Progesterone dosage.

[SusannaOh]

Can anyone tell me what the progesterone dose would be for 75 mcg of estrogen, for both combined and sequential HRT.

I'm really struggling atm. I was on Evorel patches. 75 mcg of Estadiol and 170 mcg of Norethisterone sequentially. All was good.

GP has said there are new guidelines, I need to be taking 300mcg progestogen for 14 days if I take it sequentially or 200mcg combined. She prescribed me Utrrogestan, but because I've really struggled with it in the past, she has prescribed it combined daily and I've reduced the estradiol to 50mcg to keep the utrogestan dose lower.

I'm really struggling, 50mcg is letting menopausal symptoms creep back. The Utrogestan makes me tearful and utterly exhausted. I'm taking it vaginally now but it still causes issues. I also worry as it contains titanium dioxide which I don't want to be using internally. I desperately want to go back to the old dose of estradiol, but can't face upping the utrogestan.

I'm 54 and still have periods.

I was told with the utrogestran if I take it vaginally I can take 100mg a day for 14 days rather than 200mg if I take it orally becuase it is more targetted that way. I am using a 75mg evorel patch.

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

you might find this page helpful there are different dosing recommendations partway down. Good luck with it OP I hope you feel better soon

I think this is the old guidelines, as GP is basically saying 200mg orally for 14 days isn't even high enough alongside a 75mcg patch. I think I'd cope with 100mcg Utrogestan daily, if I could just have the 75 patch back.

Thank you for the link. For low dose regimens it suggests 200mcg of utrogestan orally for 12 days. But the GP says 75mcg of Estrogen is a high dose regimen. I can't find any hard and fast guidelines on this.

I had read that new guidelines were brought in because private clinics have been prescribing very high doses of Estrogen, but I don't personally think 75mcg is high.

@SusannaOh

You mentioned being on a patch. So have you now changed to gel or estrogen only patch?

The higher doses of Utrogestan applied to women who were on very high doses about 100mgs patch or even 6 pumps of gel! OR if women on 100mgs had a lot of bleeding / irregular bleeds/ spotting.

The BMS report was a bit of a 'tactful' way of reminding some private clinics that huge amounts of estrogen could be a problem.

I have not seen any guidance about using 300mgs Utrogestan when on 75mcg patch.

@Bubbles254 That is not suggested now. You should be using the same amount vaginally as orally. 200mgs for 12 or 14 days.

The guidance literally came out to GP practices in the past week or two. Anything above 50mcg patch or 2 pumps of gel counts as higher dose so needs higher progesterone. Would Mirena coil be a option for you? It’s the best endometrial protection by a long way and for most women much less systemic side effects.

Lol, GP knew about this 2 months ago, which was when my prescription changed. 🤔

I'm using 50mcg estrogen patches atm and 100mcg utrogestan continuously, I have gel aswell, but struggle to get it to dry on my skin, so prefer patches. 50 just isn't enough though. The aim was to get used to the utrogestan so I can up the dose and go back to 75mcg of estrogen. The continuous despite still having periods is because I can't manage coming on and off utrogestan as the withdrawal from it every 12 days is awful.

In my head I thought anything over 100mcg would be classed as "high". So annoyed about it all.

I absolutely don't want a coil.

Could you quote/link this @BTcomplaint

How do you know?

The guidance as in the BMR report (which I've linked to several times as have some other posters) doesn't say a higher dose is mandatory. It says 'consider'.
That report came out 18 months ago.

The dose of the progestogen should be proportionate to the dose of estrogen. While no data is currently available on the endometrial effects of high doses of estrogen and the optimal dose of oral or vaginal progestogen in this context, women who require high dose estrogen intake should consider having their progestogen dose increased to ensure adequate endometrial protection (e.g. micronised progesterone 300 mg for 12 days a month instead of 200 mg in cyclical HRT regimens or 200 mg daily on a continuous basis instead of 100 mg in continuous combined HRT regimens)

Why don't you want to consider a coil OP? Then you haven't got to worry about what dose of progesterone to take.

The amount of hormone released, is I believe, less than utrogestan for example? But still offers adequate endometrial protection.

@JinglingSpringbells Yep, that is exactly what my GP is saying . But everyone seems sketchy as to what constitutes a higher dose of estrogen. She says 75-100mcg.

@Runaround50 It's not for me. Not something I'd consider and a family member had to remove her own, due to appalling GP care. I won't have treatment that I can't control.

I am pondering suggesting going back on Evorel Sequi and using 1.5 patches, even though Evorel say patches should not be cut. Previously I was just adding a 25mcg estrogen patch to the sequi 50mcg regime. Adding half a sequi patch instead, would give me roughly 75mcg of estrogen and 255mcg of estrogen.

I want to get used to Utrogestan though, as everything states it's the safest form. But it's just bloody awful.

And there's the titanium dioxide, which is worrying and nobody is addressing.

Sorry...multiple replies 🤦‍♀️
The Mirena is 15mcg of progesterone a day, how can the equivalent Utrogestan vaginally be 200mcg? 13x higher 🤷‍♀️ and progesterone is supposed to be a breast cancer risk. Obviously the coil delivers the goods further up, but I can place the utrogestan at my cervix. 13x higher 🤷‍♀️

@SusannaOh You can't compare the Mirena dose with Utrogestan.
The Mirena contains a strong, synthetic form of progestogen which is being released constantly. Utrogestan is micronised progesterone which is a natural form.)

