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!

I see a consultant on the NHS because I too started menopause prematurely, but I’ve had scans at one of the private hospitals near me.

I'm not sure about this but thought Utrogestan had to be taken on an empty stomach due to poor absorption?

I just wanted to mention that you don’t need to double up if you take the utrogestan vaginally - if you usually take one orally every day, you would only need to take one vaginally. If you usually swallow two (usually for 12-14 days per month) you would take two vaginally too.

@KarmaLife I’ve just googled and read that you should take it on an empty stomach because taking it in a full stomach actually increases absorption… of course if you usually take it vaginally, this isn’t an issue.

@WolfFoxHare Thanks ... so you should take it on an empty stomach, sounds strange that increased absorption is bad, but presumably it needs slow release or something like that.

Yes I wonder about this. When I have it too soon after food I feel the next day like I've had too much progesterone. Heavy breasts, headache etc. But that could just be in my mind....

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!

You may well find you get used to them.
I used to use them orally for years and TBH the sedative effect seemed to wear off after a few months' use.

My GP told me to take them at bedtime as they are sedatives, so I never have on an empty stomach.

Cyclogest does also come in 200mg pessaries. I have been using it very successfully daily for many years as part of my HRT regime as Utrogestan and I are not friends at all.

Can anyone recommend a London consultant who is good with vaginal use of Utrogestan? I need a different doctor…

What do you mean 'good with'?

Many women are using it that way anyway, from their GPs.

It's the same capsule whichever way it's used.

I meant, willing to prescribe vaginal use in perimenopause specifically. My gynaecologist said it’s only for use vaginally in IVF. I can’t take it orally - awful side effects.

It's exactly the same capsule so you can use it vaginally and how would they know?

They sound very out of touch. My gynae prefers that way of use and I've used it that way for years (must be nearly 10.)

It's used that way in France as a norm.

The British Menopause Society produced a long guide on the use of progesterone in HRT, in 2021. It's all online and vaginal use is included in the guidance, as being permitted for women intolerant to oral use.

It's online and if you google the search words it should come up.

Thanks I’ll look that up. Frankly if I’m paying the gynae privately for advice I want to know they’re on top of the research.

I’d like to have an informed discussion about whether it’s ok to use continuously vaginally the same as orally (which was how it was prescribed).
sounds like I’m probably better off going to the GP!

They sound woefully behind the times. Surprising for a London-based gynae.

The 200mgs capsule is licensed for fertility, but off licence it can be prescribed for vaginal HRT use. (It used to be licensed for HRT years ago when I started on it.)

The 100mgs is not licensed for vaginal use (in the UK- Europe, yes and has been for decades.)

But it's available on the NHS for off-licence vaginal use. Lots of women posting here are using it that way.

TBH if you want to use it solely vaginally, your private gynae should give you the option of 100mgs or 200mgs. The only difference is two capsules to insert or one!

Thank you that’s so helpful!

I’ll be starting on the patches in a couple of days but have been using Utrogestan vaginally for a couple of weeks now. I’ve experienced some spotting in the last 48 hours which hasn’t happened in the last 4 months when I’ve taken the utrogestan orally.

now I’m wondering if this means I’m not absorbing enough progesterone by using them this way?

Yes that's why I never tell my GP that I'm using it vaginally. I'm not risking her refusing to prescribe and switching me to something in a patch or a pill, it's bad enough as it is!

I'm not either. Have been taking it vaginally every night for two years and it is working just fine.
Some doctors are so badly informed on menopause and treatment, that I go by the information from Dr Naomi Potter, the menopause doctor on social media. She's great.

Does anybody vary the amount of oestrogen gel they apply depending on how they feel at certain times during their cycle? I notice that leading up to my period my breasts become really heavy and I'm wondering if I can switch to 2 pumps rather than 3 for a few days until it settles again? Thanks...