If you're on 75mg estrogen patch, what amount of Utogestran are you on?

[LifeInAHamsterWheel]

I'm 50. I started on HRT 2 years ago. Initially on a 50mg estrogen patch and 100mg Utogestran tablet which I take daily (I'm also on the mini pill as I had been on that for many years so no idea about periods and doc said to stay on it until I'm 55). At my initial 12 week check my estrogen patch was upped to 75mg (having felt instant relief, after about 6 weeks symptoms returned) and have been on that ever since. Feel great! No side effects, no bleeding or pain or anything.

I had a review with a different doc and I got the feeling she wasn't happy that the estrogen dose had been increased. She said that 75mg is a 'very high' dose and that I would need to increase my Utogestran to 200mg - so take 2 tablets a night.

Obviously I'm not a doctor, but I've felt so good this past year or more and I really don't want to rock the boat. I don't have any of the symptoms that she mentioned that would require a higher dose of progesterone. Is anyone else on 200mg? Does it have any side effects?

This is one of those grey areas.
The BMS issued more guidance a while ago about increasing Utrogestan to 200mgs for women on higher/high doses. 75mcgs is 'high' but not as high as 100mcg patch.

However, it's really down to woman/ dr to decide what is best. It's not set in stone. It would be reasonable for someone to stay on 100mg if they had never had irregular bleeding or they didn't start to have any on the higher dose patch. It's also about balancing side effects against protecting the womb lining.

I hate to say it but this is one of those things where GPs don't have specialist knowledge and tend to play it by the 'rule book' even though it's a guide, not an instruction manual.

That's what I thought. I'm not sure whether to just say nothing and carry on just taking 1 tablet a night. I feel like a bold teenager! But I do know my own body and haven't had any of the warning symptoms.

I'm 49 and on exactly the same meds as you. Just had HRT review and no mention of having to increase utrogestan or 75 being a high dose either. I get the feeling that they are happy if I am!

I'm 57. Started on 50mg oestrogen and 100mg Utrogestan. Almost constant bleeding which was investigated.
Moved to 100mg oestrogen and 200mg Utrogestan. Better, but a bit jittery.
Now on 75mg oestrogen and 200mg Utrogestan. Seems to be ok but waking in middle of night with mega anxiety is creeping in.
So for me it was and is trial and error.

See I'd understand if I'd had any issues but over 18 months of being on 75 patch and 100 Utrogestan and I have been great! I really don't want to rock the boat!

I’ve been on two utrogestan since I started on one pump of gel via Newson clinic. Now up to 100 patch plus 2 pumps and still take 2 Utrogestan.

I was looking this up yesterday (I'm getting almost constant bleeding on HRT)

The guidelines I found online were still 100 for 75 going up when you reached 100 of oestrogen. That's what I was on before I tried the patches

Currently waiting for another coil appointment as they couldn't get it in the first time

I am on 100mcg patch and 100mg utrogestan

however my Estradiol level (sp) is 307 which is quite low but I feel fine. So if your level was say 600 then you may need two tabs?

hmm

The new guidance suggests 200mgs Utrogestan for women on 4 pumps of gel or 100mcg patch.

If there is no spotting etc on 75mcgs patch then there is no need for more Utrogestan.

https://thebms.org.uk/2022/12/bms-statement-hrt-prescribing/

There is no recommended systemic level of oestrogen in association with use of HRT and response to treatment with HRT should be based on symptom control. Checking serum oestradiol levels is influenced by many factors including the timing of the dose and type of assay and cannot be assumed to be indicative of levels over a 24-hour period.

Routine testing of oestrogen levels is unnecessary and is associated with an unnecessary cost both to the NHS and patients in private clinics.

Thanks everyone, in particular @JinglingSpringbells as I'm not in the UK so can't access the link so you putting the actual wording was really helpful.