Can I split my Utrogestan dose?

[IsItWickedNotToCare]

I've been prescribed 200mg utrogestan continuously because I've had several episodes of heavy bleeding, 6 years post menopause. All checked out by hysteroscopy and ultrasound, womb lining is thin etc . Was previously on a higher dose of estrogen with only 100mg utrogestan which probably caused the womb lining to become unstable. Anyway, after taking the 200mg utrogestan I became extremely bloated and all clothes very tight overnight. Can I use 100mg utrogestan vaginally and 100mg orally to split the dose and lessen the side effects? Does anyone know??? My GP knows absolutely nothing and I went private to get the 200mg but not sure if i can ask them again without paying £££ for a follow up. Thank you!

Why did your GP not prescribe 200mgs? It's BMS guidance for women using 4 pumps of gel or 100mcg patch OR for women on lower doses who have irregular bleeding.

Is there any reason why you can't use 200mgs vaginally? (I do on sequential hrt. and have done for years with a private consultant.) You are more likely to get bloating orally.

If you split the dose orally and vaginally every day you are likely to get a slightly different rate of absorption. Less is absorbed orally. So if you split the delivery route you might get 75% of the total amount compared to 100% vaginally.

You might want to think about using a different progesterone - dydrogesterone- which is almost as 'natural' as Utrogestan. The brand is Nalvee. It's been available now for a year to be used alongside estrogen, as a tablet. It is supposed to control bleeding better. You can read about it on the BMS website.

@JinglingSpringbellsthankyou, my GP knows nothing about menopause. She has sent me down the 2 week pathway several times, panicking me, made me come off my HRT cold turkey so that I feel dreadful, anxious, dizzy, migraines, because of sudden withdrawal. Refused to prescribe me 200mg even though I showed her the BMS guidelines, said I would have to wait for gynae appointment at hospital which still hasn't come through. I went private to avoid waiting any longer. She's now let me have the 200mg because the specialist said, but after a long wait and much chasing on my part! She suggested I go on beta blockers because I seemed anxious!!! I'm anxious because of all this messing about with my hormones. I just want a small dose of estrogen and something which controls my bleeding. I'm so confused and fed up. The specialist did suggest nalvee if the 200mg utrogestan didn't agree with me. Thank you for your help x

So you could do 200mgs vaginally and that would avoid the bloating.
Or try Nalvee
Or reduce your estrogen dose- what dose are you on?

with 2 pumps of gel or up to a 50mcg patch you may be okay on 100mg utrogestan daily.

The 200mgs is only really for women on more than 3 pumps gel / 75+ patch.

I use 200mgs vaginally but on a cycle. I'd not like to do that every day as a) causes discharge and b) some irritation and c)harder to fit in using vaginal estrogen.

GP sounds ridiculously ignorant and not even noting the BMS guidance.

Op just in case you can change GP, there is a 200mg pessary available. My GP prescribed it for me to use vaginally. So you don't have to keep those tiny runaway little balls in your vagina! (who made them that shape? I lost so many under the bed).

@JinglingSpringbellsiI don't think I could tolerate 200mg vaginally every day as i get vaginal atrophy and irritation. I was on 2 sachets sandrena a day but I've cut that down now to 1 sachet. Was not advised and higher dose estrogen needing higher dose progesterone and i think that's where the problem started. Even though I'm on a lower dose estrogen now I'm scared that the bleeding will start again as it did recently even on the lower dose and it was very heavy. So I'm trying the 200mg but not sure i can tolerate it orally because of the extreme bloating. I think maybe nalvee might be good but my GP will have a fit! She'll never have heard of it and will look at me as it's I'm suggesting something out of this world!!!

on 1 sachet of sandrena you don't need 200 mgs progesterone.
why don't you try that and see how you go?

The only downside of that is it can't be swallowed- it's a bit big- whereas with 2 x 100 there is the option of mix and match if you want to.

I've had the 200mgs but prefer using the 100s.

@JinglingSpringbells thats true.

It's not particularly big, I just thought it had a coating which meant you couldn't swallow it.

I don't know. I've had both and they seem very similar but Idon't know if the capsule shell is tougher and won't dissolve orally.

Yes it is perfectly safe to take micronised progesterone orally, vaginally, rectally, or to use a combination of these routes.

Do you have 2*100mg capsules though or do you have only 200mg capsules? If it's the latter you would have to get your prescription changed to 100mg caps or use the mouth and vagina alternate nights.

Additionally, as someone who is progesterone intolerant myself, I am always super keen to spread awareness that there are multiple oral alternatives and nobody has to struggle with micronised progesterone who doesn't want to.

Nalvee (dydrogesterone) has been mentioned, NHS availability varies, but there are several others as well as the IUS although I know that isn't for everyone, myself included.

There is little data showing changes of absorption between oral and vaginal route of micronised progesterone. I’m aware that there was previously a Doctor who used to prescribed micronised progesterone vaginally at half the dose of that used orally which caused bleeding issues for women, and the BMS had to step in saying this should not be done.

Current guidance is to use the same dose vaginally as prescribed orally, so this could be split between both. I’m aware that some doctors advise this where it’s not tolerated orally. That said you might find with continued use that the bloating resolves and you do tolerate 200 mg orally.

I’ve attached some up-to-date BMS guidelines where vaginal use is mentioned.
https://thebms.org.uk/wp-content/uploads/2026/05/14-NEW-BMS-TfC-Progestogens-and-endometrial-protection-MAY2026-A.pdf

Thank you all for your replies. I am aware that on a lower dose of estrogen, 1 sachet sandrena, I shouldn't be bleeding... but unfortunately having switched to 1 sachet (from 2 sachets previously) I had a heavy bleed after 4 months and then within 2 weeks of that I had another heavy bleed, so I'm obviously worried about that happening again even on low dose. However the 200mg utrogestan is causing bloating but I'm only on the first week, so maybe it will settle?

I have got 2 x 100mg tablets so that's why I was thinking of taking one oral and one vaginal to see if that helped with bloating

Guidance is to give any new type and dose 3 months.

You can use 50-50 (oral and vaginal) but you may get the worst of both worlds- bloating and vaginal irritation.

It's all trial and error.

More is absorbed vaginally so if you can do that it may be better re. bleeding.

@JinglingSpringbells it's not much fun is it? I'll give the 50/50 a try, I must admit I'm a bit worried and het up about all this as I've had such a lot of trouble for the past year and I'm feeling wobbly after being off hrt for a few weeks. Thank you for answering x

There is no reliable data showing micronised progesterone as part of systemic HRT is more effective in controlling the womb lining than orally. If there were then BMS would advise using less vaginally (see link above). The dose can be split between the two.

I experienced no irritation when inserting progesterone vaginally.

Note that when starting, increasing (up or down), stopping or changing HRT bleeding can occur in the first few months. It’s important to be patient between changes to give it time to settle.

If you’re still experiencing bleeding three months after doubling the Utrogestan dose would suggest you see your doctor so that changes could be made or investigated further

I'd complain about your GP knowing "nothing" about something relevant to 50% of the population, eventually!
Enough women without medical degrees have educated themselves-but they shouldn't have to; some women can't read, some have language barriers. The GP needs to get themself trained or get another job. Or at least refer you on to someone who does know.