Can I use Progesterone capsules vaginally?

[Shallysally]

I’m prescribed Utrogestan capsules. Been taking them for a couple of years together with oestrogen gel.

Over the last couple of months I’ve had a couple of bouts of thrush and had some dryness.

Can the progesterone be inserted please or do I need some sort of progesterone pessary?

If HRT is affecting your liver, you should be using transdermal HRT because tablets go straight through the liver.

I'm not sure what you're saying- are you still using HRT and it's affecting your liver?

Why would you have a blood test for your liver in the first place? That's not normal practice.

You definitely need to be on vaginal estrogen in addition to whatever else you're using in HRT. Creams or pessaries. Makes a massive difference.

Thanks for your replies. I have an apt next week so will discuss again with my GP. But if I have to DIY, can anyone confirm whether it is the same dose as orally? I've seen online saying it is but then elsewhere saying half it.

Your GP needs to read the info online written by the BMS.

It's all in there.https://thebms.org.uk/wp-content/uploads/2023/04/14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf

Page 4. First paragraph.
You use the same amount- not half. Last line of the paragraph.

This is exactly what I was looking for. Thank you so much!

I'd just like to add that for some vaginal progesterone isn't absorbed very well eg if you have vaginal atrophy. I can't remember where I read that bug it makes sense i suppose.

Indeed. My menopause clinic gynae (at Barts & The London) advised me to double the dosage (so 200mg daily instead of 100mg) if taking Utrogestan vaginally.

Oh man. I have never heard that about doubling it.

Ive just also seen this week about oestrogel needing to sort of dry into the skin not be rubbed in vigorously like I was doing.

it’s like the Wild West here 😩

When you insert it vaginally, are people getting a thick white discharge/ residue? I get a lot and worried it's not being absorbed properly. I do push it up as high as I can!

Yes I do. Hmmm that’s a point that it might not be absorbing correctly.

I always 'lose some' that is not been absorbed.
I mentioned this to my consultant and they said enough would have been absorbed.

One thing I do is take a break and use it orally for a day or so each cycle and on those days use vaginal estrogen otherwise it's 2 weeks or more without any.

@HundredMilesAnHour That's a bit odd because the former lead of the meno clinic at the Chelsea and Westminster meno clinic is on video (in a conversation) saying he'd be ok about women using half the dose vaginally (even though this is not mainstream advice.) He's one of the most respected and experienced consultants in the UK.

The other issue is if you've been referred to a menopause clinic, is that because you have had some problems?

The BMS doesn't say anything about increasing the dose. but it also depends on the ratio of estrogen/ progesterone because higher doses of estrogen often need more progesterone, regardless of the route.

The other issue is if you've been referred to a menopause clinic, is that because you have had some problems?

@JinglingSpringbells No I don’t have any related problems but I have a family history of breast cancer so when choosing to investigate HRT (after discussing with various specialists) because I was really struggling with peri symptoms, my NHS GP referred me to the menopause clinic at Barts and they liaise with the breast cancer family history clinic at Barts (I’ve been under them for over 20 years).

Utrogestan taken orally makes me feel really ill and whilst other oral (non-bio identical) progesterones don’t, they’re obviously more risky for me given my family history. So that’s why I take Utrogestan vaginally instead. (I wasn’t willing to have a Mirena).

Thanks for explaining.

Have you been tested for the BRACa gene?

Prof Michael Baum (breast specialist for decades) has a video on 'inherited risk' on the British Menopause Society website. He says that for most women with a family history it's not relevant unless they have the braca gene and should be tested for it.

You could use the normal dose of progesterone and perhaps have a uterine scan annually?

There is absolutely no guidance on doubling the dose when using it vaginally and it could carry risks. The data on safety is based on the licensed doses.

Maybe query it?

Thanks but I’ve been through years of discussions and reviews with both breast cancer specialists and menopause specialists (and a gazillion other specialists) both privately and NHS so I’m not looking to get into an online discussion about it on top of all that. For my personal situation, I’m comfortable with the risks of using off-license meds although I appreciate that not everyone feels the same way.

Thank you both for posting. I’m glad that the idea of doubling it is for you as an individual and not something I’ve got wrong (another thing to worry about)

I live abroad. Regular blood tests for liver enzymes, cholesterol etc are the norm from about age 35+. Also I have other health issues which mean I get even more tests.

I use transdermal oestrogen but have been advised that, although slightly elevated, the liver enzymes are fine. When I first started taking HRT they shot up to scary levels but have since levelled out at just above the normal range.

Thank you for your advice but as you can see from my regular blood tests, my doctor is fully aware of this.

I posted with the mistaken understanding you were in the UK. Obviously here the NHS works very differently.

This is all very interesting because I have just had a load of blood tests done and my liver enzymes are elevated way above what they usually are. I was wondering what could have caused it but I've been on HRT for six months now so I wonder if that is anything to do with it.

Also I have been getting terrible acid reflux at night so it looks like that could be from taking the progesterone at night orally. Might try it vaginally and see if that helps

HRT rarely causes liver inflammation. Very rarely, it may cause some changes in the liver but that is with the older types of oral estrogen (tablets.) The guidance is that women with any established liver disease avoid oral estrogen.

If your liver shows high enzymes your GP will start to look at why or just retest in 3- 6 months.

Liver enzymes can be high for zillions of reasons but HRT is not usually one of them.

i just wanted to update on here to say I went back to my GP armed with some printouts from the BMS (so helpful, thank you @JinglingSpringbells) and she got in touch with the menopause specialist at the hospital (she said they have a helpline for GPs) and they have agreed to prescribe it off licence for vaginal use. The difference has been amazing. I feel so less tired, irritable and sleeping much better. Weirdly, my bleed this month came 2 days before I finished the progesterone (I will monitor this) so had to switch back to orally for those days and it's been awful. Really bad night sweats, weird dreams and sooo tired during the day. Which reassures me that it was the progesterone causing those issues. I'm now just waiting to see if my GP will switch me to a 200mcg pessary so I don't have to keep putting the 2x100 oral capsules up there.

That's good news.

It's frustrating that there is this '2 tier system' where specialists are very relaxed about this sort of thing yet GPs have to seek advice (even when vaginal use has been standard in Europe for years and years.)

The 200mgs pessary used to be prescribed as HRT but within the NHS it was paused and only available for fertility.
There is a massive difference in cost, by the way, so this is possibly why the NHS stopped it. (It's not just 2x the cost of 100mgs.)

I'm afraid the side effects you experience affect me with vaginal use more than orally! Not the tiredness but the disturbed sleep.

Just shows how everyone is so different.

I hope you get on okay with it.