Utrogestan…really liking it?!

[jewelsandbinoculars]

Hi all

I’m 44, been suspecting peri for a couple of years now. Night sweats, but brain fog, low mood and increasingly black/bleak moods in last 7-10 days of cycle (still pretty regular). GP has been great - she doesn’t have a great deal of personal expertise but was v supportive of desire to try HRT & recommended trial of 2 pumps Oestrogel & Utrogestan (for 12 days of cycle) and monitor how I’m doing. I’m just in third month now. After all I’d read beforehand I’d expected to lurve the Oestrogel and struggle with the progesterone but it feels the other way round for me. Gel only days I feel as foggy as ever (if not worse), plus dizzy and spacey. Whereas with progesterone I feel calmer, clearer, more competent. Significantly reduced pmt, too. Ive tried to avoid being too reductive about symptoms and causation but this is third month that it feels like I’ve just flipped a switch. Anyone else this way round? Isn't this the opposite of the “norm”. Does it mean I can/should just shelve the oestrogen? And if so can I keep taking the (lovely!) utrogestan? Any thoughts or insight from those more experienced would be so appreciated.

I was taking vaginally; I wouldn't have liked to take less. A few periods were quite heavy when I first started till later on when I seemed to go further into meno.

And that was on x2 out of 28 days.

I didn't get on with it at first so used vaginally, same dose, with Gp agreement. It was the oestrogen that was fab. However now, a year later, I really do like it and take it orally, no issues.

Is there a benefit to taking Utrogestan orally rather than vaginally?

I thought by taking it vaginally it goes straight to the area where it's needed, rather than going via the stomach/liver etc.

So why would women take it orally? Does anyone know?

Utrogestan is approved for taking orally whereas vaginally is off license for those who don't get on with it orally. Orally can have a slight sedative effect (though not for everyone) which can help with sleep.

I've used it both ways and prefer it orally as I'm already using topical estrogen pessaries for vaginal atrophy. You'd also have to consider when you're using it if sex is on the agenda.

Purple on 12 days/ 28 vaginally worked well. I found I was too groggy taking orally and was so tired anyway I had no room for more. I'm personally finding a bit of the casing builds up vaginally when using continuously (25/3) and I'm not keen. Others don't seem to have this issue.

I also was finding that the increased oestrogen was making me retain fluid a bit too much and I had v painful legs and feet (I'm hypothyroid and from others' experiences this seems to be common.) I wanted to try orally again and found no ill side effects this time (so far). It is helping me sleep and I've been feeling calmer/ less mood swingy.

My Gp was v happy to use vaginally when I first started hrt as she did say it works better for bleeding (presumably because it does go to where it's needed.)

A friend has found taking it orally continuously is the magic pill she's been missing for years to help sleep. I also know someone else on 25/3 who hates her 3 days off and is extra focussed and buoyant the rest of the time!

Everyone seems v v different.

Do the people taking it 25/3 still have periods or bleeds??

Im trialling it. I have to monitor it. I have had a light one but a few days after my 3 day break. But it would always annoyingly take a week or two when I was on cyclical.

I take it 100mg every night (no need to stop for 3 days out of 28) and still get periods - the last one was quite heavy - which is why the doc put me on that regime, but I also had periods with a mirena coil too whereas most people don't.

This is all really interesting. I've just had two weeks on utrogestan + oestradiol and it's the best two weeks I've had in years. I did try mirena, first on its own then + oestradiol but the mirena turned me into a snarling angry savage so I got it taken out and had no hrt at all . Yeah that was a shit few months. Hoping the good feelings continue on my non utrogestan days but I've not had a period since September even with no mirena or anything so I think I've probably finally hit menopause itself . Good to know that taking it continuously seems to be a positive thing as I'm pretty sure I'm close to being able to do that, but also good to know that just increasing oestradiol could also work.

I honestly feel like a different person. Although, going from two/three hours' sleep to seven/eight plus from almost constant hot flushing to NONE AT ALL probably explains that.

How are you having your estrogen?
Glad you are feeling good!
I turned down a mirena the other day. I have just started the mini pill. I also have estrogel 2 pumps and I'm utterly confused as to whether to take utrogestan on top for 12 days of the month or not. GP says no need and she has double checked.

Is mini pill progesterone only pill? If so that makes sense because it would give you the progesterone part of hrt which you need if you still have a womb.

Thanks for the good wishes.

I'm taking oestrogen via the gel. Just one pump split between two arms. It's working great right now but it's good that I can increase if necessary.

Really interesting reading as I was having awful time having been on gel & mirena coil for years, when a scan found the coil not working effectively due to fibroids growth. Whilst I’m waiting to have the fibroids zapped they gave me provera progesterone top up to stop continuous bleeds, and this is the best I’ve felt for a year and I reduced my oestrogen gel to 2 pumps. I obviously needed the extra progesterone not the 4pumps of oestrogen.

The POP should not be relied on for endometrial protection as part of HRT like the Mirena coil can. See from page 29 here www.fsrh.org/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/fsrh-guideline-contraception-aged-over-40-sep-2019.pdf

@over50 I've seen lots and lots of evidence that agrees with what you've posted. But, my GP double checked and confirmed that yes, very recently, the latest advice in my county is that it's ok to prescribe this particular POP as the prog part of an HRT regime.... I did query it. The document you've posted is 3.5 years old. This is an area where advice changes rapidly. Still, I'm going to take the Utrogestan on top anyway, because I prefer to, and she said that's fine also.

Bear in mind that the POP pill will be synthetic hormones whereas Utrogestan is body identical made from the wild yam plant. I think that means more health benefits and less health risks. I had also understood from Dr Louise Newson that HRT doses are much lower than in the pill but I would check this for yourself in case I had misunderstood.

Thanks. I'm ditching the pill. I have awful sore breasts after only 4 days and am feeling the full force of these synthetic hormones right now. Back to the plain old HRT regime and I will try and tweak it as I go along, under advice.
I think I might book a consultation with Newson Health. So much money but I need to understand the science between younger woman - higher doses of estrogen. If it's right for me to be on higher then I can present the case to my GP.

thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

This is a good read around prog, higher doses can be used

Thank you @warrior ! I will read this, do you know when it was published?

2021?

Due for review in 2024. From what a Gp friend recently said of her BMS training in the autumn, using higher doses of Utrogestan may become more usual. I believe taking with food doubles the absorption.

I find the forum on menopause matters is exceptionally helpful too.

pubmed.ncbi.nlm.nih.gov/8513955/

Thanks for sharing @WarriorN im convinced my mirena isn’t giving me a high enough dose of progesterone as I’ve felt like a different person since I started taking supplemental extra progesterone whilst I wait for fibroid treatment but I’m worried that will stop after treatment when actually I need that extra progesterone to on an even keel.

It might be possible to ask for Utrogestan if it's so beneficial?