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Menopause

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Just been prescribed Sandrena/Utrogestan, not sure about dosing. Help!

9 replies

GlomOfNit · 12/03/2022 14:52

I had a rare (first since the start of pandemic) face-to-face appointment with a GP I'd spoken to a couple of times on the phone before but never seen. I went in to talk to him about ongoing heart palpitations which I've had for years now but are really bad at the moment (and have been investigated over the last 4 years, nothing is showing up as worrying) ... he'd had me on a low dose beta blocker for them before but that was just a month's worth, I don't think it made a difference, and he said 'well, since I see you've already expressed an interest in trying HRT and it's almost certain they're down to oestrogen depletion, let's just do that' ... and I came out, somewhat stunned, with a script for HRT in my sticky mitts! Grin

The background to this is that I've had various peri symptoms for at least 3-4 years. I'm now nearly 49, and I've been trying to talk to my own GP (who is extremely anti-HRT) about HRT for years. She has always trotted out stuff that I KNOW isn't right (you've had a migraine aura (twice!) without the headache so you can never have HRT as it'll increase your stroke risk, you can only take HRT for 3 years so you mustn't start too soon, etc) but she seems to be on indefinite leave and yet another GP had expressed a tentative opinion a year ago that 'maybe you could try a trial of HRT' (and then I got Covid and wanted to get that out of my system). So all this was on my notes, I assume, and to this new GP it really wasn't a big issue. I said firmly that yes please, I WOULD like to start it but wanted an oestrogen gel not oral, he tried to locate a pump, gave up and prescribed sachets of Sandrena 0.5mg gel and Utrogestan progesterone (which I gather is micronised and yam-based and that this is Good?) at 100mg.

It's the dosing that's foxing me. He said, just rub the gel into your thigh or lower belly in the mornings, let it dry etc, and start with one 0.5mg sachet and gradually build up to 3-4 sachets daily. He also suggested I might like to have a higher or lower dose depending on how I feel (not sure about that). It's the progesterone I'm confused over. It's the lower dose of Utrogestan I believe, 100mg, one daily - to be taken on days 1-25 of my cycle.

I'd already explained that, while I'm still menstruating, my cycle length can vary from between 18 to 58 days and I'm currently on about day 37 of what seems to be a longer than 'normal' cycle. So it makes sense to take the progesterone from day one of bleeding because that's a definite point I can measure from - but right now it could be weeks before my cycle starts again! I'm very frustrated - I would like to get on with the gel but not sure if I'm meant to just start it and then bring in the progesterone when I start my cycle. Or, given the HRT will sort of 'create' my cycles (??) does this matter, should I just start with both of them?

Also, from reading on here I gather that 25 days of progesterone per cycle seems like a lot. It's definitely the 100mg dose daily but I'm seeing women here being told 12 or 14 days.

So my questions are:
first, can I just start with the gel right now and not worry about the progesterone until I start bleeding? What it that's weeks and weeks away? Or do I take both together from the onset?

second- does taking 100mg Utrogestan for 25 days of cycle seem excessive?

I emailed the practice to ask that these questions be forwarded to him but no reply. Now it's the weekend. I was prescribed on Monday. Sad

OP posts:
JinglingHellsBells · 12/03/2022 15:39

It's simple.

If you have periods, even not every month at the same time, you use Utrogestan on a cycle.

The 'daily' (or 25 days per month) dose of 1 capsule- 100mgs - is for women post-menopause. (And now, most are advised to take it daily and ignore the 3-day break.) If you start that regime now, when you still have periods, it's likely it won't control your cycle and you might spot, or bleed at any time, as you are now.

You need to take 2 capsules ( 200mgs) for 12 days, each calendar month.

You can start gel now.
You can wait a couple of weeks to start Utrogestan, or you can start it any time and it will (usually) re-set your cycle.

Initially, you might get two bleeds close together . You can expect the withdrawal bleed after 12 days ( usually starts 3 days later) but you might also get your own period before that, or even after, until it settles down into a regular pattern.

Eventually, the withdrawal bleed will be your regular monthly bleed.

Some consultants suggest starting utrogestan on the 1st of each month to make it easy to remember. You could start you gel today and Utrogestan on 1 April.

Hope this helps- you'll soon get the hang of it all:)

GlomOfNit · 14/03/2022 08:48

Thanks HellsBells! That does indeed sound simple. I guess the GP wasn't entirely informed about the dosing protocol for women still menstruating... Makes me so cross though. If I hadn't known just about enough to think this didn't sound right and seek further information...

I'm going to email the surgery again and inform him that I've done some research and now know that I'm not meant to be taking it more it less continually. I sort of feel that I do need to tell him if I'm taking it differently to how he's told me to, even if his directions weren't appropriate.

So if I understand it, taking progesterone for 12 days will shortly after that 12 days bring on a bleed, which should last for what - 5 days?? I haven't a clue - and then I go on as normal until the next first of the month and take the progesterone again.

I started the Sandrena gel yesterday. Smile Not sure how fast 'gradually build up the dose' should be, but I'm going to continue on one sachet for a week and then start using two. Does that sound ok?

OP posts:
JinglingHellsBells · 14/03/2022 09:10

Yes, that's right- as above :)

You might get get a bleed after 1 month on a low dose- it depends how much estrogen you absorb. It might be a very light bleed or could be heavier- it varies so much.

Don't worry if you don't- just keep to the same pattern of 12 days from the same date each month.

I'd give one sachet a couple of weeks then move up onto 2.

JinglingHellsBells · 14/03/2022 09:10

get get- doh!- not not get

GlomOfNit · 14/03/2022 09:13

Great, thank you so much! Smile

OP posts:
Savoretti · 18/03/2022 21:41

Interesting - I’ve just been prescribed progesterone for 25 days too. Now I’m wondering what to do..

Localher0 · 19/03/2022 07:45

I've just moved onto Sandrena 1mg / Utrogestan and have had the worst period for years! I'm
Not sure I want to stay in this or go back to the Evorel I was on.....

will this settle down with the next cycle? I'm wondering now whether to keep going as the night sweats have also been much worse than on Evorel.
Sorry to hijack the thread but hopefully someone has been in this for a while or has some advice.....

JinglingHellsBells · 19/03/2022 08:30

@Savoretti

Interesting - I’ve just been prescribed progesterone for 25 days too. Now I’m wondering what to do..
It depends a little on your menopause status and if you have been completely period-free for a long time. If you are very much post meno then most drs are advising women to take Utrogestan continuously because that's how a combined continuous patch works.
LadyGardenersQuestionTime · 19/03/2022 08:36

I'm 63, no idea of previous period status as I was a serial happy Mirena user but clearly they would have stopped years ago, and fyi I've just moved onto daily Utrogestan. I was confused when I saw people were taking them on a cycle but found out what's been said here - if you have a cycle (ish) take them on a cycle, if not just take them.

Incidentally, I think they have been making me dream more. Perfectly pleasant dreams, but more of them.

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