Did anyone switch to one urtogestan every day, from two for 14 days? When did you start? And did it make any difference to you?

[Optimisticccc]

I take 2 urtogestan tablets for 14 days a month. I am considering switching to one per day.

when should I start this if I do? On the first day of my 14 day cycle?

And did you find it made any difference to you if you switched?

if you’re still bleeding, 14 on and 14 off is the recommended schedule. Any always check with your doctor before making changes.

I changed after only a few months on HRT at the suggestion of the nurse practitioner at my GP, because the side effects of the progesterone were quite bad and my peri symptoms were not well enough managed. I feel much much better on this regime without the extremes of progesterone. I can’t remember how I made the switch unfortunately but I’d take professional advice before you change and check with them.

This - don’t mess with your meds unless you get the go ahead.
I did move after a chat with a GP and it’s easier to remember tbh.

How long have you been on the sequential HRT? You can generally swap to continuous after a few months but talk to your GP. I swapped after about 18 months but could have swapped sooner, it was just a hassle to get an appointment. The sequential HRT forces a withdrawal bleed, it’s not a true period so you will likely keep bleeding as long as you are on sequential so don’t assume you can’t swap because you are having bleeds.

The guidance to change to continuous HRT is when you are 54 or have had no natural period for 12 months at any age.

@Optimisticccc @TheSereneRaven

see this from an NHS consultant.

https://www.menopausematters.co.uk/postmeno.php

Please note: Patients should consult a health professional to decide on the appropriate treatment option to be prescribed.
POST MENOPAUSAL -
Continuous combined therapies.
"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age.

The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved.

When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin.

Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy.

Start with low dose preparations and increase as necessary for symptom control. The products marked * are licensed for osteoporosis treatment/prevention.

But if you are not over 54, not post meno, (or maybe having very irregular periods before HRT) you shouldn't be on it as it's not likely to control your own periods and you will have bleeding.
The only benefit is for HRT to be bleed-free.

If you have been on sequential HRT for 12 months you will fit the “or had no natural periods for 12 months at any age” part of that criteria. Bleeds on sequential HRT are not natural periods.

You don't know if you would have natural periods once you are on sequential HRT.

HRT resets the cycle into an HRT cycle. Ovulation can still be happening but the bleeding pattern is controlled by the HRT cycle.

That's why the guidance says over age 54 because (it's not stated in full there but is elsewhere) that by age 54, 80% of women have no regular ovarian cycle.

It's at the bottom of the page.

When?

• Patient known to be post-menopausal at whatever age, ideally by having at least one year of amenorrhoea (no periods).

• If sequential therapy started while still having periods, wait till age 54 years. At 54 years 80% of women will have cessation of ovarian function and are likely to settle on continuous combined (period-free) therapy.

• Change from sequential to continuous combined by finishing the current sequential pack and start new therapy at the end of the expected bleed.

Outside of " official " guidelines, most well informed gps will allow you to switch to this routine, regardless of age. For me, it made all the difference in my mood. On the 14 on/ off cycle I experienced horrendous depression when withdrawing. Daily use has helped massively with anxiety and helps me to stabilise emotions. In fact, I struggle to comprehend how women can cope with that routine!

I take one daily and it's really helped with my sleep. Im prescribed 2 a day for 14 days but I was miserable the other half of the month so I'm afraid I decided myself to take it daily. I real a lot of research first and it said to stop for a few days every month IF you haven't had a bleed, but im still having a period every 3-4 weeks so I don't need to skip any days.

There are many posts here where women are put on continuous too soon, they have irregular bleeding after the 6 month settling in time, and are then sent for scans or hysteroscopy. Creates stress and unnecessary tests. Their GPs seem unaware of guidance or reasons for it.

The BMS concedes that for older women on hrt for a year, it may be possible to try continuous after a year on HRT but it's always an experiment.

There are downsides to continuous which are rarely mentioned by GPs- the main one is a slightly higher risk of breast cancer - and women ought to be told of that.

Not all women like being on daily progesterone. I know women on hrt in their 70s who prefer sequential. There is no rule about 'must change to continuous' - it's a choice.

@newlifter- that doesn't sound right. There is no guidance on stopping progesterone for a few days if you've not had a bleed.
On sequential there is usually a withdrawal bleed every cycle, on continuous you shouldn't bleed at all after 6 months. You're still having your own cycle and the 100mgs a day isn't enough. Maybe talk to your GP?

https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/utrogestan-micronised-progesterone/how-and-when-to-take-utrogestan/
And https://nhssomerset.nhs.uk/wp-content/uploads/sites/2/Dr-Juliet-Balfour-New-guidelines-on-progestogens-in-HRT-121124.pdf
The first website is nhs guidance on taking utrogestan and says take for 25 days in 28 or every day if prescriber thinks its ok to not bleed (ie 25 in 28 if a bleed is needed).
The second talks about reducing unscheduled bleeding by taking a 3 day break on continuous.

Sorry in advance this is long but I couldn't reply without quoting from your links!

Yes, for you, you did it to avoid low mood etc and it's working, which is good. But a couple of things- the NHS link is out of date and the 2nd link is a list of 'solutions' for bleeding after 6 months on continuous HRT.

The first website is nhs guidance on taking utrogestan and says take for 25 days in 28 or every day if prescriber thinks its ok to not bleed (ie 25 in 28 if a bleed is needed).

This ^^ is now out of date. It was written in 2023. Continuous is now every day, regardless. From Menopause Matters -

UTROGESTAN
Micronised progesterone
100mg at bedtime from day 1 to 25 of each 28 day cycle (licensed regimen), though taken every day is usually recommended

If you have not had a period for 6 to 12 months or more, your doctor may recommend that you take 1 capsule (100mg) once a day, on days 1 to 25 of your 28-day HRT cycle. Sometimes, your doctor might advise you to take it every day, if they think it's OK for you not to have a period.

Stopping progesterone for 3 days doesn't give anyone a period. It's a withdrawal bleed. That used to be done as a 'test' to see if any womb lining was shed. no one does this now. It's now every day, the same as combined continuous patches and tablets

The second talks about reducing unscheduled bleeding by taking a 3 day break on continuous.

The link you posted is about how there has been an increase in women being referred for investigations, mainly because of the use of micronised progesterone .

One of those options is to change it to a 'half-way house' between continuous and sequential- 25 days out of 28 so there will be a predictable withdrawal bleed if the womb lining is thickened.

Although I respect the fact you know lots about hrt due to your own journey, you do have a blind spot when it comes to other women's experiences. Just because your routine works for you, doesn't mean we're all the same and therefore, some of us require a different approach. To dismiss our own Drs advice as out of date or uninformed is very negative - our individual practitioners know us best and can take into account our own health issues or m/ h and prescribe according to that, not because they're not up with guidance!

I made this switch recently and the difference has been transformational for me! Before (taking 2 tablets for 14 days) my symptoms were terrible, I was permanently uncomfortable, often in pain, like having continuous terrible PMT.
I was told you should only make the switch when your periods stop, but I discussed with my GP that this combo of HRT was maintaining my periods - forcing a cycle.
On the GP’s advice I took the 2 each day for 14 days then continued on 1 each day from there, so there was no break. I feel so much better, much more balanced, haven’t had a period since (bonus!), I have more energy and less bloating.

That's a bit unfair @SuTissues
I've posted guidance - By NICE. BMS and senior NHS consultants.
Not about me.

I acknowledged that there are women who can have the guidance tweaked when necessary.
I didn't say GPs were out of date - I said the NHS link that someone left was out of date.

I'll butt out now. I'm not here to argue or get into a personal spat..