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Learn how to use Utrogestan, natural progesterone in perimenopause to improve symptoms, aid sleep and protect the endometrial lining from excess thickening.
What is Utrogestan?
Utrogestan is a brand of micronised progesterone. Micronised progesterone is bioidentical progesterone, or in other words is identical to the progesterone made by your body so is often referred to as natural progesterone. Utrogestan is a plant-based progesterone, being made from yam sterols, harvested from wild Mexican yams. It is made into soft capsules that can be taken orally or used vaginally.
What is Natural Progesterone?
Progesterone is a naturally occurring steroid hormone in the humans. In the female body it plays an important role in regulating many different functions. It is primarily produced by the ovaries during the second half of your menstrual cycle, the LUTEAL PHASE. Functions of progesterone on the uterus includes:
it stabilizes the uterine lining or endometrium,
increases mucous production and
helps to prepare the uterus for pregnancy.
adequate progesterone is required to reduce the risk of miscarriage and preterm labor.
Some of the other functions that progesterone is responsible for include controlling hot flashes, preventing excessive weight gain, regulating mood and energy levels, and protecting the bones.
Progesterone has important functions beyond the reproductive system, in particular in the brain. These include:
regulating thought processes,
regulating mood
regulating neuro-inflammation,
regulating mitochondrial function - the energy power houses of the brain,
neurogenesis and regeneration - the creation and maintenance of nerves and neuro networks.
Myelination or adequate insulation for nerve fibers
recovery from traumatic brain injury.
How does Utrogestan work?
Progesterone is a naturally occurring sex hormone that is produced in the ovaries. It works by helping to regulate the menstrual cycle and preparing the body for pregnancy. By taking Utrogestan, you can help restore normal natural progesterone levels when your natural supply starts to decline during perimenopause. This can help to reduce or prevent the symptoms of perimenopause such as:
spotting,
premenstrual symptoms,
prolonged periods,
insomnia and
anxiety or irritability.
Utrogestan can also be used to help prevent uterine cancer, when using estrogen HRT, which risks increase after menopause.
Should I take Utrogestan during perimenopause?
If you are having perimenopausal or menopause symptoms, Utrogestan is a safe body identical hormone to use as the progesterone component of hormone replacement therapy. In particular it is useful for hot flushes, alongside estrogen, is protective for bone health and improves sleep.
Talk to your doctor to discuss this further if you feel like this is something you would like to explore.
How do you take Utrogestan for perimenopause?
You and your doctor will be able to determine the best dosage and regime for you based on your health history, your current perimenopause symptoms, and your response to treatment.
Why is Utrogestan used for perimenopause?
Utrogestan or micronized progesterone is used as menopause hormone therapy.
It is used either alone to balance the higher estrogen to progesterone ratio in early perimenopause, or alongside estrogen to replace a lack of both hormones.
If women are using oral or transdermal estrogen (gel or cream on the skin) for perimenopausal symptoms and they still have an intact uterus, they need to use Utrogestan (or a synthetic progestin) to protect the endometrium from excess growth and thickening.
When to take Utrogestan?
Because Utrogestan has a mild sedating effect, it is taken in the evening before bed.
It is also best taken on an empty stomach, so preferably take it 2 hours after food.
How to take Utrogestan?
There are 3 ways to take Utrogestan for perimenopausal hormone therapy.
Cyclical Utrogestan therapy
This regime is usually used in women who are still experiencing a cyclical menstrual period.
The dose is 2 capsules (200mg) at night on day 15-28 of a 28 day cycle (this dose may be increased at high estrogen doses).
or
The dose is 1 capsule at night on day 1-25 of a 28 day cycle with a 3 day break (this dose may be increased at high estrogen doses).
Continuous Utrogestan therapy
This regime is usually for postmenopausal women, women who have not had a period for 6 months or have had a hysterectomy:
The dose is 1-2 capsule (100mg-200mg) every night.
If women are using higher estrogen doses, a higher dose of Utrogestan may be required. Discuss the options with your doctor to work out which regime and dose will work best for you.
What is the difference between Utrogestan and Synthetic Progestins
Utrogestan is body identical progesterone, meaning it is identical to the progesterone your body has made during your life. It has identical effects on progesterone receptors and binds to these receptors exactly as it should.
Synthetic progestins include medications such as:
Medroxyprogesterone acetate
Dydrogesterone
Northisterone
Levonorgestrel (in Mirena).
