Confused abut how to take Utrogestan?

[Mennex]

I've been prescribed Evorel 25 Estrogen patches and Utrogestan 100mg capsules for the progesterone part - 50, still having periods but skipping periods.

GP appointment was extremely quick and vague. I'm clear about how to take the Estrogen - the Monday after my period starts (or the one near when it would have done for a 28 day cycle) I'm going to put a patch on - somewhere below waist, then change it on Thursday, new one on following Monday etc. That first Monday will be day 1.

I'm confused about the progesterone part though. As I understand it, there are 2 routes - oral or vaginal, but even there there seems to be variation:

Utrogestan prescripton says 2 x 100mg capsules daily on Day 15 - 27 (13 days)
Some websites guides etc say Day 15 - 26 (12 days)
Some places say Day 15 - 28 (14 days)

Does if matter? IS 12/13/14 days optimal?

Then if I choose the vaginal route, which is my preference:

Some places say that means you can half the dose, so is this:

1 x 100mg capsule vaginally from Day 15 for 12/13/14 days?

Or is it

2 x 100mg capsules vaginally from Day 15 on alternate days for 12/13/14 days?

Or is that not enough and it should be the same 2 x 100mg capsules vaginally every day from Day 15 for 12/13/14 days?

I need a specific plan, as you can see :) - what/how do other people take it? what is recommended now?

I've been using this for years- more than 8 - and my dr is a top menopause consultant.

As you are still having periods, you take Utrogestan on a cycle. That is for 12 days each month. Start 15 days after the day you start the patch. OR do it by days of the month. Start your patch on the 1st Feb and Utrogestan on the15th Feb. Stick to that date. You will have a withdrawal bleed roughly 3 days after you stop Utrogestan.

Don't worry about the 28 days. Work on calendar months.

Please forget the half dose for vaginal use. This has been suggested by one private GP. It's not been suggested to me by my consultant, who is far more experienced.

There is a separate thread here - it will be a page or so back- where I posted about the report from the British Menopause Society on doses of Utrogestan. Have a look and you should find it. Basically, what they say is that new research into using Utrogestan supersedes previous research (which showed half the dose vaginally was ok.) They say use the same amount vaginally as orally. So that is 2 x 100mg.

So 2 x 100mg capsules vaginally every night from days 15 - 26 is what you're saying right?

What if you go private and have regular scans to check the womb lining? Is that a thing? Could you get away with a smaller does then?

How do you get in the private system? Do you self refer? I have private healthcare through work but I doubt they cover something useful like menopause. What's the best way to find a decent specialist? (GP was useless).

Thankyou for your advice, much appreciated.

Most GPs recommend taking the Utrogestan orally and only switching to the vaginal route if you have side effects to the oral. It is not licensed to be used vaginally so I would suggest you try taking it by mouth in the first instance
It is usually taken at night or in the evening, on an empty stomach

@JinglingHellsBells Interesting about the dose as so many clinicians are doing LNs training so using that lower dose. I will look for your previous link

So 2 x 100mg capsules vaginally every night from days 15 - 26 is what you're saying right?

Yes. Vaginally is 'off label' in the UK even though it's used that way in Europe and has been for years. Your Gp may not be familiar with it being used vaginally.

What if you go private and have regular scans to check the womb lining? Is that a thing? Could you get away with a smaller does then?

As you have not used to yet, why are you wanting to reduce the dose?
A private dr would only suggest reducing the dose if you had bad side effects. Then, they would probably suggest a private annual scan. (costs vary but around £250 for one done by drs.)

How do you get in the private system? Do you self refer?

Yes. Most private gynaecologists who offer menopause support take self-referrals. It's all on their websites.

I have private healthcare through work but I doubt they cover something useful like menopause

You need to check the policy. It is usually excluded as it's an ongoing condition. You can usually be covered for something like heavy periods (to diagnose what causes them) but if it turns out to be menopause then they would not continue to pay for consultations for things like HRT.

What's the best way to find a decent specialist? (GP was useless)

The British Menopause Society had a list on their website. Menu bar across the top- Specialists.

