utrogestan continuously if still having periods?

[ladygindiva]

Prescribed estrogel and utrogestan; former daily and latter to be taken 12 days of cycle etc. Feeling relief from some symptoms ie heartburn, general mood, aches and pains , unexplained fatigue, all these vastly improved, all good. However my main symptom that has been driving me CRAZY for a couple years on and off is insomnia accompanied by a rumbling tinnitus during the night that keeps me awake. Alot. Could be pulsatile tinnitus, I don't know. Its like a vibration in my ears. Its worse as soon as my period is over and can last about 10 days, which can mean 10 consecutive nights with barely any sleep. Thats where I'm at right now; 8 nights with just the odd hour here or there. I'm on my knees. However; the 12 nights I was taking the utrogestan I had THE BEST SLEEP EVER and I felt ok too; contrary to other peoples experiences on progesterone treatment. Pre hrt my worst time of the month was the classic 10 days beforeand during my period but now those days are my best! My query is can I, as a still ( slightly erratically) mentruating perimenopausal woman choose to take 1x utrogestan once daily for 24 or whatever days of the month instead of having it 12 days only? I'm thinking it would mean twice as many days of possibly sleeping better. Or is this system of taking utrogestan purely for women who have ceased mentruating entirely? My period still arrives monthly, though I was missing the odd one pre hrt and the cycle varied from 27 to 50ish days if it did arrive.

currently taking 2 x tablets utrogestan 12 days of month

Also have increased my dose to 3 pumps of oestrogen a day, against GPs wishes ( they know literally bugger all, Google is far more useful) . I was on equivalent of 2 before, with limited results and I'm sure I needed to increase. I'm 46 and this peri debacle started for me approx 18 months ago.

I am 40 and take the mini pill daily (for contraception and some of the progesterone part) and 4 pumps of oestrogel and one utrogestan every single night - on the advice of Newson health clinic, menopause specialists so definitely can be done...!

www.newsonhealth.co.uk/consultations

Yes you can do this. It's a 'continuous regime'. Join the ´menopausal not mad' Facebook group from their website it's ace!!

Thanks guys; I will look up that fb page. Bagels are you still having periods though or are you post meno if you don't mind me asking?

I don’t have periods but I’m not post memo either - confusing I know! I have a pituitary tumour and other autoimmune conditions, it’s all very confusing. The mini pill also completely stops my periods. If I wasn’t on it I suspect I might have one every 6 months or so (high prolactin levels).

Ah, I wonder if that makes a difference. I'm worried about attempting a continuous system as my periods are still fairly regular. I cant ask the GP because I've tried every one in my practice and none of them know anything at all about even the most basic facets of hrt; bar one who it seems to be impossible to get an appointmnet with at the moment. Are there any other ladies out there still having monthlies who have tried this I wonder? I cant find any answers online.

@jinglinghellsbells
Sorry to tag you, hope I've done it correctly, but I recall you being a very useful poster in these matters in the past and I'd really appreciate your opinion if you have one please x

@JinglingHellsBells if capitals matter. Sorry to stalk you!

@ladygindiva Hi! The downside is you may still get your period because continuous HRT is for women who are post meno. I think I used this analogy in another thread- estrogen makes the grass grow (the uterine lining) and progesterone is the lawn mower! (Either a little trim daily to stop it growing or a big clear once a month.)

If you still have quite a lot of your own estrogen (which you will have if you have periods) as well as using the gel, then 100mgs Utrogestan may not be enough to stop the grass growing. So you will possibly get spotting and odd bleeds.

It's up to you to try it, I guess. FWIW I hated daily Utrogestan! I tried it for 3 weeks after being on the sequi regime for years and felt really tired and irritable. I also spotted daily. So I went back to the sequi regime but use it differently to once every month (my consultant allows me to extend the cycle a bit.)

Hope this helps.

Thank you! I felt well on utrogestan so I may give it a go, so it's not a big no no of a thing to try?

I've just been to the meno clinic (finally after it was cancelled due to lockdown 1!)
I'm already on Utrogestan 2x100 for half cycle but have been told I can take the same dose continuously.

I have only had a couple of periods in past year and can't remember to take it properly (How come the pill has days on the pack to remember to take it but HRT which is associated with memory problems, me included have none!!) Was told there is no need to bleed!

Can't tell you what a relief it was after years of seeing GPs who have no clue to go and be told everything I wanted to hear.
"We'll check your testosterone because it's probably low too and if so will prescribe it"
"Can you imagine if a drug for men suddenly disappeared from production (my last HRT was Femseven stopped being produced couple of years ago and still not available yet)"
Also talked about how GPs have terrible knowledge and tiny amount of education in Menopause and how this years trainees will have missed the experience of clinics as been none due to Covid.

I am on 4 squirts of oestrogen gel and utrogestan for first twelve days. My mood is so much better but I bleed from day 9 until day 23. No libido either. I can no longer access my consultant due to a change in private healthcare.

Anyone had similar? I'm happy to adjust my own medication!

This is really useful info from Louise Newsons website. Easy Prescribing Guide.

The Meno clinic are putting me on continuous Utrogestan and Testosterone.
Continuous Utrogestan for random bleeding and cos I can't remember to take it.
Testosterone for brain fog and low libido

d2931px9t312xa.cloudfront.net/menopausedoctor/files/information/229/Easy%20HRT%20prescribing%20guide%20(1)%20-%20Opt.pdf

@monkeyblonde was replying to you above

If you’ve been taking sequential HRT for at least a year you can then move to continuous HRT (taking utrogestan nightly) if you prefer. However you might still get some bleeding.

