Oestrogel & mini pill - should i trial Utrogestan

[Gemma5678]

Hi everyone, i'm 56 around 4 yrs ago i went to a private menopause doctor & was prescribed 25mg patch & 100mg utrogestan, along with my mini pill. Felt awful so stopped within a week.

Due to insomnia and occasional night sweats i toyed with the idea of HRT again and spoke to my GP about it. I thought it might be the Utrogestan that caused the horrendous depression type feelings i had on the previous trial (never had this feeling before in my life) so we agreed on 1 pump of Oestrogel & 2 x mini pill per day. I've been on this regime for the last month and all is great although still having sleeping issues.

I have a review next week with my GP. Just contemplating whether to trial Utrogestan again - its 4 yrs on since i first tried it - would it work okay this time & help with the insomnia? Anyone been in a similar situation or should i carry on as i am and not rock the boat? I feel great in all other respects so i am a little wary of testing out Utrogestan bearing in mind the number of other ladies who have issues with it.

I'm no expert by any means but why would you need to take utro as well as your minipill? That is just a double whammy of progesterone, no wonder you feel rubbish.
I'm only on utro with my oestrogel and it's awful for me!

I understand your reluctance. I had PMDD and had awful problems with all forms of progesterone. Post menopause I was a physical mess and needed HRT (I had early menopause) so I was prescribed utrogestan. It did help enormously with my sleep, but left me feeling woozy and low the next day. My gynae specialist suggested I take it vaginally rather than orally, which has been a game changer! Be warned, a GP won’t advocate this method as it’s off-licence, but all gynae/meno specialists recommend it. You literally just insert it into your vagina before bed, instead of swallowing it. It also means you don’t have the faff of making sure you’ve got an empty stomach at bedtime.

also I think your oestrogel dose seems really low? I hope someone with more knowledge will be along soon OP!

I still have problems even with vaginal insertion. I must be really good at absorbing this evil stuff🤣

Your pill alone (even 2 daily) isn't adequate for endometrial protection, even on only 1 pump of gel daily, so your GP shouldn't have suggested that.

Why are you still on the pill? It should stop at 55 - you don't need contraception and it isn't the right sort of progesterone for HRT.

@darkmodeera Sorry, i should have mentioned that, if i tried Utrogestan, i wouldn't then need to take the mini pills.

@Sidge My GP actually got in touch with the BMS by letter (i read the exchange on the NHS app) and they said that 2 x mini pill was sufficient progesterone.

@Menomeno This is what worries me about Utrogestan, a reaccurance of those same side effects i experienced before like you have. Never felt so low, awful. If i do try it, definitely go the vaginal route first.

I feel absolutely fine on 1 pump of Oestrogel, sometimes i even just take half a pump. No other issues apart from trouble sleeping.

Hi everyone, i'm 56 around 4 yrs ago i went to a private menopause doctor & was prescribed 25mg patch & 100mg utrogestan, along with my mini pill. Felt awful so stopped within a week.

This was quite odd because unless you were using the POP as contraception, why were you give it AND Utrogestan? And especially on such a low dose of patch.

No wonder you felt awful.

@Gemma5678 I would suggest your first step is to increase your estrogen.
It's a very low dose indeed.

Is there any reason why you have stuck with that dose?
It's the same as 25mcg patch.

I feel absolutely fine on 1 pump of Oestrogel, sometimes i even just take half a pump. No other issues apart from trouble sleeping

But you're not fine as it's not dealing with your insomnia.
For that reason alone, it' s worth increasing the dose.

(You're not going to get bone protection on that dose, if that's a consideration.)

The only reason for switching to Utrogestan is that it's body identical progesterone, not synthetic like the POP. That may be safer re. breast cancer if you intend to use HRT longer term.

@Sidge 2 x POP may be okay on such a low dose of estrogen (though we don't know which POP you use.) I was offered the POP as an option but told I'd need 3 a day as part of HRT. (I chose to use Utrogestan instead.)

@JinglingSpringbells Thank you and i never considered that oestrogen levels were connected with insomnia.

As i mentioned before, the only reason i wanted to trial HRT was because of the night sweats i was getting every now and again and the sleep. The half - 1 pump of oestrogel resolves any night sweats. I've not been concerned about bone health etc, i eat well & exercise.

However, i am concerned about breast cancer hence the reason i was very reluctant to start HRT bearing in mind i don't have many issues. And is it worth putting up with insomnia to not put myself at increased risk of breast cancer. I wasn't aware the mini pill increased the risk & now i'm taking 2, that does worry me very much indeed.

@JinglingSpringbells true if it's norethisterone - I should have asked - was typing quickly! But overall it's a bit of an odd regimen.

@Sidge I take Cerelle but it was permitted by the GP/BMS.

Thank you and i never considered that oestrogen levels were connected with insomnia.

They are absolutely connected. It's the main reason I went onto HRT as my sleep became terrible.

I think you may have slightly misinterpreted something in my post.
With HRT, it's now thought that it's the progestogen side of it that triggers breast cancer (because women using only estrogen HRT don't have added BC risk, they actually have a lower risk.)

There is some limited evidence that Utrogestan has a lower risk. But the risk for all sorts of HRT is low, up to 5 years.

It's worth getting your sleep sorted out because a poor sleep pattern is linked to all kinds of health issues, including the development of diabetes, heart disease and dementia.

I don't know enough about which POP you are using.

I was offered it as I wanted to come off Norethisterone @Sidge .
It's a bit off-piste but it does provide an option for women who can't take androgenic progestogens or don't get on the Utrogestan.

@JinglingSpringbells That's very helpful, thank you.

Was I correct interpreting that that Utrogestan is a safer option than the mini pill in relation to breast cancer risks?

I think then, all things considered, it would be good to at least trial Utrogestan again and see how i get on. I'm sure my GP will let me do that. Worse case scenario, i get the same awful side effects, i can stay on the regime of Oestrogel and the 2 x mini pills.

Was I correct interpreting that that Utrogestan is a safer option than the mini pill in relation to breast cancer risks?

It appears so. The BMS has a statement on this saying that for 5 years' use there are no extra cases of BC on Utrogestan.

Also be aware that the dose of estrogen ( high) is not linked to any higher risk BC.

You need to use enough gel to control your symptoms or there is no point using it at all. (This is what I was told.)

, i can stay on the regime of Oestrogel and the 2 x mini pills.

If you increase your dose of gel, you may need more than 2 x mini pill.

I'd assume the 2 is for such a low dose of gel.

Thank you, that all makes sense. My appt is next Monday. In the meantime, now that i know oestrogen affects sleep, I'm just wondering whether to experiment with 1.5 pumps of gel for a day or so before then, see if it makes any difference with sleep. Very much appreciate your help.