There are a handful of very good meno consultants in the UK I know of, and I can help if you PM me if you ever want to see one and have a short list :)

@QueenOfHiraeth

Most GPs recommend taking the Utrogestan orally and only switching to the vaginal route if you have side effects to the oral. It is not licensed to be used vaginally so I would suggest you try taking it by mouth in the first instance It is usually taken at night or in the evening, on an empty stomach

@JinglingHellsBells Interesting about the dose as so many clinicians are doing LNs training so using that lower dose. I will look for your previous link

It's not licensed as HRT in the UK vaginally. It's been used that way in France and other European countries for a long time.

I don't know why you are suggesting the OP takes it by mouth as if it's a better way. It's not. It's purely an anomaly in the licensing where it hasn't caught up with common practice.

I'd rather take the minimum dose if I can and I'd always rather take things topically if possible. It just seems more logical to me. I've never been on hormonal contraception so I am slightly concerned about suddenly flooding my system with hormones at 50. Vaginally appeals as it just seems better to target the drug where I need it, rather than having it going through my bloodstream with more potential side effects. I don't like the sound of the nausea, dizziness, fatigue etc that seem to happen to some people that take it orally. It wouldn't fit with my lifestyle. I am often up late working and still have a fairly young child. I can't just zonk out at 10pm.

But then I am starting to need the HRT for the same busy lifestyle. I have a complex job and I need a clear head and to be a le to concentrate every day. I'm starting with very low dose of the patches, 25mg as it's only just starting to be an issue and I'd rather get ahead of it, so it makes sense to me to have a corresponding low dose of the progesterone and then monitor the situation. I'd happily pay for annual or semi annual scans to check my endometrium.

@Mennex What you say makes sense but there are a couple of 'buts'. :)

You are not 'flooding' your system as the estrogen dose is tiny (25mcg) and the progesterone is body identical, so exactly the same you produce all your life, before menopause.

It's true that the dose of Utrogestan has to balance the dose of estrogen. However, you don't know how your uterus will respond to estrogen. (I use the equivalent low dose of estrogen and even with 200mgs Utrogestan get a heavy-ish bleed each cycle.)

You can pay for private scans BUT you will need a referral from another dr if you want a scan done by a dr, (radiologist or gynaecologist) rather than a nurse or other HCP who has done minimal training in scanning and works in a High St scanning centre. There is a difference.

So all I'm pointing out is that if you go off piste and vary your dose, how will you get your GP to refer you for a scan, without saying you have reduced the dose?

If you want it more tailored, the way to go is to do it through a menopause consultant.

I think you're right. I want a tailored approach. I think I'll look for a menopause specialist as you suggested. Thanks for helping me to crystallize where I am with this. Something has being making me hesitate to start it and I think it's that issue - I don't want the generic sledgehammer to crack a walnut approach.

@Mennex

I think you're right. I want a tailored approach. I think I'll look for a menopause specialist as you suggested. Thanks for helping me to crystallize where I am with this. Something has being making me hesitate to start it and I think it's that issue - I don't want the generic sledgehammer to crack a walnut approach.

I'm happy to give more info off forum by PM simply as I don't want all my private med stuff online!

Hi @Mennex, you may be sorted now but I found this video helpful in explaining more about Utrogestan and how to take it. m.youtube.com/watch?v=MfjelYv-GZ4

Thank you! I'd seen that before and couldn't find it again so that's really helpful.

Thanks for the link.

Mennex, like you I’ve avoided hormonal contraception most of my life and was wary about HRT, but I have to remind myself the clue is in the name “Replacement”. You’re not putting extra hormones into your body as you would be on contraception, you’re just replacing what has always been there but now isn’t. Hope you get on ok with it. It’s made a huge difference for me now that I have the levels sorted. I started on patches of 50 and am now on 100, with 2 utrogesten tablets on a cycle, so don’t be afraid if the 25s don’t make enough of a difference.

I have been prescribed evorel 75 patches and utrogestan tablets. I was previously on everol 50 patches.
My doctor has said to start the tablets on 1st of each month and take 2 a day for 14 days. Says this on the printed label too. However there are 30 in aa pack. So do I just use 28 or take all 30 which would mean taking till 15th of each month not 14th?