Utrogestan hopelessness

[Moredarkchocolateplease]

I have just finished my third round of utrogestan.

I feel absolutely hopeless. Like nothing will ever get better again. I feel numb. I am crying, can barely be civil with my family, am livid about everything and I'm swearing at the dog. I'm utterly exhausted too, the deep sleep makes me so lethargic.

I felt like this in month one and two but then increased my oestrogen for month three and felt amazing for a week and hoped it might over ride the progesterone depression.

This is how I have felt on three different pills and to an extent even in my natural cycle I would have days like this around ovulation. But everyone said body identical is gold standard.

Have you felt like this and if so what option worked best/would you go for?

Vaginal application of the utrogestan
The coil
Another kind of progestin
Stopping HRT despite how amazing I felt for one week out of the 12!

Thanks in advance for any useful feedback!

It’s the same capsule, it dissolves up there easily and as it’s ‘right where it needs to be’, you get fewer side effects because it’s bypassing your liver and digestive system etc.

I do sometimes get a bit of discharge and if I go to the toilet in night, sometimes I see a bit of a capsule in the bowl. That’s why you still take both capsules - if you take it orally, you basically ‘lose’ some in your digestive system, and if you take it vaginally, some might escape due to gravity. I take mine just before I go to sleep, it means I’m lying down for hours so gravity gets less chance to work!

I show it up with my longest finger, lying on my back on the bed, heels together and knees apart (like when you go for a smear). You can use an applicator - there are disposable ones but I found the capsule sometimes stuck to the end and that meant trying again which is a pain, and some PPs have said they use a canesten applicator meant for thrush pessaries.

I really hope it works for you! The discharge is a bit annoying but the improvement in emotional regulation is worth it, in my experience.

Thank you @WolfFoxHare ive got my fingers crossed!!

The weeks when I'm not on the utrogestan I'm happy. I'd like that to be a constant scenario!

I can’t lie, I still don’t love it - it’s just a faff putting it in, something extra to do at bedtime, and the discharge is annoying. That’s why I take it every other month. I always hated having periods so having 12-14 days taking utrogestan then a five day period meant that 2-3 weeks a month were ‘bad’ weeks for me (even though taking it vaginally means I’m furious or crying). I take HRT to reduce my chances of heart disease and osteoporosis, but also to improve my quality of life, and the progesterone was doing the opposite. 2-3 ‘less good’ weeks out of 8-9 weeks is a compromise I can can accept.

Taking it vaginally means I’m NOT crying or furious, I mean!

Yes yes to the crying and rage. Goodness I think DH was considering divorce, though I might have thrown myself in front of a bus first..

I actually deliberately smashed 3 bowls I was so cross with our new dishwasher. I mean irrational doesn't touch it!!

The new dishwasher is fine now 😂

I am taking HRT for the same reasons. Also I no longer wee all the time and I sleep through the night without weeing. I didn't realise this was actually a thing!

Gosh that sounds hard! The rage really is something else, isn’t it?

Interesting about the weeing! I used to get up 3-4 times a night, no GP was ever interested in doing anything about it, but I have noticed that these days it’s much more likely to be once or at most twice. I put it down to being shattered all the time! Maybe it is the HRT though.

Thank you so much WolfFoxHare very helpful. really good information you gave me appreciate it so much.

@WolfFoxHare almost certainly the HRT.

I have prolapses which have been caused by vaginal atrophy and the uro-gynae I saw told me to go on HRT. I also has associated urinary incontinence.

All this has improved massively. Well apart from the prolapses themselves!

Taking it alternative months is NOT advised and may risk not having enough endometrial protection ie risk of cancer.

I appreciate some private providers go away from the British Menopause Society advice but it’s a risk and should be FULLY discussed. It should also probably mean regular ultrasound scans to check for endometrial proliferation.
Definitely not one for readers to be doing off their own bat. The minimum advised by all the national expert bodies is two capsules taken 12 in every 28 days unless on a continuous regime when it’s just one taken daily.

The Utrogestan pessaries are actually licenced as part of fertility treatment. I have not seen them used for HRT- the advice is to use the normal oral capsules.
i wonder if that registrar is wrong?

Oestrogen pessaries used alongside the other HRT are amazing for vaginal atrophy. They are also safe systemically so can be used by pretty much anyone.

@Sausagerolex Posting this here for you and anyone else. It's from NICE Sept 2022, menopause/HRT/ prescribing.

Vaginal use of Utrogestan is fine. It's not licensed as such in the UK but that's an anomaly. In France and the rest of Europe, it is. (A friend of mine posted the French formulary directions on another forum. It says it can be used orally or vaginally [in women who want to avoid side effects].)

I've used Utrogestan for 9 years under a top menopause gynaecologist, who prefers women to use it vaginally, if they want to. (They are also a highly ranked fertility expert who has prescribed it for that.) FWIW it can also be used anally as a suppository I was told! The BMS does cover this topic in their report last year on the use of progesterone, where it says women can use it vaginally in individual circumstances.

The 3-month regime is here in the NICE prescribing guidance.
Regimen

The hormone replacement therapy (HRT) regimen used depends on whether the woman is perimenopausal, postmenopausal, the route of administration, and the woman's wishes.

Combined HRT can be prescribed as a:
Monthly cyclical regimen — oestrogen is taken daily and progestogen is given at the end of the cycle for 10–14 days, depending on the type of progestogen. The suggested dose of progestogen given in a continuous combined HRT regimen is a minimum of 0.5 mg/day of norethisterone or 2.5 mg/day of medroxyprogesterone acetate.

