At Rowena Health Menopause Specialist Clinic we are often asked for advice about how to take Utrogestan. What is Utrogestan and why do we give it as part of Hormone Replacement Therapy? What do you need to know?
What is progesterone?
Progesterone is the second main sex hormone. Your ovaries produce progesterone and oestrogen in varying amounts each month as you ovulate, until the menopause, when your periods stop. Menopause usually affects women between the ages of 45 and 55, but it can happen earlier. It affects anyone who has periods. Progesterone is produced by the ovary during the second half of your menstrual cycle, after ovulation. As you reach menopause, the amount of progesterone and oestrogen that your body produces falls.
Progesterone overall is protective. It balances oestrogen and has an anti-proliferation effect, it up regulates serotonin receptors and GABA and it maintains skin health and is involved in collagen, elasticity and hydration.
What is Utrogestan?
Utrogestan (micronised progesterone) is a medicine that contains a hormone called progesterone. The progesterone in this medicine is a type of progestogen, that’s identical to the hormone your body produces. Utrogestan is only available on prescription. It comes as capsules that you swallow and it is taken at night usually, as it can make you feel sleepy. It can be taken on an empty stomach, or with food. Natural micronised progesterone called Utrogestan in the UK is derived from the yam plant. It is used as part of Body Identical, regulated Hormone Replacement Therapy.
Utrogestan is taken along with oestrogen as part of hormone replacement therapy (HRT) to relieve the symptoms of perimenopause and menopause, you may have when your body produces less of these hormones.
If given alone, oestrogen HRT causes the lining of the womb to thicken. It is like applying a fertiliser to the lawn, with an increased risk of abnormal cells developing or a womb cancer. The progestogen keeps the lining of the womb thin, like using a lawn mower, and prevents the cells from becoming abnormal. It is very important you take your Utrogestan as it has been prescribed so that it can protect the womb lining.
If you do not have a womb usually you do not need to take a progestogen, but there are some cases, such as after a hysterectomy for endometriosis, where you are usually asked to take a progestogen to protect the endometrial like tissue which could remain after the operation.
What dose of Utrogestan do I take and when do I take it?
This is individual to you. You’ll usually take Utrogestan on certain days each month: either two capsules every day for part of the month, 12-14 days for example, or one capsule every day. The way you take this depends upon when you start HRT, and what is happening to your own natural menstrual cycle, or, if you are taking progestogen only contraception, for example. You might be advised to take higher doses.
When we prescribe this we will guide you about what dose is best for you, depending upon your medical history. We will also guide you about when to start HRT when it is prescribed, if you still have your own menstrual cycles. Taking Utrogestan in perimenopause, cyclically does not stabilise your hormones, or act as a contraceptive. We can talk with you at an appointment about this.
What might the side effects be with Utrogestan?
Common side effects include:
- changes in your periods, including spotting, or bleeding between periods
- breast tenderness
- headaches,
- a dip in mood
These symptoms usually improve in the first few months of treatment, but please talk with us at Rowena Health Menopause Clinic, if you are struggling.
Some women do not tolerate taking Utrogestan, they may experience more serious side effects, the symptoms they experience can be very similar to PMS or PMDD. They may experience:
- problems sleeping
- breast tenderness or pain
- feeling tired / dizzy or change in energy
- swelling
- bloating or fluid retention
- mood changes: mood swings, irritability, anxiety, or depression
- vaginal bleeding
- abdominal pain
- acne or oily skin
- nausea, indigestion or changing bowel habit
- mild rash
Why do some women have side effects?
Utrogestan is metabolised in the body to allopregnanlone, which plays an important role in neurological resilience. It exerts a neuroprotective, antidepressant and anxiolytic effect, via GABA receptors in the brain. For some women this produces a calming effect, for others they experience side effects, which can be severe.
If this happens we can guide you about taking Utrogestan vaginally, if we feel this is safe for you, or we can try a different progestogen. It is not wise to decide yourself to take Utrogestan vaginally, this is done off license in some patients with shared discussion with a Dr. about risk and benefit.
It could be that using a different progestogen might be better tolerated as it is metabolised in a different pathway. Usually we find one that you can take and tolerate well. The way you live your life, your diet and alcohol consumption, for example, can affect your hormonal pathways and how to respond to the hormones you take as HRT.
Are there other types of progestogen I can use instead as part of HRT?
Yes, there are synthetic progestogens which can be given instead of Utrogestan like Levonorgestrel in a Mirena IUS, Desogestrel, body similar progestogen, in Femoston, Medroxyprogesterone acetate in Provera, and Norethisterone. These progestogens have different risks for blood clot and breast cancer, and different benefits, which we speak with you about in clinic to find the one that suits you best.
It’s important to see your doctor at least once a year for a check-up if you take HRT.
For more questions to see if Utrogestan might be right for you, please book an appointment at Rowena Health Menopause Clinic and we will be delighted to help. We offer online menopause and women’s health care if you are in the UK and have a clinic in Guildford if you prefer an in person consultation. We realise this time can be difficult, we are here to help.
Last updated September 2023 -Carys Sonnenberg -Menopause Specialist Dr.