How much progesterone do I need for “high” dose oestrogen?

[HairyKitty]

I’m on 3.5 pumps of gel, apparently considered a “high” dose. But I’m on the standard utrogestan protocol of 2 x 100 for 12 days in 28 days.

Should I be on a higher dose of utrogestan? How would I know I needed more and why do we need more at high doses of oestrogen?

Hi OP i don't know if you do need more, but oestrogen causes the endometrium to thicken and so progesterone is needed to make that reduce or it could cause cancer.

I had a follow up scan to check the size of an ovarian cyst last week and at this stage I had been on HRT for three weeks and progesterone for 5days. The doctor told me the lining in my uterus was thick and wanted to check where I was with my progesterone to reassure her it would fall away soon (for info, the previous scan 6 weeks earlier, lining had been normal thickness).

I knew my uterus had felt active after I started the HRT!

You'd usually only need more progesterone if you were bleeding very heavily on the withdrawal bleed, or having bleeding at other times when it shouldn't be happening.

3.5 pumps is medium to high but the licensed dose is up to 4 pumps. So that's ok.
The concern has been around women being told to use a lot more- like 6 pumps a day.

Oh ok. My gp is speaking as though my dose is a high outlier and she wants me to try reducing it again.

I never spit and my withdrawal bleed is fairly light, less than my previous menstrual bleed

why would she think that when the leaflet says the dose is anywhere from 2 to 4 pumps?

Maybe she needs to read the patient leaflet.

Honestly, some GPs.

I've been told by my Gp there's still a range of opinions in the meno world. This may become clearer in time. I also think women are individual and there needs to be tailoring to the individual. She seems to visit Gp forums and is v pro hrt. Has also suggested trying histamines in the past for example.

This is the most recent BMS guideline

thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

I know a Gp personally who was chatting about her recent training with dr curry who said that it should be double the utro on the higher doses. I think this was in the context of continuous, which I'd started. I queried what that meant, over 100 patches or at 100. She reiterated that she understood 100 patch to be higher so I should take x200 daily.

My own Gp didn't think so, that higher meant over the usual top licensed dose, but has been happy for me to do this - she seems to work with women to find what works best and I actually think is fab.

One reason I decided to take more was that while I was still having periods on a medium dose of oestrogen which wasn't controlling symptoms at all and was too low on a blood test, they were barely there and erratic. Gp moved me to continuous and upped my oestrogen. However I then had some longer heavier bleeds. (Which I now know can happen at first.) But found mood more stable. So after talking to my friend I tried 200 utro, was fine, and have noticed a significant improvement in joint issues and some other niggling symptoms, better sleep and gut included. I may also be moving to 125 patches.

Originally when I started hrt at 44 I found it made me too spaced out (Gp happily agreed to use vaginally, when on cyclical regime) but over time I've found Ive actually needed it, I'm now 46.

The other thing is though that taking with food can double the effects. For many women this is unwanted hence the 2 hr food gap. However I've read on menopause matters forums that some are told to do this for this reason. (A friend has always ignored the advice and does it anyway and loves the sleep!)

Personally I'd increase utro rather than reduce oestrogen!

If problematic, it can be used vaginally which my Gp was enthusiastic about as it's closer to where it's needed.

The menopause matters forum is really good too.

www.menopausematters.co.uk/forum/index.php

Another good link about higher Utrogestan (near end)

www.balance-menopause.com/menopause-library/ten-tips-for-prescribing-hrt-remotely-2/

Sorry a much shorter answer would be if you're heavy bleeding too much, as Newson link says.

It's worth bearing in mind that it's the progestogen part of HRT that seems to be implicated in breast cancer and different types have higher/lower risks. (Women on estrogen only hrt have less BC than the general population.)

For that reason, I've been advised by a consultant that it's best to take as little progesterone as necessary, but still to keep the lining thin, and that hyperplasia is dealt with far more easily than BC.

This is true, though based on current they think it's the older types of progesterone rather than body identical.

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

Current research

But Utrogestan is still massively out of stock round here. Has anyone seen any improvement with the supply issue yet?

Yes I had no problems last week and was given 6 boxes. I ordered early expecting a wait but it was fine. NE.

Ooo good to know thanks!