Utrogestan vaginally, is it effective?

[Oakiedoakie]

Hello, I'm thinking of switching to using utrogestan vaginally but am just a bit anxious about how safe and effective it is? Those of you ladies that do this, have you found it to be ok, long term? Really don't want to get a mirena.

Yes. I’ve done it for years. I think it’s more effective as it acts locally. It’s licensed vaginally in Europe, just not in the UK.

Thank you, that is reassuring!

I’ve been doing this for the last couple of years. My friend is a Nurse Practitioner who has done some specific menopause training and she recommended it. (Actually initially she suggested I could use it rectally which I really didn’t want to do and she said vaginally is fine). When I mentioned it to my own meno nurse she was quite taken aback as she’d never heard of it, but didn’t say I shouldn’t/couldn’t do it. It seems to be working, in that the progesterone still makes me feel quite miserable, and I still get a bleed every month as soon as I’ve stopped it, so I assume it’s doing what it’s supposed to- I think the bleed is the main point of it?

When I took it orally it gave me heartburn (I get a fair bit of that anyway but it made it worse) and it also made me feel unbelievably fatigued- that doesn’t happen when I use it vaginally.

Thank you, I've tried it for the last few nights. I'm still having very low mood, but we'll see how it goes. I'm also hoping it might help with my very bad hair loss which I've had since starting hrt.

I struggled with it giving me heartburn too; so bad that I had to take omeprazole.

My GP said ‘taking it vaginally is unlicensed’ and that she couldn’t support me taking it that way … but I’ve read so much about it being used vaginally for fertility & in other countries, so I decided to try it.

So I have now been taking it vaginally for a couple of months, but I do find it irritates my bladder? I have to get up to pee in the night (I usually put them in before bed, at about 10/11pm)

does anyone else have that problem?

I’ve tried it vaginally, which was fine when just taking 100mg but very messy in the mornings with 200mg. Switched to rectally now and it’s honestly effortless, the tablets kind of get sucked up with no fuss or mess. Zero bladder irritation or any other side effects. Sounds grim but works well.

Utrogestan used vaginally is off license, however many women who don’t tolerate it orally use it this way. Keep in mind any changes should be given three months and then reviewed.

I’ve attached the guidance on this here: https://thebms.org.uk/wp-content/uploads/2023/04/14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf

It might or might not be related. For example, vaginal atrophy / GSM can also cause urinary frequency. Maybe try inserting it in the morning, see if you still have nightly frequency, and as long as it doesn’t drop out it should do the same job.

May I jump in here with a question please?
Bit embarrassed to ask and I promise I’m not a troll.

My GP (in England) has recommended that I switch from Evorel Conti patches to topical oestrogel + uterogestan tablets inserted vaginally. She says I should use 1 tablet daily, every day of the month, rather than 2 tablets for only 2 weeks of each month, for various reasons (I’m nearly 54, get migraines often etc).

My question: a) I’m still enduring a massive period/withdrawal bleed from my last patch (god knows if my periods have stopped or not). Can I start the vaginal utrogestan while bleeding or will it sort of get washed away?!

b) er - what happens with sex??? Do you wait until afterwards to insert the tablet? (And what about oral sex - is it safe for your partner to do this if you’ve inserted a tablet nearly 24 hours earlier?). 😳

I find it takes around 5-6 hours to totally dissolve. So don’t insert before having sex. But I usually use last thing ie after last wee so won’t be having sex then!

I find it takes around 5-6 hours to totally dissolve. So don’t insert before having sex. But I usually use last thing ie after last wee so won’t be having sex then!

I've used it that way for years with a consultant's 'ok' and they prefer women to use it that way.

@MeridaBrave
There are medical papers on serum levels of progesterone used vaginally (for HRT but also fertility). They show that serum levels rise and peak an hour after insertion. For fertility the guidance is to lie down for 30 minutes to aid absorption ( for fertility it can be 200 mgs ,3 x a day.)
The serum levels are also higher using it vaginally meaning it's more effective.

However, inserting after sex is the way- not before unless it's a few hours before.

@MrsEmmelinePankhurst No, don't use it while you're bleeding. Wait until the lining has come away fully.

Yes, you wait until after sex.

@Soleena I get some irritation after a few days so sometimes swap to orally for one day. It actually makes my bladder more sleepy, but taking it orally I always have to get up at night for a wee!

How are you using it vaginally if the GP wont support it, do you get it privately?

