Post Meno Utrogestan struggles

[VivienS]

Hi ladies. I'm looking for advice from any post meno HRT peeps using continuous Utrogestan and Estrogel. I am 59, had my last period 4 years ago but bizarrely the menopause symptoms only started a year or two ago with hot flushes which got much worse just this last year. SO, HRT was suggested. I am 3 months in.
The first 2 months were bliss in that I was zonked out on Utrogestan 100mg orally every night and took the gel that time too (late at night). But then I started getting too sedated during the day and I discovered you could take the Utrogestan vaginally. I tried this for a few nights and swapped my estrogel to the morning. My night time sleep changed from bliss to feeling wired and I had insomnia for the next few nights. I changed back to taking it orally in the evening (still taking the gel in the morning 2 pumps). I feel great on the gel - this gives me a good source of energy for the day. But now even back to oral utrogestan, it wakes me up with a severe dry mouth many times in the night, leaving me exhausted. I am thinking about utrogestan every second day - but I can't bear the not sleeping. I am considering taking it in the morning now along with the gel as the sedated effect is no longer.

Any advice?

It's really hard, isn't it?

I use it vaginally (200mgs x 12 days) and find it makes me very hot at night and I wake a lot.

Orally, I find it makes me pee at night and dopey the next morning although that does wear off by lunchtime and I am using twice the dose you are.

You can't really start using it every other day as that's too low a dose and there is risk of bleeding as it may not control the lining.

You could try using it on a cycle, which is 12 days per month only but you will get a bleed each month on this .

Also, it can make you dizzy, so using it during the morning, orally, is unwise. It's listed as a common side effect.

One other way is to use the Utrogestan vaginally daytime, as long as it doesn't slide out before it's absorbed- depends how strong your pelvic floor is!

Thanks so much @JinglingHellsBells ! (ha - love your ID)

I really appreciate your feedback. You're right. I actually missed a dose 2 nights ago (of the Utrogestan) and woke up feeling amazing, clear and lucid. Thats what made me think there was defo a problem with my reaction to it. I knew it was unsafe not to take it, so of course I resumed last night taking it (orally). I had a horrible night gasping for water, waking up at least 6 times with the driest throat. And today I did get a breakthrough bleed and a dull ache (like period pain). Its not heavy but i was alarmed as had only missed one night in 3 months.
But I'm liking your idea of switching to taking it vaginally in the morning! Thats one I had not thought of because experience at night taking it that way was so bad. I think its my last option as I just can't seem to tolerate it at night. So thank you.
But...how do you switch from night to morning? ie. not over or under dosing. Shall I miss tonight and take it first thing? What you reckon?
I'm sorry to hear you are getting the heat at night tho. How much estrogen are you taking?

It's weird, isn't it?

I'm using between1.5 and 2 pumps of gel. I'm a long term user, now in my mid-60s. (See a consultant for my meno stuff.)

I think in your case I'd do 100 mgs tonight then another in the morning- you can't overdose.

Thanks for that. I'm actually only on 100mgs and I cant do another sleepless night, so I will do it early in the morning (will be 8 hours later than usual). Ill let you know how it all pans out. Im seeing my GP tomorrow too.

Sounds like you are a bit of a pro! Thanks so much :)

Vaginally you need to halve the dose as it absorbs more. So continually you take 200mg every other day. Cyclically you take only 100mg for 12 days rather that 200mg. So you may have been taking too much.

Also, orally, you need the 2 hour empty stomach thing....food in your stomach makes you absorb more.

Maybe try vaginally (but alternate days)?

hi @SizeEleven - thanks for responding.

Yeah i did the 2 hour absorb thing when taking the pill orally. I think I am super sensitive to it. The absorption thing baffles me - you'd think it would be better to prescribe a lower dose WITH food, then we could all relax, eat and have less side effects....

So you're saying its stronger when taken vaginally? As its only 100mg I'm nervous of alternate days - the only time I missed a day (altho it was orally) I did get a bleed.

