Women who take HRT and still have their womb (uterus) are required to take a progestogen in addition to oestrogen. This is because taking oestrogen alone can cause an unhealthy thickening of the womb lining (endometrium). If this happens, there is a potential for it to develop into cancer. Taking progestogen prevents this occurring.
Utrogestan (Micronised Progesterone)
Since natural progesterone can have a mild sedative effect, Utrogestan can cause drowsiness for some women. It is therefore recommended to be taken at bedtime. It can improve sleep quality and doesn’t usually cause grogginess or a hungover feeling the following day.
How do I take Utrogestan?
Since natural progesterone can have a mild sedative effect, Utrogestan can cause drowsiness for some women. It is therefore recommended to be taken at bedtime. It can improve sleep quality and doesn’t usually cause grogginess or a hungover feeling the following day. It is best to take Utrogestan on an empty stomach because eating food at the same time as taking this medication can increase drowsiness.
There are two ways to take utrogestan:-
Cyclical HRT/Sequential HRT is often recommended for women who need oestrogen and progestogen, and who still have their periods and don’t have a Mirena coil. You take oestrogen every day and take progestogen alongside it for the last 12-14 days of your menstrual cycle. For women who are still having periods within the last 6 to 12 months, the usual recommended dose is x2 100mg (200mg) capsules taken together each evening for 12-14 consecutive nights on a repeating basis. This regime will create an artificial monthly bleed.
For women who have not had a period for over a year, the usual recommended dose is x1 100mg capsule every evening without a break. The information supplied with this medication describes a slightly different regime, but it is far more straightforward to take it in this way. It is completely safe to take it in either of these ways.
Most women should be given continuous (bleed free) HRT If a woman has not had a period for around a year, then continuous HRT can be prescribed initially. If a woman is taking sequential (cyclical) HRT then after around a year this can be changed to continuous HRT.
Will I experience side effects?
As Utrogestan is body identical, women usually experience less side effects compared to the older types of progestogens.
Some women experience side-effects initially which can include erratic vaginal bleeding, abdominal bloating, lower abdominal pains or discomfort and breast tenderness. Bleeding can be intermittent or continual and can last for the first 3 to 6 months. If bleeding worsens or does not improve with time then you should seek guidance from your menopause specialist or your GP.
Some women find that they feel lower in their mood when they take Utrogestan. This side-effect is less common compared with some of the older progestogens but can still occur in around one in ten women.
Mirena Coil
The Mirena coil can be used as an alternative progestogen part of HRT for 5 years. If the patient has had a Mirena coil in for more than 5 years, then this can be kept in situ and she should be given progesterone too. The Mirena can be replaced (or removed) in the future.
Are there any risks?
The older types of progestogens which can be given as tablets or as a combination patch, can be associated with a slightly higher risk of clot and heart disease. Studies have shown that women who take Utrogestan do not have a higher risk of clot or heart disease.
The small increased risk of breast cancer in women who take HRT is understood to be related to the type of progestogen, and not oestrogen in the HRT. Taking Utrogestan does not appear to be associated with an increased risk of breast cancer during the first five years of taking it. After this time, the risk of breast cancer is very low and studies have shown that this risk is lower than the risk for a woman taking the older types of progestogens.