Confused by advice on when to take micronised progesterone.

[TreetopsandTailwaggers]

Everything I read before being prescribed it seemed to suggest if you are pre menopause, ie still having periods, you should take it for half the month. I am confused because my GP has prescribed 100 mg capsules and told me to take it ‘on days 1-25 of HRT monthly cycle’ which I thought was the protocol for post menopause.

I am 51, still have pretty regular periods, but also just about every peri symptom going. GP was happy to prescribe, although it’s been a nightmare getting hold of the oestrogen. Trying again tomorrow with the third prescription for yet another different oestrogen product - Sandrena this time (I can only have gel or spray because I react to the adhesives in plasters and patches and topical only due to complex migraine). Can’t get through to any pharmacies this afternoon for some bizarre reason, so will have to just see what happens when I get there.

If, by some miracle, I do actually manage to fill my prescription tomorrow, is it ok for me to take the progesterone for 25 days of my cycle, given I am still having fairly regular periods or do I need to query it with my GP?

Also, after all the palaver with trying to get hold of the oestrogen, my period is actually due on Monday (although it may have other ideas of course). Does that affect when I should start taking the HRT?

I think I’ve actually read so much I’ve confused myself now.

It's easy.

If you have regular periods you take it for 12 days a month (2 tablets a day.)

GPs seem - going by posts here- to have a real problem understanding the two options.

Ideally, start it to coincide with the middle of your own cycle, so approx 2 weeks from Monday, if it's a 30-day cycle ,and stick to the same day every month.

Start the estrogen as soon as you get some!

1. if you are still having regular periods who need to take it days 15-28 (ignore the 12 days thing; no longer recommended) (2 per night for those nights)
2. if you are haven't had periods for over a year and are over 53 ish it's worth trying 1 tablet a night. There is no harm from using the "wrong" regime but you are much more likely to get irregular and annoying bleeding.

You not who!

@Chilldonaldchill Are you sure on this? Is this what you have been advised yourself? Where have you found the '12 days no longer recommended'?

14 days in one option (for women who need more to control the bleeding.)

The patient leaflet states 12 days and that is what meno consultants prescribe.

This link shows the 12 day dose. www.medicines.org.uk/emc/product/352/smpc

Please don't complicate it for the OP.

I am using this and through a consultant who trains other meno specialists.

@Chilldonaldchill

1) if you are still having regular periods who need to take it days 15-28 (ignore the 12 days thing; no longer recommended) (2 per night for those nights) 2) if you are haven't had periods for over a year and are over 53 ish it's worth trying 1 tablet a night. There is no harm from using the "wrong" regime but you are much more likely to get irregular and annoying bleeding.

That’s what my Dr says too, it’s no longer good practice to do the two weeks off.

@Foxcubs There are two ways of using HRT and two types -

1 for women with natural periods, still.
2 for women who have had no periods for at least 12 months.

1 use is cyclical, ( 12 days of Utrogestan per cycle (used with gel or an estrogen only patch). As per the instructions.

Tablet form HRT comes as a packet and has 14 days of estrogen-only tablets, and 14 days of estrogen+progestin in 1 tablet.

2 Daily estrogen and daily progestin (this supersedes the 25 days in the Utrogestan leaflet) It's been decided it's not necessary to have a break as very few women have any lining to be shed using it for 25 days.

I think 2) is what you meant? :)

Thank you. I have done a little more reading and it seems 14 days is recommended in some cases when periods are irregular.

I think I’m going to go with 12 days and discuss it with a different gp when I have my review.

I’ve been prescribed the same as you @TreetopsandTailwaggers. I am currently on day 16 and intend to stick with the 25 on 3 off. It helps my sleep so much I really hope I don’t get changed to 12 days a month.
I too had regular periods…

I've been on it 3 months. I start on day 15 and take for 12 days. Its giving me heavy periods, GP said to try for another 3 months then reassess.

Your cycle is 28 days
Days 1-25 progesterone and estrogen
Days 26-28 estrogen only

Then start over again

This allows a light bleed.

If 100% menopausal, progesterone and estrogen every day, no three day break needed.

That's the schedule I was also given (by a private menopause clinic). OP, please listen to your doctor!

Thanks @PixelatedLunchbox that’s what I was told too. Happy someone else is the same

My cycle has always been 34-36 days does that affect this?

Why is there so little consensus with prescribing?

I think I’m going to book an appointment to speak to the GP who has an interest in women’s health before I start. The one I spoke to was happy to prescribe, but didn’t explain things properly and clearly expected me to know what I wanted and ask directly for that. Luckily I had done enough research to know what I wanted and what I can’t have due to certain health issues, but I did feel she could have explained things a bit more. It will mean waiting another 3-4 weeks for an appointment, which is frustrating, as I really want to get started and see if it at least helps my horrendous insomnia, but I’d rather be absolutely sure of what I should be doing before starting.

