utrogestan tablets taken vaginally

[ninetieseyebrows]

I only recently found out that if you take utrogestan vaginally you only need half the dosage*. So I've been taking one every other day continuously. Incidentally, (I don't know for sure if it's because of this, but feel like it may be) my appetite has stopped being so out of control (lost 8lbs!) and I feel 'balanced' and I think this has really helped. I'm taking 2 pumps of Oestrogel and pea-sized testogel every other day (every day was making me jittery and hard to get off to sleep)
I just wanted to share as I know alot of people are struggling with the utrogestan and don't tolerate it well so thought it might help as the information for taking it this way isn't widely known.

*advice from Dr Louise Newson and screenshot from her Balance App

Jumping on your thread here, sorry - Ive been prescribed utrogestan vaginally in my pregnancy because of precious MCs.

My prescription comes with the tablets and applicators. I don't use the applicators and have more than I could possibly use. If anyone could make use of them please PM me, I'm happy to post them. The pharmacy said they'd just chuck them.

Interesting, did you consult your GP first? and another stupid question, does it just melt?

Oooh I didn't know this. I've had a full hysterectomy and my nurse specialist just said take them orally or vaginally but didn't mention anything about halving the dosage! I might ping her an email. Thanks for sharing.

@Offredismysister Personally, I didn't consult my GP although I will mention it at my next review. Dr Newson is a menopause specialist so I'm happy to take her advice, but of course, that's just me and it's probably more sensible to run it by the GP first if you are needing that reassurance.

@Offredismysister yeah the whole thing melts and absorbs. I've noticed a slight filmyness (sp!) In my morning pee but apart from that nothing untoward. Some women report more thrush symptoms. My nurse did say it's more effective vaginally because it's not processed by your digestive system and liver.

I also take cerelle daily & I’m starting to feel a bit off, have had some spotting for this first time since I started hrt (8 months ago) & was considering a coil, but this route might be an alternative.

Pleasure to share @Nightynightnight 😊

@ninetieseyebrows This is old advice. Please be aware that the British Menopause Society has contradicted this advice. It's in their report on the use of progestogens in HRT (it's been linked to on this forum many times so if you search you may find it.)

The outcome of the report is that women must not reduce the dose of Utrogestan when using it vaginally . (I've used it that way for years and always the full dose, under a consultant.)

It's slightly concerning that this 'half the dose' regime is still out there.

If you can't find the BMS report I am happy to add the link for you.

@Nightynightnight why are you using Utrogestan if you have had a hysterectomy? It's only for women who have a womb, (or in some cases if they have had endo.)

Thanks for flagging this @JinglingSpringbells I will ask the Newson clinic to clarify in that case.

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

Stute et al. 2016 reported a systematic review on the impact of micronised progesterone on the endometrium. The authors suggested that estrogens with sequential micronised progesterone (4% corresponding to 45 mg/day for 10 days per month) or intermittent (100 mg every other day) for up to 3–5 years may be safe (off-label use). The authors acknowledged that there was lack of sufficient data regarding optimal vaginal administration within HRT to guide practice.18 However, more recently, a publication from the Early versus Late Intervention Trial with Estradiol (ELITE) showed that lower dose vaginal intake of progesterone resulted in a substantially higher rate of endometrial hyperplasia. This randomised double-blinded placebo-controlled trial, reported on the effect of oral estradiol plus vaginal progesterone against placebo on endometrial thickness, endometrial biopsy pathology, cervical cytology and total cancer incidence among healthy postmenopausal women.

Based on current evidence if progesterone was considered for vaginal administration (out of license use) in women who experience side effects with oral intake, this should ordinarily be given in similar doses and durations as suggested for oral progesterone intake with HRT

@ninetieseyebrows My understanding is that in 2016 (see info above) there was one small study using a reduced dose. This appeared to be safe. However, subsequent information cast doubt on this.

There are still some drs who appear to carry on prescribing lower doses, maybe on the basis that Utrogestan is not an absolute safe level, shown by current data.

But not all drs agree with that and wouldn't want women to use something that was recommended for another woman, because all women and estrogen doses can differ.

It is also not (maybe surprisingly) licensed at all for vaginal use in the UK, but it's been commonly used that way for a long time in other countries.

Bear in mind that women using private menopause clinics and consultants can access scans as part of their treatment, on an annual basis, or if there are any concerns.

I honestly don't know if the clinic you are using has changed the way they prescribe, but all I can say is that not all drs agree with the reduced dose, unless it's closely monitored and it should be done on an individual basis.

Sorry this is so long!

@JinglingSpringbells yeah I had stage 4 endo. Was advised it may re-emerge with an estrogen only regime.

Thank you @JinglingSpringbells ..... if only we could have clear guidelines, feels like a minefield

I went to see a menopause specialist a couple of weeks ago. She told me I was in peri menopause and has prescribed me HRT - estradot patches and utrogestan. As I have stomach issues the doc advised me to take the utrogestan vaginally.

I filled the prescription yesterday and it says they can be taken either orally or vaginally (which I was surprised at - I assumed there would be different tablets for each method). But the dosage is the same for either method.

So that's pretty up to date information.