Oestrogel (2pumps) and Utrogestan

[Katie000]

I’ve just been given HRT in form of Oestrogel (2 pumps) and Utrogestan 100mg tablets - I haven’t had a period for years but have read that I may start getting periods again which I’m not keen on.
Also read that my breast size may increase and start lactating - again not keen on this.
Has anyone had this and how quickly after starting this did they experience this?

Hi,
I’m 47 and peri and I wondered if someone could offer advice please? I started taking 1 pump on oestogel 15 days ago and i’m due to start taking the utrogestan part tonight. Can I ask if 100mg vaginally will be enough to protect my lining on 1 pump. I have a history of very heavy periods (due to a small polyp) which have been controlled with tranxemic acid so I’m keen to not have a thick lining for obvious reasons.xx hence the starting on 1 pump.. my periods actually scare me!
doctors seem a bit clueless and so many people are on forums asking for advice.. it’s bonkers.
Thanks in advance for any help offered.

has your dr told you to a) use one only- forever and b) 100mgs Utrogestan?

Because the dose for gel is 2 pumps if you need it (and up to 4 a day) although it's a good idea to START with 1 pump and work up to 2.

The dose for utrogestan for women aged 47 and with regular periods is 200mgs- so that is the cyclical regime, of 12 days with 2 capsules each day.

A small polyp (small means anything up to 1cm) is unlikely to cause heavy periods- so whoever told you that is incorrect.

The dose for utrogestan for women aged 47 and with regular periods is 200mgs- so that is the cyclical regime, of 12 days with 2 capsules each day.

This is on the leaflet in the pack so if your GP is telling women to use 1 capsule only, they are wrong.

It was gynaecologist who told me my polyp was likely the cause of my heavy periods.
thanks for your advice re the utrogestan. You seems very knowledgeable, may I ask are you a medic?

There are also many forums from people (doctors included) that state 100mg of Utrogestan inserted is more affective than an oral dose of 200mg

Those that did bleed on the hrt....did it happen every month. I took it and had really heavy bleeding for about 10 days and then gave up as I couldn't bear thought of it every month. I think I've been too hasty though.

Also did anyone in hrt find it helped with losing weight?

Hi Osta.. I can’t tell you about the period side of things as I’m yet to complete a full cycle ..
I’m interested to hear people experiences with their bleeds though.
regarding losing weight, I have actually lost weight already.. usually going to the gym would just keep any weight gain at bay, but I’ve noticed this last couple of weeks I am
less bloated and looking a little better in my clothes. That said, I’ll wait until the progesterone kicks in as I’ve heard that part can cause bloating. X

@Kelwar

I have linked before to a report by the British Menopause Society that was published last year about the use of progesterone. It states clearly that there is not to be any reduction in the dose of Utrogestan for vaginal use.

Dr Louise Newson started advising patients to use it that way (after 1 research paper in 2016 said it was fine to reduce the dose) and then wrote a guide for GPs who are still following that, even though the BMS advice supersedes it.

BMS progesterones and endometrial protection

Stute et al. 2016 reported a systematic review on the impact of micronised progesterone on the endometrium. The authors suggested that estrogens with sequential micronised progesterone (4%corresponding to 45 mg/day for 10 days per month) or intermittent (100 mg every other day) for up to 3–5 years may be safe (off-label use). The authors acknowledged that there was lack of sufficient data regarding optimal vaginal administration within HRT to guide practice.

However, more recently, a publication from the Early versus Late Intervention Trial with Estradiol (ELITE) showed that lower dose vaginal intake of progesterone resulted in a substantially higher rate of endometrial hyperplasia.

The authors concluded that 10 days of vaginal progesterone 45 mg/day is insufficient to completely oppose the effect of oral estradiol 1 mg/day on the endometrium. More evidence in adequately powered studies is required to assess the optimal dose and duration of vaginal progesterone intake to provide optimal endometrial protection within HRT regimens.

Based on current evidence if progesterone was considered for vaginal administration (out of license use) in women who experience side effects with oral intake, this should ordinarily be given in similar doses and durations as suggested for oral progesterone intake with HRT.

@Kelwar If your polyp is causing heavy bleeding, why is it not being removed? It's a very simple op that can be done usually without a GA depending on the location and size.

Fibroids can cause heavy bleeding as they cover a larger surface area, but small polyps don't usually cause heavy bleeding, and if they do, they can be removed.

Thanks ..
This is about taking 45mg of progesterone.. not 100mg.. and if 100mg it’s saying not to take it intermittently but I’m talking about taking 100mg every day.. thanks, but it’s not relevant to my situation as it’s talking about completely different dosages.
Regarding my Polyp.. you have the choice to have it removed or keep and monitor..
I’ve opted for the latter as there can be bleeding complications with removal. I had to double check your statement that polyps do not cause heavy periods.. and they certainly do.
Thanks though x

This is completely wrong OP.

Oestrogen is the only component of HRT needed to help with symptoms.

Progesterone is only needed because oestrogen alone can increase risk of cancer of the uterus.

If you have no uterus (ie you've had a hysterectomy) , you do not need progesterone at all.

If you have gone over a year without a period, then you can take HRT in a "non bleed" form. In your case OP, it would mean using the oestrogen gel every day and taking the progesterone tablet every day. Non stop. No breaks.

If it is less than a year since your last period then you have to have a regime which involves having a period. So that would mean using the oestrogen gel every day, and the progesterone tablets for 2 weeks out of every month. You would then have a period some time in the progesterone-free time.

Spotting is common in the first 6 months of non-bleed HRT, but if it happens after 6 months then it needs to be investigated.