Although the Mirena is marketed as being 'contained in the uterus' I have read research which shows the amount of progestogen from it that gets into the blood stream is roughly equivalent to a low dose 25mcg combined patch.

The BMS does say they have no way of knowing exactly what dose is needed for higher doses of estrogen. In an ideal world, women would be offered an annual scan to see what was going on with their uterine lining if they were on a high dose simply because Utrogestan may be less powerful than the other progestogens.

I don't know if any type of private meno care is an option for you but one way to perhaps move this on with your GP is to suggest either she organises an NHS scan for you if you want to stay on 200mcgs, or you agree to pay for a scan yourself annually.

@JinglingSpringbells

But Norethisterone is a similar dosage to the Utrogestan despite N being synthetic.
It blows my mind a bit that Utrogestan is considered to be less powerful, I find it feels so, so much stronger.

I do have private healthcare, but it doesn't cover menopausal treatment. I could use them for a private GP phone consult, but my GP is tbf really clued up, I feel lucky in that respect. I can't afford a private ultrasound.
I think I may just have to accept utrogestan isn't for me. I am going to suggest cutting up sequi patches so I can use 1.5 patches, which will give me a higher Norethisterone dose.

This all makes me feel a bit iffy about the research done on HRT. I don't have much choice as my joints go to hell without it and I can't think straight. But really all these questions should have clear answers.

But Norethisterone is a similar dosage to the Utrogestan despite N being synthetic.

In the patch, the norethisterone is micrograms. (mcgs - 1000s times less than a milligram)
In utrogestan it's 200mgs (milligrams)
[[https://www.menopausematters.co.uk/perimeno.php

Oh! I was being so careful not to confuse writing mg with mcg, but that had completely passed me by!

Hello everyone.. I new to this forum but realy need some advice.. I've been having menopause symptoms since I was 44 and I'm now 47.. Hot flushes, night sweats, anxiety, palpitations my libido is terrible and when I'm realy down I just can't even interact with my partner or my 7 year old daughter.. I'm crying everyday and not sleeping because of waking up wet with sweat.. My periods are only lasting for 2 days sometimes with hardly any bleeding.. My doctor said I have to have a blood test before she will do anything for me but my levels have come back normal.. I read that levels can fluctuate so a blood test isn't a good reading for perimenopause.. I also have vaginal dryness which is not helping..I have argued with my doctor who is trying to tell me I have pms.. That in itself makes me feel horrible and stupid.. I'm 47 and have had pms since my 20s so I know I'm not going crazy which I'm bring made to feel.. The doctor has put me on ghd mini pill of progesterone.. Can anyone plz give me some advice.. I'm so down and feel like I'm losing my mind.. I Cant cope with how I feeling..

FFS, when are these GPS going to at least skim read the NICE guidance??

No need for blood tests over 45. Take this to your doctor, preferably a new one:

www.nice.org.uk/guidance/ng23/chapter/Recommendations#diagnosis-of-perimenopause-and-menopause

I'm sorry you've had such negligent medical care, @jaymar.

Transdermal HRT (patches or gel) have the least downsides for most women. You also need local oestrogen for the vaginal dryness (vagifem or Ovestin).

I'd be tempted to send a complaint to your practice manager with a link to the NICE guidelines.

Thankyou.. So I'm not going crazy then.. I feel so alone even though I'm surrounded by family..my partner argued with a receptionist at the doctors who told me there was nothing my doctor coukd do further as I'm still having periods and had a normal blood test.. He told her the last 6 months he had been worried for my mental health and physical well being and he had never saw such a drastic change In me.. To the be told its pms made me feel like I was being dramatic which has closed me off even more because now I feel Im just being a pain to everyone.. I can't even talk about this now without breaking down.. The only thing I coukd think of to do was find a forum to help which is when I found this one.. My mom went through menopause at 44 and it nearly destroyed her marriage.. I coukd tsdlj to her about it but she passed away last November.. I will show the nice to my doctor but I can't see it helping.. Thankyou for you'd reply

When my patches went from 50 to 75, my GP increased my utrogestran from two tablets to three.

I’ve since reduced from 75 to 50 Evorel as I was spotting a lot. GP reduced my progesterone back to two tablets

Keen to follow this - thanks

What's happened to you is appalling, @Jaymar139. Can you not see a different GP/change practice?

The NICE guidelines are the gold-standard in England and Wales. They are not legally binding, but if a GP refuses to follow them you can ask for their refusal to be recorded in your notes. That can be enough to change the doctor's approach. Additionally you can contact the practice manager, in writing, with your complaint.

You could also start your own thread on here to get more support. I'm going to tag @JinglingSpringbells as she is brilliant on all of this.

Thankyou so much gardeningidiot..im not very good with tagging people and wouldnt have a clue how to start my own thread.. I am going to go back to my practice Monday and put in a complaint and tell them about the nice.. I'm just worried about how long it will take to sort out another gp and coping with my well being at the moment. Will the mini pill help with any of my symptoms because unfortunately that's all I've been prescribed to deal with all my symptoms.