Ive just started patches, sequential I think the term is but am worried about reading that progesterone makes you depressed, I have huge depression symptoms. I dont really have any physical symptoms at all.

So wondering if that doesnt work for me I would have to go for estrogen gel and progesterone separately, is utrogestan the same as progesterone?

To answer this your GP isn't in your bedroom when you go to bed!
It's the same product, although there is a 200mgs capsule intended for vaginal use (but it's more than 3 x the cost.)

I'd not get too worried about depression. Everyone is differet.
All of the progestogens used in HRT can have some side effects.
I felt worse on Northisterone (which is in most patches) compared to micronised progesterone.

Norethisterone is a synthetic progestogen.
Utrogestin is a body identical natural progesterone.

Thanks Im a bit confused then, so there are tablets for vaginal use?

Im just thinking ahead obviously I dont know if the patches will give me depression, I havent started on the combined set yet, that comes in 2 weeks. The Dcotor told me nothing about any of this, really poor appointment

So is the progesterone in the patches body identical because I specifically asked about this and she said she didnt know what body identical meant

My main symptoms are depression and its stopping me from working so I dont want something that risks that.

I only took my first patch this week so on estrogen only at the moment

So is the progesterone in the patches body identical because I specifically asked about this and she said she didnt know what body identical meant

That's pretty awful to be honest as it's basic knowledge of HRT.

Micronised progesterone is a capsule .

I don't think it's worth worrying to much about this at the moment unless you really want to insist you use it. The sequential dose is 200mgs x 12 days and you can either swallow it or insert it.

@over50andfab left a BMS link and a few pages in it discusses this in detail.

I wouldn't stress too much now, wait for 3 cycles of your patches and then see how you feel. The progestogen in patches is not body identical..

Might be worth changing to another GP if possible as yours seems clueless- as if she has no HRT training.

Im so totally fucked off with the appointment, Im really confused by the whole thing (confusion and lack of focus and memory are huge symptoms for me as well as utter depression) and my surgery doesnt have a well woman clinic/nurse/expert and every time I ask about this Im told Dr X is the one who deals with 'womens problems', thats how its touted

And I turn up for the appointment and she knows fuck all.

Im furious (like normal).

Thank you for this. I have never heard of taking them that way. I find the 200mg is so messy and I dont want to wear underwear overnight. It would make it easier because I feel I have got so much to insert, moisturiser and vaginal oestrogen tablets and the Utrogestan. I feel like a slug 😂😂

It might be a good idea to separate those out.
I never use vaginal estrogen at the same time because I assumed it would prevent it from working so well.
You could use Vagifem in the morning. Unlike vaginal ream it does stick to the walls so shouldn't fall out.

Some of these questions are ones I was also wondering about, particularly using vagifem and ovestin as well. I suppose they just have to be done at different times. Not sure how I feel about doing utrogestan rectally, that might be one to keep in the back pocket, literally, if things get desperate🤣

Have used it rectally on and off for 3 years, as my stomach isn’t a fan. I was actually put on rolling progesterone (every day) by a doctor as I had so much trouble with bleeding. I sometimes switch to oral but find the slightest thing will give me stomach cramps when on it like that. Unlicensed yes, effective though!

The point of using progesterone with hrt is to stop estrogen causing too much growth of the womb lining.
I've always assumed that using vaginal estrogen (which is very very weak) at the same time could make the vagifem/ ovestin ineffective

When I used Utrogestan vaginally instead or orally to see if it was more effective in controlling bleeding (it wasn’t, if anything it made things worse 😕) I inserted Vagifem in the mornings on the days I took it. I haven’t actually seen any recent data showing it works more effectively this way as part of HRT, but I thought it was worth a try.

I’m aware that some women use Utrogestan inserted high up and Vagifem lower down at the same time at night (lower down is closer to the urethral tract for the estradiol to absorb through to help with bladder frequency anyway) with no issues. This is particularly very helpful if the vagina is dry where that Vagifem might drop out if inserted the following day, although adding a blob of moisturiser can help it stick to the vaginal walls.

Estriol cream applied externally on the vulva can continue to be used at night.

I would definitely need to keep using the vagifem and ovestin as well. I'm hoping the following day is OK? Maybe just a dab of the ovestin externally at night? Obviously don't want to make the utrogestan in any way less effective. I've been using it vaginally for a week or so, now, and have been getting some slight cramping afterwards. Hope I can keep going.