HRT and Me: Utrogestan vs Cyclogest Natural Progesterone

Box of Cyclogest 400mg natural progesterone vaginal pessaries

Do I kill myself or give in to the uge to kill others? That’s what it ultimately came down to when I weighed up the difference between taking Utrogestan or Cyclogest natural progesterone.

A year ago I wrote a post HRT and Me: Progesterone Intolerance in which I described the problems I had been experiencing with progesterone. Thanks to the responses to that post I realised I am not alone and that there are many women out there who are suffering from progesterone intolerance and battling to find a solution.

Since then I have changed the type of progesterone I was taking and in this post I share my experience of the differences between Utrogestan and Cyclogest natural progesterone.

Utrogestan Natural Progesterone

The first type of natural progesterone I took was Utrogestan which comes in the form of oral capsules and is available on the NHS. Utrogestan is a micronised form of progesterone that is bioidentical, which means it is structurally identical to the progesterone produced by a woman’s body.

Because it is bioidentical it is meant to produce fewer side-effects and, unlike synthetic progesterone like Provera and Climanor, does not increase cell proliferation in breast tissue in postmenopausal women. Unfortunately if you are progesterone intolerant, as I am, then any amount of progesterone, natural or synthetic, is going to upset the apple cart.

Utrogestan Side-effects

A box of Utrogestan 100mg capsules

I took Utrogestan 200mg for 12 days a month, on days 15 to 26 of my cycle. On those days I became extremely bloated, my libido disappeared, I suffered from migraines, my breasts were often tender, and I became very antisocial. I was too tired to want to do anything much and felt so fat and ugly I just wanted to hide away from the world and wait for my period to be over with. I was an absolute ‘joy’ to live with and my poor partner never knew when I was going to over-react to something and snap at her. Work became more difficult as I often struggled to think straight and focus. On the plus side, because I took the Utrogestan before bed and it has a calming effect, I did sleep a lot better.

My periods usually started on day 6 of the progesterone cycle and continued for up to 10 days. They were excruciatingly painful and so heavy that I ended up with iron deficiency anaemia yet again. The period pains felt as if my womb was being slowly scraped clean with a medieval torture implement made of spikes and nails. My days and nights revolved around mega doses of Ibuprofen which had little effect, hot water bottles, towels in the bed to mop up leakage at night and increased spending on sanitary products. It was nothing if not exhausting.

Utrogestan and Depression

But the worst symptom in the lead up to my period was the depression. With each successive day of Utrogestan treatment I sank further down the black hole of despair. Some days I had suicidal thoughts which really frightened me as I knew I didn’t really want to kill myself but I couldn’t stop the thoughts.

That’s when I knew I had to change my progesterone treatment.

Alternatives

My consultant enthusiastically recommended having the Mirena coil inserted as it can actually stop periods altogether but I was not keen on the idea of having something inside me permanently releasing progestogen.

The other option was to increase the Utrogestan from 12 days to 14 days a month. Yay! Two extra days of bloating and depression. What was there not to be happy about? But I opted to give that a go. Better the devil you know, right?

However, I was confused. I knew that Professor John Studd, a well-known London gynaecologist and menopause expert, often prescribes Utrogestan 100 mgs daily for the first 7 days of each calendar month for women who have difficulty with progesterone and yet I was being prescribed double that dose. When I asked my consultant about it he said that reducing the dose can reduce the symptoms of intolerance but you may have more of a problem with heavy and prolonged bleeding. It also increases the risk of endometrial hyperplasia (thickening of the lining of the womb) which can develop into womb cancer in some women.

After two months on 14 days of Utrogestan I felt ready to give in to the suicidal thoughts. Although my periods had been lighter and less painful, my depression had gotten worse. The discovery that I had fibroids, an endometrial polyp, adenomyosis and a thickened endometrium did nothing to lighten my mood. And after a hysteroscopy and polypectomy I was ready to throw in the towel on HRT, menopause, the whole damn lot.

Out of desperation, I made an early appointment to see my consultant to discuss changing my progesterone. As expected, he enthused about the Mirena coil again. Every time I hear about the Mirena I get a bad feeling and wince at the thought of having it inside me. Instinctively I know that it will not be good for me and all the persuasion in the world is not going to change my mind.

When I asked my consultant about the possibility of taking Utrogestan vaginally instead of orally he said that it was the same product and would have the same side-effects. But he did prescribe progesterone in the form of Cyclogest vaginal pessaries 400mg to be taken for 14 days each month.

Cyclogest Vaginal Pessaries

Cyclogest progesterone pessary
Like Utrogestan, you need to take Cyclogest just before bed to benefit from progesterone’s calming effect. Take it during the day and you’ll be drowsy. But unlike Utrogestan which is a capsule you swallow with water, Cyclogest needs to be inserted in your vagina the way you would insert a tampon with your finger. It looks like a wax bullet, but it is actually solid vegetable fat and once inserted the fat melts and the progesterone centre is then absorbed into your uterus. This means that you need to lie down as soon as you’ve inserted it, otherwise it could slip back out again, and it also means that you will be slightly messy in the morning once all the melted vegetable fat has dribbled out of you during the night. Just be prepared. If this doesn’t appeal, there is also the option to insert the pessary in your rectum.

