Utrogestan dose - don't reduce it, vaginally is new advice.

[JinglingHellsBells]

There has been a trend to reduce the dose to 1 capsule when used vaginally as part of the 12 day cyclical regime. This was based on a small research paper a few years ago. Since then, it's been suggested that one capsule is fine. It's not and this BMS says why.

In cases where you are very sensitive to Utrogestan it may be possible to reduce the dose with a consultant's advice and access (not on the NHS) to scans. But that is the only way you should be doing it. GPs have now got to get up to date and this new directive from the BMS came out in October 2021.

The information is here.

progestogens and endometrial protection

Based on current evidence if progesterone were considered for vaginal administration (out of license use) in women who experience side effects with oral intake, this should be given in similar doses and
durations to those applied to oral progesterone intake with HRT

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

link!

Thanks!

Thank you

'In cases where you are very sensitive to Utrogestan it may be possible to reduce the dose with a consultant's advice and access (not on the NHS) to scans'

Scans are possible on the nhs. I know someone who has had a surveillance scan on the nhs purely because they are on vaginal utrogestan to check the endometrium. Not saying it is routine, but neither is vaginal utrogestan so those on it could request one via their GP before paying privately.

The article is interesting because it states 10 days of vaginal utrogestan is not sufficient to protect the lining however alternate nights would be 15/16 days a month. Who is only taking it for 10days?

More research is clearly needed. I wonder if The Newson clinic and GP notebook will change their advice?

Are you using HRT yourself @JaniieJones?

I know you've posted on this topic quite a bit and mentioned your friend who is having routine scans. That's pretty unusual, so I guess she has a history or reason for it, in order for her GP to request a scan. I know other women on Utrogestan and there is no way their NHS would pay unless they had symptoms.

Maybe ask her and feed back for info here? Genuinely interested to hear as will be other women.

The 10 days is not quite as you posted.

It's if it's less than 10 days that's the issue.

Studies have suggested that women taking sequential HRT regimens with less than 10 days of progestogen each month are at increased risk of endometrial hyperplasia and endometrial cancer

Some of the progestogens in the list are only taken for 10 days. Again, there is some flexibility with dose under a consultant, where the dose and efficacy is monitored, if there are side effects on higher doses.

The alternate nights regime is based on ONE Swiss study and again, it's not the prescribed dose. The risk with that is it's a variation on a continuous regime (combined continuous.) There is no monthly withdrawal bleed. So it's harder to be sure that the lining has not grown. Continuous regimes are a fine balance between estrogen daily and progestogens daily. Using it on alternate days may result in spotting, (it happens anyway for up to 6 months on the full dose, initially.)

Interesting. I have been getting on badly with the progesterone phase of my tablets. Anxiety, depression, anger - PMS basically. I asked the nurse (had a GO appointment but they changed it to the nurse at last minute!) if the duration of progesterone could be reduced and she had no idea, nor what the risk was.

@Summerhillsquare

Interesting. I have been getting on badly with the progesterone phase of my tablets. Anxiety, depression, anger - PMS basically. I asked the nurse (had a GO appointment but they changed it to the nurse at last minute!) if the duration of progesterone could be reduced and she had no idea, nor what the risk was.

TBH it's not something within a nurse's remit. The drs who are able to really 'individualise' HRT are consultants and many are working like this privately. The reason is they monitor it closely and set a 'low threshold' for any symptoms like odd bleeding (which can be a sign of too little progesterone) and then do a pelvic scan very quickly to check everything.

Some consultants (they are quoted online in research papers on this) allow women to take anything from 7 to 10 days of progesterone BUT on the basis they are scanned, privately, when necessary.

Unfortunately, the NHS isn't set up for this and it's also a cost issue.

'Unfortunately, the NHS isn't set up for this and it's also a cost issue.'

