100 or 200 Utrogestan?

[Praline55]

Hello. I’ve just been prescribed HRT, Evorel 50 patches and Utrogestan 100 tablets, two to be taken daily for 25 days. The reason for the Utrogestan is that I am still getting periods, although very erratic, last one early August. On reading the leaflet it says to take 100mg daily for 25 days, not 200, so I’m confused and can’t speak to the GP who prescribed. Can anyone offer their own knowledge experience? I’m 55 if that makes a difference. Thank you!

If still having periods the dose is 200mg for 12days per month, when post meno the dose is 100mg every day.

You need to always take utrogestan or an equivalent when you have uterus, it protects the lining thickening which oestrogen can cause.

Thanks Liila, my GP has said take 200mg for 25 days, then have 5 days off for a controlled bleed. Which seems to contradict the drug leaflet, hence my confusion. I’ll have to wait and speak to her I think.

Your GP is incorrect.

The dose for anyone with periods is 12 days x 200mgs ( two capsules.)

For women post menopause (no period for 12+ months) the dose is continuous HRT which is 100mgs daily.

Not much point asking your dr, as they were wrong in the first place!

It's shocking that this mis-prescribing is happening.

I'm surprised the pharmacist didn't pick up the error.

If you took 200mgs a day you'd be doing twice the dose and possibly feel terrible.

(I've used it for years.)

There is also no need for women on continuous to have a 5 day break. This has been 'scrapped' and most drs now say take it daily ( which is what women are doing if they take a tablet form of HRT or have a patch. They don't have a 'break'.)

I would speak to your Dr but only to inform them of their error. It's pretty bad that they can't get this simple stuff right when they can read the dosage instructions online.

Thanks Hellsbells, yes it is a bit shocking. I’m glad I read the leaflet and questioned what the GP told me. It’s also on the label they stick on the box. Take two daily. I will call the surgery today. Have to say I’m feeling pretty anxious about the whole thing, low mood is a major symptom recently, and not feeling confident in the advice I’m getting is not helping! I’m grateful for the input on here.

Name changed incase my friend recognises me!

I've had a bit of confusion around whether to move to continuous or stay on cyclical; Gp agreed could try continuous but I also went up to 100 patches which seems to have levelled things out, but I've since had a lot of break through bleeding.

A friend is a Gp and attended a meno conference this week run by Dr Heather Curry. She said they're saying that 300 utrogestan is preferred for higher patches whether orally (or vaginally but it's not technically licensed here) and if still erratically bleeding to remain on cyclical regime. She said it's very new and on the BMS website.

Personally, my bleeds were barely there and erratic hence why I asked about continuous and Gp agreed. I also knew I wasn't on enough oestrogen based on symptoms and blood tests. But the higher level of patch seems to be bringing a cycle back, so I'm returning to cyclical. I use it vaginally so may try 300 with Gp approval.

I think it's here: thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

It does say it here on p3

"The dose of the progestogen should be proportionate to the dose of estrogen. While no data is currently available on the endometrial effects of high doses of estrogen and the optimal dose of oral or vaginal progestogen in this context, women who require high dose estrogen intake should consider having their progestogen dose increased to ensure adequate endometrial protection (e.g. micronised progesterone 300 mg for 12 days a month instead of 200 mg in cyclical HRT regimens or 200 mg daily on a continuous basis instead of 100 mg in continuous combined HRT regimens)."

I wouldn't have said that 50 patches are particularly high though. You also may find that they get heavier and lots of break through bleeding on continuous(- which may be why they gave you 200) A cyclical regime may be easier to deal with. But I'd go back to the Gp and discuss it again.

@cocoamad The higher doses of progesterone that are in your quote are usually only for women whose bleeding is not controlled by the usual dose of 200mgs x 12/14 days.

Many women would find that amount intolerable ( a lot struggle on 100 and 200mgs.)

As you say, the 50mgs patch is a medium dose, the same as about 2 pumps of gel.

Women on 100mcg patches may need more.

Sadly, the NHS is not able to cater for individual women's needs, because one easy way to evaluate the dose is an ultrasound scan. These are available privately and are a good option for women who can't tolerate high doses of (any) progesterone and need an eye keeping on their womb lining. The NHS will only do scans if bleeding occurs, rather than as prevention.

I know (of) many women (via various forums) who use less progesterone than 12 days a month, and they pay for a scan once every 12-18 months, to check everything out.

I agree, I use it vaginally as I have felt awful on it orally in the past. I may be better now on a higher oestrogen level.

One thing I noticed on the menopause matters forum which Dr Currie has something to do with is that you can apply for an email consultation with her re your hrt regime for around £30 which is more affordable than other private gps. But I'd go back to Gp and query it OP, as you really should be able to get this right via nhs gps!

Submit an econsult to double check? I know of a few patients on double dose for specific reasons, to ensure sufficient endometrial protection. So important to get actual medical advice from someone who has access to your notes.

The manufacturers of Utrogestran do recommend 25/28 days as a continuous regime, because their research showed that this reduces episodes of problematic bleeding. In reality most people do prescribe/use it daily for a continuous regime.

Alternatively, it could just be a mistake.

Hi, quick update. I spoke to a different GP today and they confirmed that the correct regime would be 200mg for 12 or 14 days, alongside the 50 patches, changed twice a week. This is for 12 months and then a change to continuous. That’s if I get that far! Not sure about any of this tbh.