Beginning HRT - Pro's & Con's of 100 vs 200 Utrogesten?

[Curlynewty]

Hi everyone. : )

My background is that I'm 51, have had masses of symptoms for the past 6 years, insomnia, aching joints, night sweats, hot flushes, IBS, low mood, loss of libido, tinnitus, itchy skin, memory problems, palpitations, irritability, well the list goes on, not pleasant to be around I'm certain!
Always largely explained away with other diagnoses, including depression, cue prescription of Sertraline, I then sort of gave up looking for answers as this seemed to fit.

Fast forward to now, obviously Covid put paid to F2F Dr visits for a while and symptoms increased. My hair is thinning but seems to have gone curlier and more wiry and I have dry skin now too. My stomach is bloated, I have weight gain, boobs are much bigger and heavier and I'm SO tired ALL the time it's just frustrating as hell - as I'm sure you can all relate to. Eye bags galore.

I've been reading for a little while here and soaked up all the info here from you all and the increase of up to date info over Menopause Day, the Balance app etc and finally asked my GP for HRT.
Initially she suggested antidepressants again! To help with the night sweats not because I was depressed she hastened to add. Having read so many of you also experienced this plus having checked the NICE guidelines which clearly state this should not be offered, I managed to decline these saying I didnt think they were appropriate.
I have family history of cancer but again had checked that gel or patch along with Utrogestan tablets would not be as risky. She agreed with this but still said the risk was high and that after 5 years the risk rose incrementally. I will need to check this as I thought this was no longer the case?
Anyway, to cut a long story short, she agreed to prescribe me with gel - I have Oestrogel (I'm to try 1-2 pumps) and also Utrogestan 100mg tablets. Finally to my question - well done if you're still hanging on, haha - there were two options of these, to take for 25 days then a break, when I may or may not get a period again apparently (mine had dropped to every 3/4 months) or to have 200mg tablets and only take them for fewer days. My Dr couldn't tell me if there were pro's and con's with either so I am wondering what everyone's experiences are?

They need to be taken on an empty stomach so cant see me getting up an hour before breakfast to do that!

I did remember reading that some get on better using them internally but when I mentioned this, she was surprised and said this wasnt what they were prescribed for and that pessaries were not available?! By this point, my levels of confidence to contradict were well and truly shot so I just accepted this.

Also there was no mention of testosterone at all? Should this form part of my treatment?

Sounds like you have had a horrendous six years, so sorry to hear that @Curlynewty

I’m not an expert but I thought if you are still having periods, albeit infrequently, you should take 2 x 100 mg on day 15 - 26 of what would be your cycle.

Other people have suggested on other threads to begin a HRT cycle so that might mean 15 days in, from when you started. Hopefully some other responses will come in to clarify.

Also the leaflets states, take them at bedtime (not the morning) and two hours after food.

I’ve just started HRT so yet to take the utrogestan myself but hoping they will have a sedative affect on me.

@Curlynewty ps I have read elsewhere on here that Testosterone is not available on the NHS but women can get it through a private GP.

Similar situation to you op, having studied the Balance App contents in detail for 12 months, I understand -

Testosterone can be added in 6 months after commencing HRT, and although not yet licenced for women in UK, there is hope that this situation might change soon. (I managed to buy on a trip to Turkey).

The Balance app mentions the option of using the actual Utrogestan vaginally which is what I am trialling at the moment. Alternate nights was the recommendation.

The Balance App also mentions newer research and that there is no reason to not continue the HRT treatment for life…

@Curlynewty

Some short answers:

If you are still having periods, even irregular, start on Utrogestan for 12 days per calendar month. 2 capsules x 12 days.

Take at night as they can make you dizzy ( listed side effect.)

You do not have to take on an empty stomach. Only reason that is listed is because taken close to food, more of the active ingredients are absorbed. That can give some women more side effects, but not everyone.

The risk profile of Utrogestan shows no increase in breast cancer for at least 5 years. Some research shows a slight increase after that but other research shows none.

You can insert the capsules vaginally if taking them orally makes you feel sick , hung-over, or upsets your tummy. This is off-label, but only in the UK, as it's a common way of using it in Europe.

There is some research that shows using progesterone on a cycle has less risk for breast cancer than taking them every day.

Your family history of cancer- not sure what this means, if it includes male family members, only female, or only breast cancer. The relevant one is a lot of females with BC, in which case you might want to see a menopause specialist to assess your own risks.

Good luck with it all.

Thanks for answering me so quickly @Periperinotchicken

I think this is where I've become confused as all I'd read said about either 100mg on day 1-25 IF you've not had periods for a year or 2 x 100mg for 12 days if you do still have them but then she more or less said it was a choice and that most women choose the second one merely as there's less tablets but that she didn't know of any pro's and con's!!
I've just double checked thinking I'd perhaps misinterpreted her but no, my prescription states to take 1 per day for 1-25 days! It really shouldn't be this hard to get reliable medical help should it!
My first night I did manage to sleep through so I was relieved, last night wasnt quite as good, I woke up hot and uncomfortable so perhaps need to tweak when I use the gel?

