Too much utrogestran?

[Bubbles254]

I used to take 200mg utrogestran orally for 12days a month. I found that I was getting a bleed towards the end of the 12days and wondered it this dose was too low.

My gp told me to try taking it vaginally but only 100mg a day for the 12 days as supposidly it is absorbed better. I posted on here about this a while ago and was told to take 200mg vaginally for 12 days as the clinical guidelines have changed.

I have been doing this but wonder if it is a bit high for me, I am getting a 10 point increase in heart rate whilst taking the utrogestan and hot flashes have returned at night whilst taking it.

So I am wondering if I could reduce it just a little e.g take 200mg vaginally for 10 days rather than 12 or taper the dose at the end so for the last few days I am taking 100mg? What do people think? I am not sure it is worth asking my gp seeing as they said 100mg is ok for the entire 12 days.

I read the research that the new clinical guidelines as based on and the concerns over vaginal utrogestan seemed to be based on a trial of a really low dose (under 50mg) a day.

How old are you? My GP just changed my plan to one a night (100g) instead so that I don’t have a bleed at all-but I’m 55 now so should have and would like to have stopped!

43 and have been on hrt for 18 months. Using a 75mg evorel patch. How many days do you take the 100mg for?

@Bubbles254 If you are only 43, and in peri, the continuous regime of taking it daily is not for you (it's for women post menopause.)

I've been using it for many years and like you find it makes me very hot and sweaty at night (and restless sleep.) To be honest, I just accept that as it's not interfering with my life too much. Likewise, I used to bleed (sometimes) before the 12 days were up when taking it orally. I use a slightly different regime (under a consultant) where the cycles are longer than a month. But I'm many years post menopause.

Are you having normal periods? If you are, it's possibly ok to reduce the dose to 10 days because you will be having some of your own progesterone in your body anyway, if you are ovulating.

Out of interest, what made you check your heart rate? (guessing you have a smart watch 24/7?)

My clinic says you can go to 100 every day ( continuous utrogestan, 3 day break for a bleed ) after being on it 12 months. I actually can;t tolerate the days without it, there must be too mucho if a drop off of for me, so I take it every single day.
Why did it concern you getting a bleed at the end of the 12 days? That is what is meant to happen, either a few days later or around the end of it. It can change though with menopause.

I had the palpitations, pounding heart thing at one point. I dropped my evorel from 75 to 50 and found it helped. It can take a bit of tinkering to get things right.

@JinglingSpringbells thanks so much, I am happy with sequential but 10 days would suit me much better, it is only towards the end of the progesterone that I get the symptoms. I use a fitbit to track my heart rate.

@Iwantcakeeveryday the bleed was coming at day 9 whilst still taking the oral utrogestan . It was more annoying than anything as it was very on and off and prolonged my period. I didn't get a proper period until the utrogestan stopped. I don't get this now I take it vaginally, I think becuase more is being absorbed.

My clinic says you can go to 100 every day ( continuous utrogestan, 3 day break for a bleed ) after being on it 12 months.

This is all becoming quite strange.
I've read this before and it appears (could be wrong!) to be something 'suggested' by Dr Newson, as an option in the GP guidance her clinic produced, but it's not accepted prescribing or licensed use.

It might work for women with low estrogen levels but for women in their 40s who are still having periods, the outcome can be irregular bleeding.

@Bubbles254 NICE gives the option of 3-monthly cycles for women struggling with progestogens/progesterone.
The absolute lowest is 14 days in every 84 days (so 2 weeks out of 12 weeks.)

I don't really understand this. If it is ok to take 200mg for 14 days out of 85 why is 100mg for 12 days out of 30 too low in the guidelines. Surely you will get more progesterone this way?

Strange? I don;t know. Theres a lot of changes in understanding and I value what private doctors have done around this. I feel much much better taking it daily, the difference is amazing and theres no way I would continue on the other regime.

Also I am in my 40's still having ( irregular ) periods.

I don't really understand this. If it is ok to take 200mg for 14 days out of 85 why is 100mg for 12 days out of 30 too low in the guidelines.

It's because of the amount each day.

100mgs may not have any effect.

