Your Guide to Using Utrogestan in Perimenopause

What Is Utrogestan?

Utrogestan** is a brand of micronised progesterone. Micronised progesterone is body identical 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 and during pregnancy. 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 plays a role in during perimenopause includes controlling hot flashes, improving sleep (Progesterone for menopausal women 2018).

Additionally, unlike other progestins, it does not promote excessive weight gain (Impact of micronized progesterone on body weight, body mass index & glucose metabolism 2019),

It has also been shown to be helpful in regulating mood and energy levels (Estradiol & Micronized Progesterone in the Prevention of Depressive Symptoms in Perimenopause 2018).

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 during the luteal phase of the menstrual cycle. Progesterone levels start to decline during perimenopause - contributing to a variety of perimenopausal symptoms throughout the body. Taking progesterone can be taken during the luteal phase can help to reduce or prevent the symptoms of perimenopause such as:

spotting,
premenstrual symptoms,
prolonged periods.

Natural progesterone is metabolized to allopregnanolone. This steroid hormone has neuro-calming effects via GABA receptors. or this reasons it is helpful at reducing insomnia and anxiety or irritability.

Utrogestan (like other progestosgens) are used to help prevent endometrial thickening while using estrogen HRT, which is a risk of using estrogen without a progestogen in women who have a uterus.

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.

It is generally tolerated better than the alternate synthetic progestins that are used in HRT or the combined contraceptive pill.

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 several 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).

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 usually 1-2 capsule (100mg-200mg) every night depending on your estrogen dose.

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 likely continue to have a 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.
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.

Some women experience lower mood when on natural progesterone so if Utrogestan is affecting your mood, talk to your doctor to discuss alternative dosing or a different progestogen.

Related: Progesterone Intolerance

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?

Utrogestan is funded in New Zealand and is most commonly used alongside estrogen for the treatment of perimenopausal and menopausal symptoms. It is also used in fertility trestments.

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, alternate brands of micronised progesterone are available.

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. Pharmacokinetic data shows vaginal use of utrogestan shows comparable absorption to oral use (Micronized progesterone: clinical indications 1999).

Dr Deborah Brunt is a menopause doctor at Rebelle Health and would love to support you through the perimenopause and menopausal stages, supporting all aspects of your health and wellbeing.

Join our Menothrive Programs to feel great and love your life during peri and menopause.

Dr Deborah Brunt | Rebelle Health | Book Appointment

**1. Utrogestan, Prescription Medicine: It is used as an adjunctive with an estrogen in postmenopausal women with an intact uterus (for hormone replacement therapy [HRT]). Utrogestan has risks and benefits. Ask your doctor if Utrogestan is right for you. Utorgestan 100mg. For product information check with your doctor or Consumer Medicine Information on www.medsafe.govt.nz