I took it vaginally this morning for the first time and so far so good as in dont feel drowsy or any other negative effects... I'm hopeful this could be a good way. Only time will tell.

Also considering getting a womb scan to see what the lining looks like so at least there is a ball park to measure.

I will defo keep you posted.

Vaginally you need to halve the dose as it absorbs more. So continually you take 200mg every other day. Cyclically you take only 100mg for 12 days rather that 200mg. So you may have been taking too much.

@SizeEleven I'm sorry but that isn't correct. Where have you seen this, out of interest?

There has been ONE study which looked at a reduced dose when used vaginally, but it is not accepted as common practise or advised.
There is (to my knowledge) only one private dr currently advising that half-dose. Women are picking this up from the web but it's not what most menopause gynaecologists advise.

@SizeEleven

The licensed dose for continuous is 100mgs daily. (not 200 as you wrote.)
Half that dose would be 100 mgs on alternate days.

This is an 'experimental' regime as it is not yet licensed to use that way and for women who may be intolerant to progesterone.

It's only being suggested by one private GP, as far as I know, but it appears it's got round the web, as the 'norm', when it's not.

www.menopausedoctor.co.uk/menopause/your-utrogestan-questions-answered-by-dr-sarah-ball

@SizeEleven The link is from Dr Newson's website. I am aware of her prescribing practice.

It goes against the grain of other menopause consultants and should not be used as a licensed regime by women reading the website.

What a private dr advises for their own patients is often individual. They take full medical responsibility for what happens to their patient. Also, they are able to sort out any issues far more quickly than the NHS would (and usually offer on-going monitoring, obviously at a cost.)

Fair enough. I am just trying to suggest why the OP maybe having problems though. Potentially too much progesterone for her needs?

My NHS consultant said if I had issues it could be used vaginally. I am OK orally so not something I have explored further.

Some women do react badly to Utrogestan. However, any deviation from the licensed doses should be done with medical supervision.

Dr Newson and the other GPs who work with her can prescribe for their patients but that doesn't mean all consultants do the same.

It is POSSIBLE that half the dose used vaginally is okay but there has only been one research trial on it (I read it ages ago and can't find the link at the moment) so it's not superseded current licensed doses yet.

The videos on Dr N's website are for patients of theirs, rather than for other women reading the site.

@JinglingHellsBells
You sound very like you know your stuff (more than most GPs to be honest!) Are you a GP or a consultant?

well I'm very grateful for all the info you both have given me. It's much appreciated. Day 2 of vaginal insertion this morning. So far no side effects and a great nights sleep--a NORMAL sleep which felt really good.

I do intuitively think that alternate days in what I need as I think the progestin is a bit of an overload for me, so I relate to the video. I knew nothing about any of it before but felt instinctively that this would be a good idea. However, as confirmed my GP yesterday, we dont know enough yet as to whether its safe or not--yet. Whats exciting though is that Menopause is so much more talked about now and can only get better. Thanks ladies. I hope you have a fabulous week.

I am 50 and am suffering with peri- menopause.
I have been deathly tired, angry, depressed, have gained stacks of weight and suffer the most drenching hot flushes day/night.
I contacted my doctor but they seemed useless on the menopause so I had an appointment with a specialist doctor who sent a prescription to my doctors I ended up with oestrogel 750 pump ( 2 pumps daily )and utrogestan 100mg capsule ( take 2 tablets for 15 days at night ).
I have used the above for a week and feel a little better hot flashes are slowly disappearing, I don’t feel so hungry and am sleeping loads better, but I’m still easily irritated and angry.

My question is will my anger disappear in time or is it a side affect?
Do I perhaps need to pump more or less ?
Or does it really take 3 months to settle?
No bleeding as yet but am told I will bleed monthly.
Will it all change once I bleed ?

I couldn't tolerate Utrogestan. My consultant switched me from oral to vaginal which was a little better but not much. I gave it a 6 month trial but it never got better. I used to dread having to start the progesterone phase each month.