@SynchroSwimmer Thank you for the information, I've clearly not investigated the Balance app thoroughly enough haha!
I must admit that my stomach has been a little unsettled so am wondering about using the tablets vaginally now. Although I've also read that most who do have regular scans, would this be necessary do you think?
I think I need to clear a few hours (somehow!) and immerse myself in the science.

@JinglingHellsBells Thanks, I'm glad to see that the 2 capsules x 12 days is deffo what I should be doing. It's annoying that this actually reduces the risk yet my GP has misinterpreted this information!

I am two days in having only taken 1 capsule each night, in your opinion would I be ok to just start correctly from now? I think I may try vaginally as my stomach is a little upset. So 2 capsules not half the dose?

My history does include breast cancer, my sister had breast cancer which was found during her 1st mammogram aged 50, she's ok now thankfully following treatment. I have had early mammograms due to this and so far I'm healthy. Both my aunties had cancer, one bowel, one lung. No male cancers as far as I'm aware.

Another thing I wondered about was the gel. Should I apply it all in one go or can I split it between morning and evening? I had 1 pump on day 1 then 2 today.

I am starting to feel a little more alert and brighter, which is really good news (unless its psychological but even so I'll take it!) Only had two hot flushes in last 12 hours.

I had to pay double for the two hormones so I'm looking forward to knowing whether this regime suits me then hopefully get it on a repeat prescription to pay just one annual charge.

I split my oestrogel morning and night: two pumps in the am and one at bedtime.

@Curlynewty Just move onto the 2 capsules now and don't worry about the other days.

TBH I'd recommend that you might consider at some point seeing a menopause specialist to discuss the family history etc. (You might have to do it privately, if that's possible for you.)

Reason being, there are various 'tweaks' to the dose that can be individual to you, but all off-label, and not to be done without supervision. This applies to how often you use Utrogestan and at what dose.

Timing of gel- I split mine am and pm, because I found a full dose in the mornings gave me nausea.

I must admit that my stomach has been a little unsettled so am wondering about using the tablets vaginally now. Although I've also read that most who do have regular scans, would this be necessary do you think?

The latest research reported by the BMS says that in trials, oral and vaginal use was absorbed equally, but not to reduce the dose vaginally (as was suggested by previous research trials and which has been suggested as ok by some drs.)

Thank you @Abra1d1 it's reassuring to hear this is ok and it helps more this way.

@JinglingHellsBells I feel so much more relieved having read yours and others replies on here and I agree, I think to have peace of mind I will need to see a menopause specialist. Obvious next question is, where do I find a good one?
I'm guessing once I have a good regime that works for me then I can ask my regular GP to prescribe it.
I had bookmarked the BMS to read but hadn't got round to it. There is a lot of information out there but I'm determined to understand it all eventually and feel the best I can.

So tonight I shall try another pump of gel and 200mg vaginally. I do hope I get a good nights sleep like the first night.

Thank you for helping everyone.

and I agree, I think to have peace of mind I will need to see a menopause specialist. Obvious next question is, where do I find a good one?

The BMS website has a list of specialists on their site and it's based on location.

If London is an option, the NHS Chelsea and Westminster Meno clinic is the best place for women with special issues like family history. They take GP referrals from all over the UK.
Your GP can refer you although some of the consultants there also work privately (but may have a long-ish waiting list.)

@JinglingHellsBells

and I agree, I think to have peace of mind I will need to see a menopause specialist. Obvious next question is, where do I find a good one?

The BMS website has a list of specialists on their site and it's based on location.

If London is an option, the NHS Chelsea and Westminster Meno clinic is the best place for women with special issues like family history. They take GP referrals from all over the UK.
Your GP can refer you although some of the consultants there also work privately (but may have a long-ish waiting list.)

Thanks @JinglingHellsBells

I live in the North West so it would depend whether a one off visit would suffice or whether ideally follow-up appointments would need to be arranged.
The two nearest specialists to me share the same Dr - is there any way to find out people's experiences of the specialists?

As the progesterone is to protect the lining of the womb (so I believe) does this mean regular scans are necessary to check if it is working? My GP said to arrange a telephone consultation in 3 months time and if all is fine, to continue for 6 months.

Hope you are getting used to hrt. I just started after years of trying to get it and male doc would not give it so had to go to a Wellwoman clinic which are great. I take Divigel daily single sachets on the leg and 14 days after start of my period take the progesterone 200 nightly for 14 days then stop that for 14 days. I sleep great when take progesterone and should be taken few hours before bed on empty tummy. So helps my insomnia so cannot wait until take it again in few days. Worth finding someone who specialises in hrt who can go through it all with you as I was so confused also and write down your questions and talk through family history etc. take care and hope you start feeling better soon.

@BOOTS52 Are you not in the UK? The types of treatment you mention aren't known here - Divigel? Might be worth 'converting' it to the UK brand name if possible! I think here it's Sandrena.

Yes am in Ireland and Estriadol is Divigel I think and generic is Sandrena. But there is such a low supply of them all and I had to ring lots of chemists in week to find my gel. Thank god got a few boxes. So many doctors are clueless. Do you have WellWoman clinics there/family planning, which were great here as low cost or free if on medical card.