Utrogestan two weeks on two weeks off: do you this precisely or take it on the same days every month?

[aquaspot]

I am new to taking HRT. My prescription says to take Utrogestan ‘two weeks on two weeks off’. Do you stick to this precisely or take it on the same days every month, i.e. 1st - 14th of every calendar month?

I’m not sure how important having a 28 day cycle is, so the dates vary every month, or whether it’s ok to add a few non progesterone days each calendar month (I.e. days 15-30/31). I feel like the latter might be easier to remember.

(I know some people take it for 12 days but I’ve been having heavy bleeding so will be taking it for 14 days)

Thanks

Different drs will tell you different things.

Until quite recently, the regimen was 12 days per 28 days, although in practise it was often 12 days per calendar month.

The 14 days (2 weeks) was introduced by a dr who wrote a GP prescribing guide. She suggested '2 weeks' to make it easier for women to remember.

However, the 14 days is not always necessary especially as some women get side effects from Utrogestan. It's really there as an option for women with heavier or irregular bleeds ( as more progesterone can help stop that.)

When I started on it, years ago, with a consultant, I was told to choose the same date each month, to make it easier.

There are other women on the forum who've been told the same.

I take it for 12 days and have 16 days off. I use an app which sends a reminder on the 12 days I need to take it.

I take mine from the first to the 12 of each month.

I do 2 weeks on 2 weeks off. I double checked with my GP after reading on here that it is wrong but my GP confirmed she wanted me to do it that way.

Don't take advice from MN. Check with your GP. If you aren't happy with that then get a 2nd opinion from a doctor!

I do two weeks on, two weeks off as advised by my GP. I track using an app on my phone to remind myself. I always start on a Saturday which also seems to help me remember!

I do the 12 days per 28 days, and have an old fashioned paper diary where I note down my cycle day, which days I need to change my patch and when I need to take my Utrogestan.

I have a reminder in my phone when to start it and do 14 on 14 off. But a recent GP told me I could change to 12 days starting in the 1st of every month.
She said it doesn’t)t matter how you do it.

Different drs have different views on this.

Thanks everyone.

I would check with my GP if I could, but getting through to the surgery can take up to an hour of redialling then waiting for a callback and I have the DC at home. I might ask the pharmacist for their opinion.

I went into my appointment on no medication and came out of my appointment with five different prescriptions (!) so I’ve started recording my medication on a paper diary to help keep track. So as long as I keep that up to date I should be ok.

My GP told me I need to take it on days 15 to 26. You stop taking it on day 26 and your period comes in the next few days.

That fits in best with what would be a typical cycle, with progesterone increasing after ovulation and dropping if an egg is not fertilised.

It means it's not fighting against any natural cycle you may have and encourages the regular bleed.

The problem with this is it's not realistic long term IF you're waiting for your own cycle to come.

Obviously, further into peri, cycles come further apart- sometimes with gaps of weeks /months.

Taking it from 'Day 15' works if that day is the same date each month.
So that's the same as choosing one date every month and sticking to it.

I think the problem with all of this is that some GPs have a 'little knowledge' and stick exactly to the 'rules' whereas consultants who are menopause experts have more knowledge and see the bigger picture (which means they often give advice that's different to a GP.)

Mine has always said use the same date each month.

So if you take it for a higher number of days eg 14 out of 28, are you more or less likely to have a bleed?
Ive never quite understood the role of the progesterone.

@JinglingSpringbells

I understand that the same approach doesn't work for everyone but this one is well recognised. And the OP hasn't mentioned any particular irregularity to her cycles.

And don't assume all GPs don't know what they are taking about just because they are a GP!!

Mine is highly trained in menopause and other womens health and is considered an expert in our area and is the go-to for anyone covered by our group of surgeries. She trains up the other GPs and in a large practice she deals mainly with women and menopause.

She is excellent and I trust her to give really good advice - appropriate to the individual situation of her patient. I am aware of how lucky this makes me and the other women in our area!!

I suggested this method as an alternative to the OP, as if she has fairly predictable cycles it may be suitable for her.

My cycles have become more unpredictable as I go through peri-menopause. I can usually count from Day 1 of my bleed and start my Utrogestan on day 15. When I start missing periods and that becomes more tricky I'll get different advice from my GP I'm sure.

Fair enough. But your GP sounds like the exception.

When I start missing periods and that becomes more tricky I'll get different advice from my GP I'm sure.

Very few women in peri have regular cycles.

This is the problem with the instructions on the leaflet- it doesn't allow for women having irregular cycles. It assumes women have regular cycles.

No that's not the case.

The role of progesterone - if you want to 'biology' of it (!) is to change the womb lining from proliferative (growing/thickening) to secretory (ready to accept a fertilised egg). When progesterone levels fall (naturally, or by stopping progesterone in HRT) the lining believes that no egg is there, so it starts to shed.

My understanding is that progesterone slows down or stops the lining growing, so the number of days you take it has this effect.

It doesn't mean there is no bleed, just that the bleed may be slightly lighter on 14 days compared to 12.

There are many variations on the number of days it's used but not via a GP as the variations are off-licence. It can be taken for far fewer days but only under medical supervision with scans to assess the lining. When I was first on HRT in very late peri, I was using progestogen for 10/12 days every 3 months.

These variations can be for several reasons but include women who are intolerant to progesterone.

There is a tablet form called Tridestra which is a 3 month cycle.

Sorry if this is a longer reply than you expected!

I have had no typical cycles as of the last few months. I’ve had cycles ranging from 17-49 days. I recently went one week without bleeding before another period appeared - and they’ve been longer than usual and extremely heavy - the joys of peri-menopause.

I’ve been told to start the oestrogel straight away but to wait until after my period to start the Utrogestan - for the first time I take it only and I’m guessing this is just for my situation. From then on to take it two weeks on two weeks off irrespective of my periods.

I called the GP yesterday as advice seems very mixed and I want to get it right. I decided that the phamacist would likely just take what the prescription said literally. My GP was fantastic; she said that it’s absolutely fine for me to take it on the same 14 days each month i.e. the 1st-14th of every calendar month i.e 1st-14th Sept, 1st-14th Oct etc as it is only a couple of days difference and will make it easier for me to remember.

Can I just add that for women who find they have side effects, it's okay to do 12 days.

I checked this out on the GP Notebook (online) which is a guide written by a well known menopause GP (!) for GPs.

It actually says that the licensed amount is 12 days but '2 weeks is easier to remember'.

If anyone wants to see that I can find it again and paste it.

I’ve read that 14 days is often used for women with very heavy periods, which mine are - I’m now on iron tablets as my levels are very low.

Anything I’ve written has been about my personal situation, and what I have been advised for myself only.

On the 28 day cycle thing, I’ve read on a peri group that it refers to your 28 day HRT cycle, not your natural cycle. So day one starts again after day 28 whether or not your period has started.

I’ve been using oestrogel for a few days. Does anyone know if that will affect my period arriving? I thought it had started but it appears to have been spotting as it’s stopped. But I need it to arrive and finish before I can start the Utrogestan…