Not routinely no, but if someone is taking utrogestan vaginally on alternate nights they may be able to get a surveillance scan. As I've said a couple of times I know someone who has had exactly that. I think it's great that some GPs are so proactive regarding women's heath, it isn't always necessary to pay extortionate amounts to private clinics raking it in.

Still a bit unclear a out the article, I don't know anyone who takes utrogestan for less than 10 days a month and if it is referring to other progestogens then the thread title may confuse some people.

I don't think you are yet menopausal or using HRT, are you @JaniieJones? I'm sure you said that a while back.

I may be mistaken but some time ago, did you mention this friend of yours and say that she had a history of some bleeding, hence the scans? And therefore her GP is managing to request ongoing scans? Otherwise she is the only person I know of who can access scans as drs have to tick a box with their reason for requesting a scan.

I can't see how the thread title is confusing because the word Utrogestan is the first one in the subject line. Utrogestan is the only form of progestin that is given separately - all the others are already packaged as a monthly dose as tablets or a patch, so it's not possible to women to adjust the dose anyway.

You possibly don't know anyone taking progestins (of any kind) for 10 days or fewer. There are some and they do post on other meno forums.

It's an option there, mainly for consultants, but the paper I linked to also shows that some of the stronger progestins can and are given for 10 days, depending on the estrogen dose.

This is an extract from a paper which includes Mr Nick Panay's guidance (he leads the meno clinic at the Chelsea and Westminster Hospital and is a key researcher into menopause/HRT.)

The minimum recommended duration of progestogen required to prevent endometrial hyperplasia completely is 12 days (Sturdee et al., 1978). However, if a patient is progestogen intolerant the duration of progestogen can be reduced to 10 or even 7 days per month. This will increase the risk of endometrial hyperplasia, particularly if implants are being used, so it will be necessary to have a lower threshold for endometrial sampling should there be any suspicious bleeding. Heavy/prolonged bleeding may also be a problem with the shorter duration of progestogen

There are many 'off label^ variations on HRT which GPs are not aware of or using (the latter because they are not at consultant level and have to stick to the prescribed dose.)

Still a bit unclear a out the article, I don't know anyone who takes utrogestan for less than 10 days a month

It's not (just) about the number of days - it's about the dose per day.

So if you’re taking utrogesten (either 1 tablet for 23 days with 5 days off, or two tablets a night for 14 days and 14 off) and not getting a withdrawal bleed would that be an issue? Sorry if this is a derail.

@RoyKentsChestHair Love your user name though don't know who Roy K is!

Evidently, something like 20% of women do not get a bleed. It may be that the amount of estrogen you are using is too low for your lining to grow much. Using it for 23 days a month is classed as continuous anyway, and it's unlikely you would get a bleed.

Why 23 days? Now it's usually every day, or 12 days per cycle.

BTW if you want to know 'how I know' I've written a lot of articles on women's health for the media, as well as my own experience of meno, and spoken to many leading drs for information.

Thanks Jingling. TBH I made it 23 days myself as I can’t get a GP appt and was worried that taking it every day and not get a bleed at all was a problem.

Having read the leaflet inside the box it mentioned taking it for 23 days with 5 off or taking 2 a day for 14, so I started doing 23, still didn’t get a bleed, do have done 2 x tablets for 14 days this month. If continuous (1 a day) isn’t an issue I’ll go back to that as I’m getting a lot of night sweats at the moment - don’t know if that’s related or not?

It’s just so annoying trying to juggle all this myself without being able to see my GP unless I can get through at 8am and be 75th in the queue, which of course I can’t as I have to get to work!

'Otherwise she is the only person I know of who can access scans as drs have to tick a box with their reason for requesting a scan'

I'm sharing an anecdotal situation. It is a good thing surely, maybe progess? I know someone who had a dexa scan too on the nhs without fulfilling the box ticking choices, but there is also an 'other' option thankfully with all investigation requests.

Think the best advice is to discuss the situation with a GP rather than following online advice citing BMS articles that aren't very clear as there are so many different prescriptions available.