For low-dose sequential regimens norethisterone a minimum of 1mg/day given for 10 days a month, oral micronised progesterone 200 mg/day for 12 days a month, medroxyprogesterone acetate 10 mg/day for 10–14 days a month or dydrogesterone 10 mg/day for 14 days a month are suitable options.

Three-monthly cyclical regimen — oestrogen is taken daily and progestogen is given for 14 days every 13 weeks.
Continuous combined regimen — oestrogen and progestogen are taken daily.
For perimenopausal women, monthly or 3-monthly cyclical regimens may be used.

A 3-monthly regimen may be more suitable for women with infrequent periods or who are intolerant to progestogens. See the section on adverse effects for more information.

A monthly regimen produces monthly bleeding whilst a 3-monthly regimen produces a bleed every 3 months.

A continuous combined regimen is not suitable for use in the perimenopause or within 12 months of the last menstrual period.

Note: the absence of bleeding whilst taking a cyclical regimen reflects an atrophic endometrium.

Exclude pregnancy in perimenopausal women or women with premature ovarian insufficiency.

Check compliance with therapy if the progestogen component is taken separately.

If HRT was initiated in the perimenopause, consideration should be given to switching from monthly or 3-monthly cyclical regimens to continuous combined regimens after the woman becomes postmenopausal.

For postmenopausal women, monthly or 3-monthly cyclical regimens, or a continuous combined regimen may be used.

A continuous combined regimen may be preferred as it does not produce withdrawal bleeding.

Note: a continuous combined regimen may produce irregular bleeding or spotting for the first 4–6 months of treatment. If bleeding persists beyond 6 months, becomes heavier, or occurs after a spell of amenorrhoea, endometrial pathology should be excluded.

I have no issue with it being used vaginally at all. That is standard use esp in those with intolerance but it isn’t usually the actual uterogeston pessaries that are prescribed it is the oral tablets that are used vaginally.

I link the British menopause society advice on progesterones. This organisation is widely agreed to e gold standard. Fourth paragraph.

There is also a less-commonly prescribed form of HRT (tablets) called Tridestra. It's a 3-monthly regime.

I am assuming the OP is perimenpausal rather than post menopausal also

But that's not what you posted. You were criticising someone for using it on alternate months, and also it shouldn't be used vaginally as it wasn't the right sort, and you'd never heard of it being used vaginally only as fertility treatment.

The Utrogestan pessaries are actually licenced as part of fertility treatment. I have not seen them used for HRT- the advice is to use the normal oral capsules.

It's not clear what you mean. The page you have posted from the BMS doesn't contradict the NICE guidance. (I've posted that link before many times.)

What it does say is that there should be no reduction in dose for vaginal use because some women were using info they'd seen online (by a private GP) that they could use half the dose vaginally. That's not the same as 3-month cycle, under guidance.

There are two options for utrogestan.

1 the 200mgs capsules
2 the 100mgs capsules

They are identical (I've had both) except the larger one are, well...larger!
If you have ever seen them, you'd understand how they identical.

Are you using it yourself or any HRT?

Me too! I had to go private to get utrogestan and the consultant said to take 100mg every day without a break to control by horrid mood swings.

My gp then said no you should only take 200mg for 12 days a month. So I tried that and I felt so awful.the days I wasn't taking g utrogestan.

I'm now back to taking 100mg every day and feel a.lot better. I've just started taking it vaginally this week on the back of this week and I feel great! Long may it continue!

No you took me wrong and I’m not criticising I’m concerned!

The vaginal pessaries are licenced for fertility treatment. The oral capsules are commonly used vaginally for HRT. PP said the GP registrar prescribed the actual vaginal pessaries.

Less than 12 days per calendar month is not recommended safe use for utrogestan for peri menopausal women. Some private providers do this but that’s on them and hopefully with full counselling of the women. They would usually then suggest regular endometrial scans for safety.

And yes oral capsules can be used vaginally or orally at the same dose. And it’s the SAME capsule. There is an actual vaginal pessary that is used in early pregnancy.

@Sausagerolex luckily for me in my case it HAS been fully discussed with my NHS menopause consultant. I’m not recommending anyone else do this, I’m saying it’s what I do, having weighed up the risks and benefits with my experienced consultant. I’m pretty sure I’ve said that in this thread already.

It also doesn’t contain utrogestan

Yes, that's right. It's Norethisterone.

This doesn't change the fact that HRT can be used on a 3-monthly cycle where appropriate. There is nothing to say that long-cycle Utrogestan is not effective.

There are many variations, some of which only consultants are familiar with and who are experienced enough to prescribe.

You appear to be contradicting what you posted earlier.
You said you'd never heard of anyone using the 'pessary' (assume you meant the 200mgs pessary for fertility) for HRT.

The 200mgs capsule is also used for HRT not just fertility. I've had both as HRT on private prescriptions.

The BMS report on progesterone (that you linked to above) actually states further on in that document, that the 200mgs capsule is the one that is 'acceptable' for vaginal use as HRT in women who can't tolerate it orally.

They go on to say that 2 x 100mgs can be used if necessary under supervision (but that there is no data on the effectiveness of absorption of 2 x100 compared to 1 x 200mgs.)

I use 2 x 100mgs as I pay for it (private prescription) and there is an enormous difference in cost - the 200mgs comes with a plastic applicator (30 in a box.) My consultant has never said that there is an issue with using 2 x 100mgs. It also means that on the odd day when I can't face vaginal use (it does cause some irritation after a while) I can swallow them.

@Sausagerolex

I am the OP 🙋

I am using the 200mg vaginal pessaries for 12 days a month, vaginally. Prescribed by GP registrar.

I previously took the 100mg tablets x2 orally.