Surprising advice at gynea appointment

[Ginsoakedcatlady]

Hi, just wondered if anyone can tell me if this sounds right?

I was referred by my GP to gynaecology due to fibroids / heavy painful periods which leave me in agony every month. After a 6 month wait I had an appointment last month. I’m currently on HRT (gel and utrogestan), the progesterone just for 13 days a month as I’m peri and still having periods, although they were very irregular when I started hrt about a year or so ago.

The gynaecologist recommended the mirena, which I don’t want as I’m really sensitive to progesterone - the utrogestan isn’t great but it’s way better than the others I tried first. And it worries me I’d have to wait for a mirena to be removed if it didn’t work for me.

Anyway today I had my follow up phone appointment and she has told me to start taking utrogestan daily (instead of just part of the month) at half the dose I’m on now. I said my GP had told me not to as I’m still having periods but she said it should be fine? I asked if I should maybe try just taking the progesterone cycle every 3 months rather than every month as my periods were irregular when I started hrt and she said you can’t do that with utrogestan?

it just sounds weird to me! Any advice? Sorry for the long post!

My understanding is that once you have been on sequential HRT for a year you can try continuous.

The withdrawal bleed you get when on sequential is not necessarily a "period".

The reason they are suggesting daily Utrogestan is to try to control the build up of the lining and stop your painful periods.The daily dose is 100mgs.

It's worth a try BUT as you are in peri there is a risk it won't be a high enough dose and you will bleed anyway - either around your natural period time, or off and on.

The Mirena might be worth a try. I don't know if it's in your reach, but you can do all of this privately and you won't have to wait ridiculous times for removal if it doesn't suit you. (I was offered it privately but didn't want it, but my dr said it could easily be take out after 3 months if I didn't like it.)

You most certainly can use Utroestan on a longer cycle (I do- not as long as 3 months) BUT the odds are you might get a heavier bleed when it happens, (the withdrawal bleed) as you are having unopposed estrogen for 12 weeks.

Your own periods might also break through in between.

Ideally, what you need is to try one of the above but if you can afford it, it's really worth seeing a private gynae to get time and expertise, otherwise you end up with all this conflicting info.

Thank you so much! I really appreciate you took the time to reply. I will go ahead with the daily utrogestan and see how that goes. I can’t afford to go private unfortunately but I have been reassured I wouldn’t have a long wait to have it removed if I do choose the mirena (although who knows!). I have my next appointment in 8 weeks so fingers crossed the new regime will work out. Thanks again.

I do utrogestan daily. Amazing! I'm on that and 100 estradot
Brilliant combination. Suits me. No fluctuating progesterone just a nice steady stream of hormones

It surprises me that daily utrogestan isn't recommended when first starting hrt, but daily progesterone via the Mirena is.
(I know it's actually 25 days not the full month, but the principle is the same).

I’ve been told to just take it every day though, not 25 days a month?

When I first started HRT my GP told me I had to have sequential or I’d just bleed constantly. 4 days in to halving the dose of utrogestan and I’m having the heaviest bleed of my life :( I hope it calms down soon!

They are very different forms of action @Astralis The Mirena works directly in the uterus to stop the lining building up. It's a powerful synthetic progestin.

Utrogestin (micronised progesterone) is much less effective when taken orally. A lot can be lost in digestion and in women who are not post-meno, it sometimes doesn't control the growth of the lining very well, so it can come away and cause spotting or normal periods can still happen @Ginsoakedcatlady