The point of using progesterone is to prevent proliferation (growth) of the lining.)

100mgs daily, every day, will have that effect.

100mgs for 12 days won't.

Theres a lot of changes in understanding and I value what private doctors have done around this.

My consultant is private and far more qualified than Dr Newson (she looks up to him.)

Some women may get away with daily low dose, but some won't.

[[https://www.menopausematters.co.uk/postmeno.php

POST MENOPAUSAL -
Continuous combined therapies.
"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age. The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved. When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin. Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy. Start with low dose preparations and increase as necessary for symptom control. The products marked * are licensed for osteoporosis treatment/prevention.
See below: WHY AND WHEN TO OFFER CONTINUOUS COMBINED THERAPY.

This other thread discusses it. As you've said there @JinglingSpringbells the downside may be irregular bleeding or spotting. I already had irregular bleeding so nothing has changed for me, although its less often so that's good.
I like it for convenience, taking it daily is simple, and more importantly I feel much better without any drop off of progesterone which for whatever reason really affected me.

If a woman is taking sequential (cyclical) HRT then after around a year this can be changed to continuous HRT, regardless of her age. This should lead to her periods stopping. If women are taking body identical HRT then they should be given 100mg micronised progesterone (Utrogestan) each evening. If a woman has no bleeding with the continuous micronised progesterone then this can be considered a contraception.

https://www.mumsnet.com/talk/menopause/4253007-utrogestan-continuously-if-still-having-periods

@Iwantcakeeveryday I don't want to criticise all the good work that Newson Health has done around the menopause, BUT they are ONE clinic and there are specialists with different opinions. (The clinic has come under criticism from the BMS- without being named- for prescribing ultra-high doses of estrogen.)

My consultant was prescribing Utrogestan before Dr Newson was offering menopause help and when she was 'just' a GP.

Different doctors have different opinions. Newson Health produced guidance for GPs but not all consultants agree with that guidance - as shown by the link to Menopause Matters written by another consultant gynae.

of course, and its good for all of us to share what our different specialists or doctors have told us or what our experience is. Your doctor is ONE doctor too. I am not sure what the issue is with me sharing what Ive been told by my clinic, a well known clinic and well respected doctor, even if she is younger or less experienced than yours. It's working well for me. As you yourself said on that thread, the side effect is irregular bleeding for some or no problems at all for others. Each women weighs the pros and cons with this as no single regime is perfect for everyone.

There is no issue sharing your experience @Iwantcakeeveryday. I'm talking about the guidance written for GPs by the Newson Clinic that not all specialists would necessarily endorse.

I linked to the advice by Dr Currie too (awarded MBE for menopause work) so it's not just 'my dr versus your dr'.

No single regime is right for everyone- true. But there are regimes that can be more risky and, as I mentioned, the BMS felt so strongly over super-high doses being prescribed by 'certain clinics' that they had to issue a report.

Variations on the doses are fine in private care as women can pay for scans as part of that.

It's good that it's working for you and that's what matters.

I don;t have much faith in the BMS, women have been suffering with little help with menopause care until Dr Newson and others made it headline news. they haven;t been doing their job IMO and they don't have much to say regarding testosterone for women. I have had two friends use Dr Currie's service and forum and neither had much positive to say. So it just goes to show really that this is an area where there are variations in prescribed regimes and advice and women will find a doctor that suits them in the end. I was grateful for all the different experiences online because it helped be more flexible when I started all this and that, I found, was probably the best advice I could get. Be flexible and open to tweaking things to find what suits you. While I have irregular bleeding, I probably would of anyway, the symptoms I really struggled with are gone. I would still have them if I stayed with 2 weeks on/off.

The BMS....

Not many people seem to know, but the BMS holds training sessions for GPs and nurses all year round. These courses are relatively cheap and GPs can claim (I assume ) for part of their CPD.

They also hold an annual conference in London with a long list of speakers, all top menopause specialists.

This is just one page from their website of the training they offer. There are usually short courses on prescribing HRT every couple of months.

[[https://thebms.org.uk/education/rcog-bms-menopause-advanced-training-skills-module/

The reason many women aren't getting the right care for menopause is that GPs are not going on the training on offer.