Utrogestan vaginally

[Allfurcoatandnoknickers]

Anyone on here using Utrogestan vaginally? I'm on 100mg per day with Oestrogel x 2 pumps a day, and have been taking it vaginally for 2 or 3 weeks or so now with no breaks. I'm feeling terrible - headaches, tired, sleeping really badly, night sweats, and feeling wired with mind racing etc., most of the time. I'm 57 and saw a gynae who put my bleeds down to being periods and nothing sinister after doing scans etc., they suggested a 3rd mirena but reluctant to go down that route as last two were horrible insertions. Just wondering if anyone taking 100mg continuously or having a break??

Can you give a bit more info?

You mention bleeding- when? Was this prior to using HRT or since? Had your periods stopped before HRT?

At 57 you are likely to be post menopause. Did a scan show any ovarian activity?

Lots of women use it vaginally. ALL continuous HRT can cause spotting for a while (up to 6 months) until the estrogen-progesterone ratio works enough to stop the lining getting thick.

You don't have to use it vaginally. You could take it orally, or every 12 days each month (200mgs each of those days.)

When do you take oestrogel? if pm try applying it in the morning as it can interfere with sleep and perhaps go to one pump for a couple of weeks. It may well be the utrogestan that is causing the problems but I know women who feel jittery, sweaty with poor sleep if taking too much oestrogen at bedtime. Worth a try.

If problems persist it may be with trying to grit your teeth, 2 to 3 weeks isn't long and your body may well adjust, obviously some women are progesterone intolerant but many suffer unpleasant effects in the initial weeks then it settles down.

I had a full blown period last Christmas and was put on the two week pathway for suspect cancer and had scans etc., Prior to that I had a period last Spring and prior to that I'd not had one for almost a year, so very very sporadic! Yes the GP thought I was post- meno but my scan showed there to be some activity so the gynae consultant said not and to give the vaginal route a try. I'm thinking I might try every other night to see if it helps as it's making working and concentrating impossible.

I've been taking Oestrogel for years so not sure that's the problem - just feels like it's since I've been taking Utrogestan vaginally every night

but my scan showed there to be some activity so the gynae consultant said not and to give the vaginal route a try

What's the connection between your gynae saying use it vaginally 'because there was some ovarian activity?'

The idea of using it vaginally is more about reducing side effects from oral use. The research shows there is no difference in absorption whichever route is used BUT a lot of women find they have fewer side effects using it vaginally.

You shouldn't reduce the dose to alternate days. That's not enough to control the effect of estrogen on the lining.

Why don't you try it orally, (or sequentially instead of using it every day?)

I only take my Ustrogen tablet vaginally every other day as prescribed by the clinic. Apparently that's sufficient to control the womb lining

There's no connection. I was just saying I'd prefer to use it vaginally as I thought this was more effective than going down the oral route as I was doing and having more breakthrough bleeding. I've still had breakthrough bleeding using it vaginally and have been sleeping way worse, so I guess what I'm wondering is what do I try now? I've been going through the menopause for 15 years so I've tried a lot of different things!

It's not.

This was in a report by the BMS over a year ago.
They said the dose had to be as stated and that some clinics were giving out incorrect information.

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

Page 4

It says that vaginal use should be at the same dose as an oral dose. The previous 'lower regime' including alternate days was based on limited research. Newer research shows it's not always enough.

(I'm summarising this- it's all there on page 4!)

The jury is still out on whether vaginal use is better or not.

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

It's approx from Page 4 onwards.

It can take 6 months for continuous HRT to work and no bleeding occur.
Continuous is supposed to be for women aged 54+ or if they are 12 months with no period. Otherwise they may be ovulating (rarely) and have normal periods.

Are you opposed to using it on a monthly cycle for a few months then at least you should get a predictable bleed?

TBH I get some of the side effects you mentioned, (especially poor sleep and feeling hot at night), but I only use 200mgs for 12 days and find that I can just about cope with that.

Your other option which a specialist might suggest is using it on a 3-monthly cycle, so you get a good 10 weeks of just gel. This is often used for women still in peri.

To be honest I've no idea at this stage what to do. I'm 57 so theoretically should really be post menopausal but I'm clearly not. I am ovulating rarely by the looks of things, but I have been advised to take Utrogestan continuously... As you say, the jury is still out on which way is the best way to administer this - I'm finding the conflicting advice confusing especially on little sleep and with a lot of different information out there.

Well, you can use it monthly ( 12 days out of each month) and that should tide you over the last stage of peri.

Your other options are patches (sequential) or tablets like Femoston (pretty much body identical like Utrogestan, and at 57 you are young enough to use tablet form.)

Yes I'm pretty sure this is a 'last hurrah' but I've thought that before over the last couple of years. I didn't get on with patches very much so hoping to stay on the Utrogestan/gel regime as that had suited me well. I'm actually wondering if it's more of the gel that I need and that's making me feel 'wired' and sleeping poorly, which would correspond to the night sweats I'm having again - not had those for a good few years....

Maybe it's less of the gel you need? I know you've been on it years but as women get older they can need less oestrogen so try one pump on a morning for a few days see if sleep and jitteriness improves?

The easiest options are

-take it orally and see how that feels

-stop taking it every day and try a sequential regime (that way you can judge one hormone on its own.) Using both every day makes it impossible to know if you are reacting to too much/ too little estrogen, or too much progesterone.

Thanks- good plan 👍

I have just been encouraged by the clinic to up my oestrogen, as I had hit a bit of a plateau in terms of feeling any benefit from HRT, despite feeling intuitively that I probably didn't need as much as I'm older and have been post menopause since my early 40's. Having upped my dose to three pumps, I'm now feeling tearful and jittery and not sure whether to keep on at the higher level and hope I stabilise, or reduce back to two pumps and accept that HRT just doesn't do much for me.
Honestly, what with receiving outdated utrogestan advice (as per my post above) and being encouraged to increase my oestrogen dose to levels that I might not need, I'm starting to feel it's almost impossible to get good advice, even if your paying for it!