Vaginal use of Utrogestan

[Beithe]

I started HRT last spring (oestrogel and utrogestan). The GP who prescribed it gave me 200mg Utrogestan pessaries (for 12 to 14 days per month), which I was a little surprised at (having heard that it was usually tablet, oral form), but I was happy to accept it.

Fast forward to today, I saw a different GP about switching from the gel to patches (recurring symptoms with the new oestrogel). She insisted that her colleague must have made a mistake, and that I ought to be taking the oral form. She was not happy at all with vaginal use.

I'd much rather use it vaginally, since I've had zero side effects.

Unfortunately the other GP is away on sabbatical so I can't have a chat with her.

Is there any published research about vaginal use of utrogestan? It's quite off-putting to have a GP saying this isn't the right way.

Thanks!

It's good you have had one forward-thinking dr!

I've used Utrogestan for about 10 years. My consultant told me that in Europe it's used vaginally mostly.

In the UK the 100mgs is licensed only for oral use, but plenty of women use it vaginally and it is 'allowed' if they have side effects from oral use.

I'll find a report by the BMS that's helpful and leave the link.

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

Page 4- discusses oral and vaginal use and doses.

I changed from orally to vaginally as had so many side effects orally and felt suicidal and made me feel just out of it. Vaginally is what a lot of people use and keep doing that if you are happy.

You should be on 100mg ; 2 tablets orally or vaginally for 12-14 days of the month.
The 200mg pessaries are not used for HRT

@yikesanotherbooboo

The BMS link covers all of this including information on what you posted (which is incorrect.)

200mgs are available for HRT but are off-licence (stated in the link.)

All vaginal use is off-licence.

Many women use them (200mgs) and I have a friend who's prescribed it on the NHS.

To save time if you don't want to read the whole doc.

Vaginal administration of progesterone within HRT regimens

Micronised progesterone can be also administered through the vaginal route although there is limited evidence assessing the efficacy and the optimal regimen of vaginal progesterone administration in the context of HRT.

In the UK, vaginal micronised progesterone preparations that offer the doses commonly used within HRT include 100 mg vaginal progesterone tablets (Lutigest) and 200 mg vaginal pessaries (Utrogestan or Cyclogest).

The latter combinations are not licensed for use as HRT but can be used off-license to provide the progestogen component of HRT in women who experience progestogenic side-effects with oral intake. In addition, in women who do not tolerate oral progesterone intake, vaginal administration of oral micronised progesterone preparations (Utrogestan 100 mg capsules licences for oral use) can be considered on exceptional basis. This will be off-license of the products and there is no available evidence on the absorption kinetics of progesterone preparations intended for oral intake when administer

I take one everyday, no break in the month. I don't have periods. Is that unusual/not right?

If it’s good enough for women in Europe, it’s good enough for me. No way am I changing to taking Utrogestan orally. I have enough gut issues as it is.

Yes, every day is normal for post-menopausal women who no longer have periods. Peri-menopausal women only take it for a number of days each month, so they’ll still have a bleed.

I see a consultant for early menopause and she actually recommended taking utrogestan vaginally. I’m prescribed two 100mg capsules 12 days per month, they’re exactly the same as the 200mg pessaries (except smaller obviously!).

Yes, agreeing with what's being posted - vaginal use of Utrogestan is common & appears to help with side-effects (in my case, I decided not to continue to taking Utrogestan either way as the symptoms were so problematic for me & switched to Duphaston but this isn't available in the UK)

Thanks all. Thanks @JinglingSpringbells for the link and info.
I think I will continue to use it vaginally. At least the well-informed GP is back from sabbatical in March.

I’ve just spoken to my GP about this today. I’d switched to vaginal use of my 100mg utrogestan a couple of weeks ago due to severe bloating and pain. Anyway,she says that she can’t prescribe for use in that way, I’d need referring to the menopause clinic with a waiting list.

i’m post menopausal so was taking utrogestan every day.

I’ve switched to the Femseven conti patches. At least I would if I could find a pharmacist with any stock 🙄

I'm using Utrogestan tablets 100mg vaginally everyday...Yes you can!
It doesn't matter how you take orally or vaginally.
Do what works best for you.

@astarsheis I will do for now, especially given the supply issues with the patches!

Hi all, do you think you can switch between oral and vaginal progresterone during one cycle? I ended up eating late last night and I know when I take Utrogestan on a full stomach I feel groggy the next day so I just took one tablet orally but then I thought maybe I could have taken 2 vaginally?

It should be okay. I do this sometimes because I can't use Ovestin at night otherwise for 12 days. (And I'm supposed to use 2x a week.)
The only downside is you might get some spotting if the serum levels of progesterone fall a lot by using a different route. But that's an IF not a definite!

Fab thanks - it's all such a juggle isn't it? And a guessing game....

Hello! Does anyone know if other progestogens than utrogestan are available that come as ‘proper’ pessaries? I have the Utrogestan 200mg pessaries but they’re just capsules with applicators and I don’t get on with the chalky gluey texture which seems irritating. Whereas my estriol comes as proper pessaries that melt and I find that fine.

I’ll start a new thread if this isn’t the right place to ask 🙂

There is no other form available except Cyclogest which is 400mgs and it's a fertility drug.

Utrogestan is also used for fertility by using several capsules a day.

Do you have to use them vaginally rather than swallow them?

I tried a couple orally and they made me feel like I’d been necking sleeping pills til the following afternoon. I imagine I’d have other side effects too if I routinely took them orally as I never could tolerate the pill. Even just the sleepiness would have to wear off PDQ if I took them orally or I won’t be able to do my job!
I’d like to ask the dr to let me take 3-monthly, but I suspect they’ll tell me to persist and see if the side effects wear off taking them orally. Not keen on mirena as my body is good at getting rid of coils.

*and I got some (limited) systemic side effects even with the vaginal utrogestan. (Sorry don’t know how to edit posts)

If I take both capsules orally, it does knock me out, but I feel fine the next day. Tbh that was the only good thing about taking them orally - I sleep pretty badly as a rule. These days I often take one vaginally and one orally - I sleep better but the side effects aren’t as bad.

Also, you don’t HAVE to tell your doctor you’re taking them every other month or every third month. My consultant knows I take them every other month but my GP is under the impression I take them monthly. I can afford the occasional private ultrasound though.

Stealthy!! 😂
Where do you go privately? I’m in London and on waiting list for meno clinic (as I’m slightly young). I’d gladly shell out to find a workaround quicker than this waiting.