@Kelwar

I know it talks about 45mgs of progesterone but (without looking at the actual paper in detail) I think they possibly used a progesterone gel in the trial (which is called Crinone) that is equivalent to the micronised capsule of 100mgs. There is no option of a 45mgs capsule of micronised progesterone anyway.

The BMS is the absolute 'gold standard' when it comes to advising women on HRT. It's headed up by the most eminent gynaes in the UK.

The point is, that as you have periods, one capsule daily whichever way, is not what's used. That is for continuous, combined HRT for women post menopause.

I've used Utrogestan for around 8 years (and another, synthetic type of progesterone before that.) I've not been advised to reduce the amount for vaginal use by my meno consultant (who trains other drs) even though he is very much in favour of vaginal use and prefers his patients to try to use it that way.

If you are happy to carry on with 1 capsule, that's your choice, but I can assure you it's not the advice of many consultants.

@Kelwar Ignoring the 45mgs part of the whole article, the summary on Page 1, says this.

^Based on current evidence if progesterone were considered for vaginal administration (out of license use) in women who experience side effects with oral intake, this should be given in similar doses and durations to those applied to oral progesterone intake with HRT*.

@Kelwar Sorry to keep adding to this, and I know you will think I'm being a PITA, but it is probably best if you read the whole paper that I linked to, as the dosage is mentioned several times. At the top of Page 4, it says this (which has nothing to do with a 45mgs dose.)

Start of quote

Vaginal administration of progesterone within HRT regimens
Micronised progesterone can be also administered through the vaginal route although there is limited evidence assessing the efficacy and the optimal regimen of vaginal progesterone administration in the context of HRT.

In the UK, vaginal micronised progesterone preparations that offer the doses
commonly used within HRT include 100 mg vaginal progesterone tablets (Lutigest) and 200 mg vaginal pessaries (Utrogestan or Cyclogest).

The latter combinations are not licensed for use as HRT but can be used off-license to provide the progestogen component of HRT in women who
experience progestogenic side-effects with oral intake.

In addition, in women who do not tolerate oral progesterone intake, vaginal administration of oral micronised progesterone preparations (Utrogestan
100 mg capsules licences for oral use) can be considered on exceptional basis.

This will be off-license of the products and there is no available evidence on the absorption kinetics of progesterone preparations intended for oral intake when administered vaginally. ^Such intake should follow the same
doses recommended with oral intake^.

end of quote

Is it okay that I've been on the below for the past year:

Two pumps oestrogel
Utrogestan x 200mcg 2 weeks out of every 4
Cerazette daily

I never ever bleed/get a period/any breakthrough bleeding.

Should I be bleeding? The cerazette keeps my mood stable.

I'm on the same and when I first started the Utogestran, I was following the 14/16 schedule where you have a break and this did cause a bleed which was a bit of a nuisance. However, if you have not had a period for over a year, you can take it continuously which then does not cause a bleed. That is the schedule I follow now and the bedding stopped after a couple of months.
It should soon all settle down for you.
I suggest you have a look at Dr Naomi Potter on Instagram, FB or Youtube. She gives brilliant peri-menopause and menopause advice.

Also within the report

‘In addition, in women who do not tolerate oral progesterone intake, vaginal administration of oral micronised progesterone preparations (Utrogestan
100 mg capsules licences for oral use) can be considered on exceptional basis’

Also, have a look at Dr Sarah Ball on you tube if you get a chance, she gives a really great explanation of Utrogestan..

Hi Flurb, do you take your Utrogestan orally? X

Hmm, I've been on this regime for a year now, doing the two weeks of utrogestan and two weeks off. I had occasional periods before starting HRT and regular break through bleeds for the first six months or so of HRT. But I don't get any bleeding at all now. Is this a problem? Does it mean my uterus is over-lined and could cause me problems?
yikes.

@Kelwar yes I do take it orally, at night, thanks.

Hi can I hijack this thread please as I asked this question before on a separate thread and got no replies - does anyone take 1 tablet Utrogestan 25 out of 28 days instead of 2 tablets 12/14 days?
My GP has recommended this regime after I went to see her about side effects during the progesterone days.
I am nervous about taking it for longer even though the dose is lower - she wasn't keen on the vaginally option and said it was this or Mirena coil.
Would love any experiences or advice @JinglingXmasbells I hope you dont mind me tagging you but you seem very knowledgeable and helpful !

Hi! No problem.

The 25 days has been superseded now by ever day (which brings it in line with other combined continuous types - tablets and patches.) The 3 day break was there to allow a small withdrawal bleed but they now think that so few women have this on 25 days that it's better to go to using it daily.

You will just have to see how you go. I didn't get on at all with daily Utrogestan and am still with a sequential regime 14 years on! Yes, the bleeds are a pain but it's swings and roundabouts.

There are other variations which are mainly used through a specialist, such as extending the monthly cycle to 6 weeks, but this is usually on the basis of occasional scans (paid for- not usually NHS) to check all is ok.

If you found Utrogestan intolerable, you could try other types - it's not the only one- or see a specialist for a more individual approach.

It's surprising your GP hasn't caught-on yet to the continuous use of Utrogestan (every day) as it's been like that now for a few years.

@JinglingXmasbells thanks so much
For the reply - I am possibly misunderstanding you but I thought I had to do sequential if I was having periods ? But then I guess Mirena isn't .if I took 1 tablet a day is it possible I would have reduced side effects and no bleed or would that
Still happen?
Gosh I feel like I went into this quite blind really as don't know all the options at all!
GP was pretty uninterested and said Mirena was the other option no mention of patches etc.
My nearest clinic would be Dr Newsom so possibly can try that in new year .
Thanks again and sorry to OP for hijack !