I, friends and family are all at various stages peri/meno. Some on HRT, some not so this topic is often discussed hence my interest

Oh and this is my dream man - Roy Kent from Ted Lasso. It’s on Apple TV at the moment - well worth a watch if you have it, it’s nominally about a football team, but like most shows, more about the characters, who are all brilliantly written.

Roy Kent’s chest hair

@JaniieJones There is absolutely nothing wrong in flagging up new developments in prescribing guidance and leaving links. I'm actually rather shocked you think there is.
You may or may not be aware that GPs are under no obligation at all to train in menopause and there is a national campaign by consultants to get them up to speed. The posts here, day after day, show how women are being mis-treated by GPs who are not educated on menopause or HRT.

I don't think you are being very helpful by suggesting women ignore a professional document, produced by the British Menopause Society or that posters shouldn't share them.

@JaniieJones Am I imagining it or do you always take issue with what I post? It seems to be a case of whatever I post, you want to disagree.

[quote JinglingHellsBells]@JaniieJones Am I imagining it or do you always take issue with what I post? It seems to be a case of whatever I post, you want to disagree.[/quote]
No I find you incredibly informative and knowledgeable, I just like to offer another view sometimes that's all and yes occasionally I do disagree but that ok isn't it?.

'I don't think you are being very helpful by suggesting women ignore a professional document, produced by the British Menopause Society or that posters shouldn't share them.'

I don't think they should ignore anything, just as you discussed there are lots of different regimes so it would be best to discuss it with a hcp rather than reading an out of context document.

Research and studies aren't always easy to interpret for individuals, as I say some taking utro vaginally on alternate nights on a conti basis may be confused by the thread title that it all.

The advice from the BMS (which ought to trickle through to GPs eventually!) is that the dose for vaginal use ought not to be reduced @JaniieJones

It isn't an out of context document. It's a very simple change to what some drs have been doing, which is now shown to be inadvisable.

The knowledge of HCP is lacking regarding menopause. Many GPs have not even read the NICE guidance (yet) which is 5 years old.

There was one research paper some time ago which showed that with vaginal use the dose could be halved, safely. This meant that women on conti could use it on alternate nights. Women on sequi could use 100mgs for 12 days, not the usual 200mgs.

This information found its way online - via the website of Dr Newson- to this forum and another meno forum- and women started using those doses.

This 'reduced dose' advice filtered down to GPs through the same source. Your link credits Dr Newson for the info.

Since then, another paper has been published which contradicts the former one. It said that the dose should remain the same for vaginal use.

Like all menopause information, it will take time for most GPs to catch up on this new directive.

She may change this or she may- with her own clients- prefer to allow them the variation if they are progesterone intolerant (as shown in the quote above by Nick Panay) as through her they can access a scan easily.

The point of posting the link (and it's really NOT confusing or hard to understand - it's clear bullet-point) is for information.

'Since then, another paper has been published which contradicts the former one. It said that the dose should remain the same for vaginal use.'

The BMS article you linked or a different paper? Because if you're referring to the BMS paper it states that 10 days or less isn't enough. Those that take it continuously on alternate nights would be 15/16 days. That is why it is confusing as I said in my first post on the thread.

Women do need to discuss their individual situation with their GP imo.

If you are not personally using Utrogestan @JaniieJones, don't worry about it :)

I don't find it confusing, because the basic message is don't reduce the dose if using vaginally.

The link is there for information. (It was actually left by another poster a couple of weeks ago but was buried in a longer thread!)

Two posters at least have already said thanks for it, and for me, that mission accomplished. It's been brought to attention and that's the point of the link.

If other women read it and want to talk to their GP that's absolutely FINE!

Let's not overcomplicate something that was purely passing on new information.

Thank you JinglingHellsBells your posts are always incredibly helpful and I always look out for them.

I appreciate the link thank you @JinglingHellsBells

Do you work in this area?