Synthetic progestins are progesterone-like molecules that have effects on the progesterone receptors with variable
Utrogestan is metabolised to allopregnanolone which is a neuro steroid which acts on the GABA receptors in the brain. This has a calming and mild sedating effect in the brain, supporting mental health and sleep.
Many women prefer Utrogestan to synthetic progestins, feel better using it and experience less side effects and than when using synthetic progestins.
Will I have a period with utrogestan?
If you are using cyclical Utrogestan, you will have a withdrawal bleed, like your regular period every 28 days. If you are using continuous Utrogestan after you have stopped having periods, you should not have a period.
Women sometimes have irregular bleeding in the first 3-6 months of starting Utrogestan but this usually settles down after this. If bleeding is heavy or persistent please see your doctor about this.
Is Utrogestan safe?
International opinion recommends micronized progesterone such as Utrogestan be used as hormone replacement therapy as natural progesterone has a lower side effect profile compared with synthetic progestins.
Utrogestan is preferable to synthetic progestins because:
it has beneficial effects on cholesterol levels and lower risk of heart disease
less risk of breast cancer risk (Asi 2016).
lower risk of blood clots
It also has an additional advantage of having a calming effect that supports sleep.
If you have any of the following conditions it is important to discuss these with your doctor when considering using any form of HRT including Utrogestan:
allergic reactions to soy or peanuts
breast lumps, personal or family history of breast cancer
personal or family history of blood clot
history of severe depression
severe liver disease
porphyria
migraines.
Utrogestan Side Effects
Like most medications, Utrogestan can cause side effects in some patients. Common side effects may include upset stomach, headache, breast tenderness, acne and bloating. These are less dramatic with lower dose or when used as continuous menopausal hormone therapy rather than cyclically.
It's important to note that these side effects are usually mild and will often subside as your body adjusts to the hormone. In order to minimize your risk of side effects, be sure to follow the dosage instructions.
1 in 10 women experience lower mood when on natural progesterone so if Utrogestan is affecting your mood, talk to your doctor to discuss lower dose, trial vaginal Utrogestan or alternatives.
Frequently asked questions
Why Should I Take Progesterone at Night?
Progesterone can have a relaxing effect, helping you go to sleep and feel less on edge. If it is taken during the day you may feel light-headed, tired or groggy so it is recommended to be taken at night.
Is Utrogestan funded?
Funding progesterone in New Zealand has taken sometime. From Dec 2022, PHARMAC funds Utrogestan in NZ for a range of uses including for treatment of perimenopausal and menopausal symptoms.
If utrogestan is prescribed by a psecilaist you may have a dispensing fee at your pharmacy.
Read more about Utrogestan NZ & other funded HRT in New Zealand.
What are other brand names for micronised progesterone?
Utrogestan is the brand of micronised progesterone used in New Zealand. In other countries such as Australia, Prometrium is the common brand of micronised progesterone.
Who should not use Utrogestan?
Utrogestan contains soy lethicin so should NOT be used by people with soy allergy.
There are 2 types of Utrogestan. One type contains peanut oil and the other contains sunflower oil. If you have a peanut allergy, it is important to let both your prescribing doctor and your pharmacist know so that they can ensure you have non-peanut oil containing Utrogestan.
In New Zealand only the sunflower oil Utrogestan is available. The peanut oil containing Utrogestan was phased out in 2015.
Can I use progesterone cream rather than a tablet?
Natural progesterone is poorly absorbed through the skin. Oral progesterone is more effective, especially for those needing to use it for endometrial protection.
However, for those with progesterone intolerance, the same oral capsule can be inserted high into the vagina at night. The British Menopause Society recommends the use of the same dose vaginally as orally.
Dr Deb Brunt @ Ōtepoti Integrative Health would love to support you as you navigate perimenopause and menopause.
She practices Lifestyle Medicine and Integrative Medicine in New Zealand and Menopause health coaching internationally. She has a passion for supporting women adapt to their changing female physiology for optimum health and wellbeing.
Dr Deb Brunt | Ōtepoti Integrative Health | www.otepotiintegrativehealth.co.nz/book-now
References
Asi N, Mohammed K, Haydour Q, et al. Progesterone vs. synthetic progestins and the risk of breast cancer: a systematic review and meta-analysis. Syst Rev. 2016 Jul 26;5(1):121.
British Menopause Society. Progestogens and endometrial protection. 2021
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