms or legs. I think Louise Newson even says you can put it on your tummy or bum (that's where patches go.) And no need to 'swap sides'. Why would that be needed?

I'm on 2 pumps so apply a pump each to upper arms/shoulders daily since I started last week.

@Elphame interested why you say you'd prefer to be on oral?

Much less faff for a start! Waiting for the gel to dry each morning, having to track the coming on/off the progesterone etc.

Also I felt dreadful on the combination. I got breakthrough hot flushes and the progesterone gave me abdominal pain and made me sick and dizzy.

The patches suit me a lot better but I don’t like them cosmetically and I don’t like the random bleeding.

I used to take my HRT pill every morning with breakfast. Quick, easy, effective and nothing to remember and keep track of! I could predict the bleed to the hour. Just overall easier! Unfortunately I have a breast condition that makes it less suitable for permanent long term use. The specialist will prescribe it if I insist (we have had the conversation already) but I agreed to at least try the patches.

You've succinctly explained all the reasons I preferred oral but felt they increasingly weren't effective for me at 2mg. Interestingly I've had night sweats again this week since starting on the gel.

@Elphame sorry for the stupid question, is the tablet a combination of oestrogen and progesterone? So one tablet everyday? What’s that name please?

Just for info @pinkrabbits39, the BMS (and most menopause experts) are trying to get all women to use transdermal HRT as the main choice.

It's safer.

And unlike tablets, the dose can be lower as none is lost in digestion. So if you take a 1mg pill, a large amount of that won't be absorbed, so you might need a higher dose and that comes with more possible side effects when it's digested.

It doesn't cause blood clots as it doesn't pass through the liver.

For older women, or women with migraine for example, transdermal is used anyway.

I've used gel for ages and find it fine but know it's about personal choice. I use 1 pump after my morning shower and the same before bed. I squirt 1 pump into my palm and apply over both upper arms or thighs. Truthfully, it's dry before I've cleaned my teeth or applied my deodorant. I appreciate that if someone is using 2 pumps at once, it would take longer to dry.

Having said this, some women are perfectly happy on tablet types but if they carry on to 60, they'd be told to change to patches or gel anyway.

@slidingdrawers I think my reply was meant for you! Sorry!

Thanks @JinglingHellsBells I may adjust to am and pm dosing.

@pinkrabbits39 there are a number of oral brands/manufacturers. I was on Femoston. The initial 14 tablets of a 28 day pack were oestrogen, followed by 14 both oestrogen/progesterone combined. Elleste are another brand. I have changed as was on the highest oral dose and was having breakthrough symptoms and as JinglingHellsBells says, it's a safer route of transmission.

Administration not transmission!

@JinglingHellsBells and @slidingdrawers thank you so much for the excellent answers, much appreciated