Vaginally administered Utrogestan

[Hagbard]

Hi, I'm currently prescribed Evorel Conti. Due to post-menopausal bleeding, GP is starting me on Estradiol 0.06% gel 2 pumps a day with Utrogestan 100mg capsule once a day.

I've read on here about administering the Utrogestan vaginally - but is that only recommended for tablets? Or is it OK to use the capsules like this? In the past, progesterone has made me feel a bit bleak and ragey, so would prefer not to take orally if possible.

GP has recommended 2 pumps, but said to use more if needed. Does this sound OK?

Bit nervous about changing to a new system - the Conti worked quite well apart from the bleeds (which were checked out with a scan + blood tests)

Also, will I now get a monthly bleed? Even if taking the estradiol gel and Utrogestan continuously (as prescirbed)? The leaflet inside the gel box says I will (I'm post meno)

If you take utrogestan continually no you shouldn't get bleed but as you have been bleeding already on conti it may take a while to settle and yes it's just the same capsules that are taken orally that are inserted vaginally, as high up into your vagina as you can manage.

How many years post meno are you? Good that the post meno bleeding has been checked out with a scan.

Thanks so much Janiie, that's reassuring. I'm 6 years post meno (age 52 now)

I’m the same age as you OP and been doing this for the past couple of years due to a health problem that means I can’t absorb the Utrogestan properly. It’s totally fine for me and I know the GP was insistent that I do take it as otherwise there’s a cancer risk through too much oestrogen.

@Hagbard What was the dr's rationale for swapping you to this regimen?

The progestogen in patches is synthetic and stronger than Utrogestan. It's Norethisterone.

So it seems slightly odd that you've been taken off a continuous patch (I assume you mean it was combined continuous?) and given Utrogestan which is often slightly less efficient at controlling the lining.

(Is your GP HRT trained?)

I've read on here about administering the Utrogestan vaginally - but is that only recommended for tablets

There is only one type of Utrogestan. For HRT it's the 100mgs. (For fertility there is a 200mgs capsule but it's exactly the same, just bigger. Off-licence for vaginal use you may be able to be prescribed those.)

In the past, progesterone has made me feel a bit bleak and ragey, so would prefer not to take orally if possible.

You've been using a progestogen (Norethisterone) in your patches all along.

Are you genuinely post meno? That's at least 12 months with no natural periods before using a combined continuous type of HRT. If you started HRT when you still had periods, you may not be post-meno.

So many women seem to experience bleeding but often they've been put on a combined continuous type too soon and that's why they bleed.

No it doesn't say that.

It's a monthly bleed for women using cyclical HRT (12 days of a progestogen a month.)

'In the past, progesterone has made me feel a bit bleak and ragey, so would prefer not to take orally if possible.'

'You've been using a progestogen (Norethisterone) in your patches all along.'

Don't some women struggle taking it orally though that's why many take it vaginally, I presume transdermal also has less side effects?

I think that @Hagbard may be referring to Norethisterone in her patches as 'progesterone'.

'In the past, progesterone has made me feel a bit bleak and ragey, so would prefer not to take orally if possible.'

Norethisterone is a progestin. (A synthetic type of progesterone.) It's not possible to take it vaginally. But in a patch it is transdermal . The benefit of transdermal is a lower risk of clots.

The only progesterone is micronised progesterone (brand name Utrogestan.)

This is why I asked if she'd used micronised progesterone before. or did she mean Norethisterone (because she's had combined patches.)

Utrogestan is infamous for causing side effects (some the same as progestins, some not.) The main one is drowsiness (hence taking it at night) and using it vaginally means it bypasses the nervous system. And is less likely to cause indigestion/bloating.

Hi, thanks for replies.

JinglingSpringbells, the first HRT I was prescribed was estradiol and progesterone, both oral tablet form. Felt fine on the estradiol part, but felt miserable on the progesterone. I didn't get on with that, so GP prescribed Conti patches, which I felt pretty good on, apart from the bleeding really. So I wondered if oral progesterone (or it's equivalent) doesn't suit me, hence wanting to use the utrogestan vaginally.

I don't think my GP is menopause trained - she was very reluctant to prescribe HRT and pushed antidepressants. I was 4 years post meno when she said the guidelines had changed (after Davina McCall publicity) and agreed to HRT.

Thanks for clarifying.

It makes no sense (sorry) to take you off patches with Norethisterone which is stronger and better at controlling bleeding compared to Utrogestan.

I was on Norethisterone as separate tablet along with gel for around 6 years (private meno specialist.) I moved onto Utrogestan as it's safer for long term HRT use and I've been using it for many years now.

By all means give vaginal use a try but if you had bleeding on patches, I can't see how this new type would be an improvement.

Good luck with it anyway!

This is why I asked if she'd used micronised progesterone before. or did she mean Norethisterone (because she's had combined patches.

I realise that the Conti patches release norethisterone (but thought it was progesterone) as well as estradiol. What I was trying to explain, that when prescribed orally in the past, it caused very unpleasant side-effects. The patches caused no such side effects (the bleeding is unpleasant, but preferable to side effects from oral progesterone). So to avoid some of the side-effects, I'd prefer not to use Utrogestan orally, and I wanted to check on here that this medication is OK to use vaginally.

Does 2 pumps of estradiol sound OK - should I work up to it, starting with one?

Oops, I'd typed all that as a follow-up to my pp.

Thanks for the advice

Did you ever got to the bottom of the bleeding?
How long were you bleeding and how often?

Presume your Dr told you that bleeding on any combined continuous type is normal for up to 6 months?

The advice is that any irregular bleeding after 6 months on conti is investigated. Was that done? Have you had a scan?

Sorry- I didn't realise you'd use Utrogestan as well. I replied earlier based on your use of patches.

(Some women refer to (micronised) progesterone and progestin as if they are the same - which they aren't.)

2 pumps of gel is approx 1.5mgs of estrogen, the same as a 50mcg patch. So it's probably best to stick to the same does you've used before.

No more investigation after the scan showed no abnormalities (and a smear to check cervix). Bloods were all clear (for cancer?)

The bleeding started after about a year, and occurred in 2 weekly-ish cycles, going on for about 6 months . Can weight gain affect hormones/how we store them? Because I'd quickly gained a couple of stone in weight at that time. Now I've shed most of that weight, it seems to have calmed down, just the very occasional light spotting.

I'll see how I get on with the gel/Utrogestan, but may end up going back on Conti patches from what you've said. I feel like I need more estradiol, but the Conti patches only come in one size.

Cheers for all the info

The bleeding started after about a year, and occurred in 2 weekly-ish cycles, going on for about 6 months . Can weight gain affect hormones/how we store them? Because I'd quickly gained a couple of stone in weight at that time.

Yes.

One of the biggest risk factors for endometrial cancer is being overweight.
This is because fat cells help women's bodies produce estrogen. (Risk factors are listed on the NHS website for this.)

So it's possible that your extra weight was adding more estrogen to the HRT you were using.

Hopefully all will improve now.