UTROGESTAN & other progestogen-THE 3-MONTH CYCLE OPTION

[JinglingSpringbells]

Loads of threads here about unwanted side effects from Utrogestan.

It's worth knowing that in the updated NICE guidance 3-monthly HRT is listed as an option for women in peri and post menopause.

This means you take progesterone for 12-14 days every 10th week or so and estrogen only for the rest of the time.

This option is not offered (often/ at all) by GPs but is by (private) consultants.
But no reason why it can't be especially as there is a tablet form for the 3month cycle, called Tridestra.

Some doctors may be concerned there is a risk of hyperplasia with longer cycles, but it's very rare and doesn't usually happen in peri as women are producing their own progesterone some months.

Thank you @JinglingSpringbells 💐

thanks for this

Thank you

I'm just moving this up because so many women are posting here to say they have side effects on Utrogestan.

There are other sorts of hrt not using this.

Please ask your GP for other options if it's not suiting you.

There is no need to suffer when other types may suit you better.

Utrogestan is supposed to be safer for long term use (more than 5 years) but this is only relevant if you use HRT long term.

This is very interesting, and also very reassuring. I’ve been on a 2 month Utrogestan cycle for the last couple of years and it’s made a massive difference to me but as it wasn’t ‘recommended’, I have been worried about using it this way. Thank you for sharing this.

I use my patches on the 3 month cycle. Have given up waiting for my specialist referral to come through and couldn't cope with the 2 weeks of progesterone every month.

Hi there @JinglingSpringbells

I have literally just joined Mumsnet as I came across your posts after googling in absolute desperation and my goodness me you’ve just completely changed my life! Thank you so, so much.

I have been on HRT since June of 2023 - Utrogestan + Everol. Every single Utrogestan cycle has been hell on wheels but my GP doesn’t seem to have half the knowledge that you do! She increased the Evorel in September as my symptoms were getting worse, not better but having devoured all of your HRT posts I can now see that it’s the it’s the Utrogestan that’s the issue. I have dizziness, nausea, extreme fatigue, severe anxiety, hot flushes, memory issues, bleeding and a this month a new one, allergic reactions to food and drink. I’ve never been allergic to anything in my life!

I’m booked in for an ultrasound next week to check my uterus etc due to the bleeding but I suspect everything will be fine and all of this is due to me being progesterone intolerant. Something I had never been informed of prior to finding your posts as the GP has never mentioned this to me despite the repeated appointments I’ve had with her.

I have just looked up the NICE guidance that you very kindly referenced with regard to 3 monthly cycles and it’s like I’ve had an epiphany! I’ve been so downhearted about everything but I now feel so much better, and reassured. Thank you!

For info I’m peri and was still having regular periods every 28-30 days when I was prescribed HRT.

I’m exactly the same. It’s been a complete nightmare every single month for me too. I didn’t know anything about progesterone intolerance until I came across jinglingspringbells posts. I’ve been referred for a scan but not to a specialist. The scan appointment wait has been long enough so to get to see a specialist is probably going to take forever.

Have things improved for you going to a 3 month cycle?

Thank you.

bumping x

This is the best news and thank you for reviving this thread - Ibwas looking for the same info @TinkSparks . The 14 day Utrogestan is miserable for me too, was wondering if I should just give all the HRT up completely. I have consultant appt in a couples of weeks so will ask then.

is there a link to the updated NICE guidance?

https://cks.nice.org.uk/topics/menopause/prescribing-information/hormone-replacement-therapy-hrt/

It's under REGIMEN

@Laundrytrousers

I also didn't know about this and actually did give up HRT due to the progesterone. But I am due an appointment with my consultant (which is the one you recommended to me @JinglingSpringbells so will discuss other options). I'm probably heading into menopause now as I'm about 3 months period-free.

@JinglingSpringbells thank you so much for reposting the link. I've just had an interesting conversation with my GP about switching to the 3 month regimen. She told me that she can't prescribe or authorise for me to do this as they go by the BNF for prescribing, not NICE. She so however say that's not to say I can't switch to this way of taking it. But, she needs to speak to gynaecology to get their approval. So I'm not too sure what to do now, whether just to go ahead and do it anyway or wait for her to get back to me. It's a bloomin minefield sometimes!

Anyway, thanks again for posting the link. My apologies for not replying more quickly, I had turned off my notifications for a bit.

I don't know the ins and outs of the legal side, but it seems odd that NICE can suggest options yet GPs aren't allowed to prescribe because the Formulary doesn't include that option.

I know other women being prescribed this by the NHS who are doing longer cycles with a GP's knowledge.

I think it might be worth checking if possible with someone - maybe a pharmacist- or a different GP.

@JinglingSpringbells thank you. After the discussion with my GP I emailed the NICE guidance to the surgery and asked the Admin to pass it on to her. Within half an hour my GP texted me via their central texting system (we're very lucky at our surgery that the GP's communicate like this, I know some others don't have this type of engagement with patients as an NHS practice). She said after doing her own reading she was happy to approve me going to a cyclical regimen and didn't need to speak to gynaecology.

Hurrahhhh! Result. Thank you so much for posting this. Without you I would never have known that this was an option. Even if I do get symptoms from the progesterone taking it like this at least it will only be once every 13 weeks and that's good enough for me.

So pleased for you :)

I think the issue is that as the info is in prescribing information (from NICE) it's sometimes not that visible.

It is a regimen that's been used off-licence for years (more so perhaps privately) but it's good that NICE has stated it as an option.

@JinglingSpringbells thank you. I think that is the case because the GP mentioned licensing when I first spoke to her. I'm off to spread the message far and wide in my meno groups now too. It's surprising that it's not more well known. But, if it isn't present in the BNF I can understand the possible reasons why.

Thanks again. Have a lovely weekend.

Does the Utrogestan need to be taken orally in order to have a 3 month cycle? I am in peri and have been give 200mg vaginally 14 days out of 28 (to minimise systemic side effects compared to orally) but it still seems to make me tired and low, plus the texture is chalky and gluey and it makes me itch. I really want to either have it less frequently or for fewer days each month.

Do you mean you want to take it orally? (That's what I'm interpreting from your post @WashableVelvet )

I'm not a medic and only posting my own experience (with a consultant) so I don't want to give misinformation. However, my own experience is that either route is ok. If you have been prescribed 200mgs that is a vaginal capsule/pessary so there shouldn't be any difference using it that way however long the cycle is.

When I first started and was on a long cycle, I was using Norethisterone , not Utrogestan, and that is only orally.

No I’m happy to stay with vaginally, I’d just also like a longer break between. Thanks for sharing your experience! I’m waiting for an appointment at the specialist clinic so wanting to really figure out my options and be an informed patient.