If a woman is taking sequential (cyclical) HRT then after around a year this can be changed to continuous HRT, regardless of her age. This should lead to her periods stopping. If women are taking body identical HRT then they should be given 100mg micronised progesterone (Utrogestan) each evening. If a woman has no bleeding with the continuous micronised progesterone then this can be considered a contraception.

Taken from here: www.menopausedoctor.co.uk/professionals/ten-tips-for-prescribing-hrt-remotely

@monkeyblonde That amount of bleeding is not great, is it? You really ought to be having a 'normal' amount of blood loss such as 3-5 days.

Based on my own experience and advice given, I'd say the amount of gel you use is a bit too high for the amount of utrogestan you use. (Utrogestan is sometimes poorly absorbed anyway compared to stronger, synthetic progesterones.)

You could try:
1 reducing gel to 2 or 3 pumps

2 Using Utrogestan vaginally (last thing at night) just insert the capsule as far as it can go. This is the preferred method in Europe and with many consultants here.

3 If you want to carry on using it orally, maybe take it with food, as this doubles the concentration, so you will get more into your system.

Thanks for the advice @JinglingHellsBells @over50andfab and @Ouch44. I will have a look at how I may adjust my current meds.

I am really interested in the testosterone element, however Dr Newson's prescription guidelines state that this cannot be prescribed directly from the NHS. Has anyone else had this prescribed and does it make a difference to libido? I definitely feel as though my moods have improved but with the bleeding and lack of libido I'm finding it hard to work out next steps.

I have already had an ablation/Mirena (fell out) and sterilisation.

@monkeyblonde

Thanks for the advice *@JinglingHellsBells* *@over50andfab and @Ouch44*. I will have a look at how I may adjust my current meds.

I am really interested in the testosterone element, however Dr Newson's prescription guidelines state that this cannot be prescribed directly from the NHS. Has anyone else had this prescribed and does it make a difference to libido? I definitely feel as though my moods have improved but with the bleeding and lack of libido I'm finding it hard to work out next steps.

I have already had an ablation/Mirena (fell out) and sterilisation.

Testosterone can help with libido but needs balancing with other hormones. Have a look at the Easy HRT Prescribing link given by ouch which has more detail of it. Although it's off-license if you have a knowledgeable GP they should be able to prescribe it for you - some do. However you might find that they refer you to a menopause clinic or gynae instead.

It's important to be on HRT first (which you are) as otherwise the testosterone might convert to estrogen

@monkeyblonde @over50andfab I think the reason GPs can't offer testosterone is it IS off licence. There is no such product as testosterone for women; only for men. Women need to find the right dose themselves which is a fraction of the men's dose.

The reason GPs can't offer it is it is beyond their practicing remit (legally) not that they don't understand its use or benefits. I don't know anyone whose GP has prescribed it, but do know women who have it on repeat from their GP having been prescribed initially by a consultant (and usually a private one not NHS.)

[quote over50andfab]If you’ve been taking sequential HRT for at least a year you can then move to continuous HRT (taking utrogestan nightly) if you prefer. However you might still get some bleeding.

If a woman is taking sequential (cyclical) HRT then after around a year this can be changed to continuous HRT, regardless of her age. This should lead to her periods stopping. If women are taking body identical HRT then they should be given 100mg micronised progesterone (Utrogestan) each evening. If a woman has no bleeding with the continuous micronised progesterone then this can be considered a contraception.

Taken from here: www.menopausedoctor.co.uk/professionals/ten-tips-for-prescribing-hrt-remotely[/quote]
The sequential and continuous regimes are not set in stone. In theory I ought to use continuous being 14 years post meno but don't, in agreement with my consultant. (Reason: intolerance to daily Utrogestan and also there is a higher risk of breast cancer with continuous regimes.)

The only reason to avoid premature use of a continuous regime before post meno is certain, is breakthrough bleeding = a nuisance.

Similarly, there is no absolute need to use continuous but most women do to avoid 'periods'.

Exactly Jingling - re. moving to continuous as mentioned it's personal preference, and backed up with a reliable source of information. Some women prefer to continue with sequential for their own reasons.

I'd be interested to see any information you have of increased risk of BC when sequential and continuous HRT are compared, specifically utrogestan as I haven't seen much in the way of research done of this?

I do know some women who've been prescribed testosterone by their GP rather than by way of consultant/NHS menopause clinic though not many as the latter tends to be more the norm. Off licence medication can be prescribed by GPs - eg low dose tricyclic ADs like amitriptyline for nerve pain. As Dr Newson wrote: GMC guidance on the prescription of unlicensed medication should be consulted when prescribing and of course it will depend on each area drug formulary and what the GP is able to prescribe.

First port of call is to ask the GP and take it from there if referred on.

@over50andfab I can't link to that info readily just now, but if you research papers on risks etc the data is there. It comes up in two different ways
1 Risks of each type of progestins (MPA being the highest, then Norethisterone, then the lowest risk with dydrogesterone (in Femoston) and micronised progesterone (similar risks.)

2 Risks between continuous and sequential. This did come up in the stats of the Lancet report (you need to go into the stats in it) and although some of the data in that report has been criticised, the lower risks with sequential correspond to other earlier data- it's about a 1% lower risk.

My consultant told me over 12 years ago that the BC risks of HRT are with progestins and the less used in total, the better.

I have actually looked before, but not been able to find much reliable research done on utrogestan and risk, also the level of risk generally - plus taken orally or vaginally (off license). Risk of HRT and BC generally tends to be overstated and there's a lot of work being done currently to address this.