If days 1-25 result in a lighter bleed and it is medically advisable, that might be preferable, as I have been having a really heavy loss. It would be great if it would help with that, because and it’s sp exhausting, not to mention causing issues with one of my health conditions.

@PixelatedLunchbox

Your cycle is 28 days Days 1-25 progesterone and estrogen Days 26-28 estrogen only

Then start over again

This allows a light bleed.

If 100% menopausal, progesterone and estrogen every day, no three day break needed.

That's the schedule I was also given (by a private menopause clinic). OP, please listen to your doctor!

Sorry and hate to turn this into an 'argument' but it's not the case and your Dr sounds confused, private or not.

The 25 days is for women who are post meno. (I've used Utrogestan for years from one of the top meno consultants in the UK, who trains others.)

The regime is either sequential, or continuous. The leaflet in the pack makes this clear. It says 12 days for sequential regimes.

The 25 days is for continuous. for women post meno with no regular periods. The 3 day break has now been re-thought and most women are advised/allowed to take it every day (which is the same as the progestins in tablets and patches , for continuous regimes.)

@TreetopsandTailwaggers The confusion seems to be happening because many drs are not aware of different regimes.

One private dr (who will be nameless but is in the media!) has (I think) tried to simplify the use by saying '2 weeks on, 2 weeks off' and some GPs are following this. It also makes it the same as packs of tablets.

But the actual regime is 12 days simply because that is enough for most women AND there are downsides to using more progesterone than needed. That's a whole other discussion.

The 25-day regime is suggested by the manufacturer but many specialists have decided that the majority of women will be fine using it daily, so that it becomes the same as continuous/combined patches and tablets (that contain both hormones every day.)

My periods might have stopped (it hasn’t been for long enough to be sure they have) and I just started taking HRT. My doc has told me to take progesterone for the first 15 days of the calendar month.

@JinglingHellsBells please could you elaborate on the downside to women taking utrogestan for 14 days?

I'm interested as my GP prescribed it for 14 days per cycle which I am aware is different to what the PIL says and I've been using it that way since September. I did query it with her at a review and she said that 12 days is the minimum required to protect the womb so she recommends 14 and it's also easy to remember 14 days on, 14 days off but I could reduce to 12 if I want to. I carried on with 14 because I like and trust my GP and I didn't know of any downsides and everything seemed to be going ok for me. I generally have a bleed a few days after stopping the Utrogestan although the last couple of months the bleed started a day or so after finishing and this month the bleed started on day 11 of Utrogestan.

Thanks in advance!

If there are downsides I might change to 12 days.

I got in a pickle as to when to start as following calendar month method I'd been told was completely out of sync with my cycle (it didn't occur to me to do the other half, but that's meno brain!)

So I followed this: (nhs Liverpool leaflet.)

My cycles been a bit wonky though and covid also upset it. This month I would have been using progesterone around my period so I skipped a week so it matched mid cycle. I aim to continue and apparently my cycle should match up.

www.liverpoolwomens.nhs.uk/media/3548/taking-utrogestan-patient-information-leaflet.pdf

My Gp said vaginally is better for bleeding (yes my Gp!) So that's what I'm doing.

I started on 14 days of utrogestan but was moved to 25/28 by an NHS gynae because of continual bleeding.

So Jingle bells are is wrong. 25/28 is not just for post-menopausal.

[quote JinglingHellsBells]@Foxcubs There are two ways of using HRT and two types -

1 for women with natural periods, still.
2 for women who have had no periods for at least 12 months.

1 use is cyclical, ( 12 days of Utrogestan per cycle (used with gel or an estrogen only patch). As per the instructions.

Tablet form HRT comes as a packet and has 14 days of estrogen-only tablets, and 14 days of estrogen+progestin in 1 tablet.

2 Daily estrogen and daily progestin (this supersedes the 25 days in the Utrogestan leaflet) It's been decided it's not necessary to have a break as very few women have any lining to be shed using it for 25 days.

I think 2) is what you meant? :)[/quote]
What would you advise for me...I'm still having periods but take Estrogel and Provera every day. Is that harmful? I do have random, irregular bleeding which is quite annoying.

My GP switched me from taking provera half the month because I was having terrible PMS. Her logic was that if I don't have a break from the progestin it's less likely I'll have the mood swings etc.

I’m pre-menopause and the nurse practitioner has me on 25 days, off for 5, is this not right? I did query it after reading the leaflet and she said I could take it continuously if I wanted to get no bleeding as I’d mentioned extra heavy periods since starting on progesterone.

My periods are really close together now though, like between a 15 and 19 day cycle usually.

@JinglingHellsBells No, I don't think my doctor, (who is a menopause specialist, not just a GP) was confused at all. The regime worked well for me, and I felt great.

HRT isn't a one size fits all, as evidenced by the difference in dosing and schedules. What the OP's doctor has prescribed may or may not work well for her and may be adjusted. My point was that my schedule was the same as hers, and while it may not be typical, it isn't necessarily incorrect.