Cyclogest Side-effects

Cyclogest is natural progesterone, just as Utrogestan is, and I hoped that by taking it vaginally instead of orally I may lessen some of the side-effects.

That did not happen. I still got bloated each month to the point where I could no longer fit into most of my jeans. And in place of depression I became extremely irritable, unreasonable and angry. Instead of having suicidal thoughts about wanting to kill myself I was having murderous fantasies about killing others. Let me be clear, I had no intention of acting on my fantasies but I felt irritable and angry enough to attempt serious damage if provoked. I still had swollen, painful breasts occasionally and felt even more tired than usual which added to my sense of overwhelm.

Periods from Hell

Two days after I completed my first 14 days of Cyclogest my period began. The period pains were the worst of my life. I have never given birth so I can only imagine what it’s like and this is how I imagined childbirth to be; mindblowingly painful. Enough to cancel out everything in the world except the pain. The cramps had me doubled over, unable to move, moaning like a cow in labour. I writhed and sweated and panted and cursed everything and everybody I could think of and nothing helped.

For several months in a row I actually PASSED OUT from the pain. Twice I happened to be at home, which was lucky, and on one occasion I was in the hairdresser’s. On all occasions, I lost sight and vision, the world went black and silent and I crumpled to the floor. When I came to, I was ghostly white and sweating, barely able to breathe from the pain and the cramping. It was terrifying.

It got to the point where I was too afraid to leave the house on the first two days of my period. What happened if I passed out on the train or in the supermarket or in a busy London street? It was too risky.

On the plus side, my periods only lasted for about 5 days, with two to three of those days being extremely heavy. And, like with the Utrogestan, I slept well.

That’s the long story of it. If you’d like a summary, here’s a table with the main comparison points between Utrogestan and Cyclogest.

Utrogestan 200mgCyclogest 400mg
Oral capsuleVaginal pessary
Take for 12 - 14 daysTake for 12 - 14 days
Side-effects include: breast tenderness, tiredness, bloatingSide-effects include: breast tenderness, tiredness, bloating
Main side-effect: Depression and wanting to kill myselfMain side-effect: Irritation and anger and wanting to kill others
Period starts on day 6 of 12 - 14 day progesterone treatmentPeriod starts 2 days after completion of 12 or 14 day progesterone treatment
Period lasts for 10 daysPeriod lasts for 5 days
Period pains, but don't pass outPass out from period pains/cramps
Period is heavy for approximately 3 daysPeriod is heavy for approximately 3 days
Makes me sleep betterMakes me sleep better

It’s obvious that neither of these forms of progesterone is ideal. The alternative offered by my consultant was to try a synthetic form of progesterone such as Norethisterone or Provera, but after my experience with Prempak-C I was not keen. Also, synthetic progestins are more likely to cause breast cancer.

I’m Sticking with Cyclogest

I decided to stick with the Cyclogest mainly because I hate feeling depressed so much that I preferred passing out to feeling as if life was not worth living. Also, I decided it was better to want to kill others than to kill myself and I preferred having a 5 day period as opposed to a 10 day period.

In the past few months I have gradually reduced my dosage of oestrogen, I’m currently on an Evorel 25mg patch twice a week and I’ve noticed that the less oestrogen I have in my system, the less severe my period pains are. I guess that’s because there’s less build up of endometrial lining.

The situation is far from perfect and I feel stuck between a rock and hard place. Because of my progesterone intolerance I have decided to come off HRT altogether – more of that in a later post.

In the meantime, I am soldiering on and looking forward to a time in my life when I will be progesterone and period-free.

How about you? Have you had a similar experience? If so, I’d love to hear from you. Please leave a comment in the box below.

Further reading:
HRT and Me: Progesterone Intolerance

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26 Responses to HRT and Me: Utrogestan vs Cyclogest Natural Progesterone

  1. Charlie F December 4, 2017 at 2:41 pm #

    Sorry if this replicates info given…. I went to see Prof Studd as I wasn’t getting anywhere after 7 years of awful night sweats/brain fog and rage!
    I am on oestragel, provided by my GP now, and am about to go onto Utrogestan, also from my GP. As directed by Prof Studd, I only take progestagen for first 7 days of every month. Periods are a little variable, but fine. I have my life and my brain back. Could not be happier.

    • Angie Macdonald December 4, 2017 at 6:51 pm #

      Thanks for sharing this, Charlie and glad to hear you have your brain and life back.

  2. Ellen Matless July 5, 2017 at 6:49 am #

    Hi
    I too have been suffering with this intolerance and it seems that my gp and gynaecologist don’t know what to do with me. I am waiting for an appointment with a menopause clinic after being referred a couple of months ago. I have had so many problems with hrt and being batted back and fourth doesn’t help. I’ve tried the same as you in the form of progesterone and also have the same feelings about mirena coil. I’ve felt so alone in my struggle until I found your posts.
    My mood is low and I am close to giving up but the oestrogen makes me feel better. I’m confused on what to do. Thank you for writing about your experience it has helped me.

    • Angie Macdonald July 11, 2017 at 8:07 pm #

      Hi Ellen. Thank you so much for your comment, it is heartening to know that reading about my experiences is helpful. I wish I had an easy answer for you but I’m afraid I don’t. Progesterone intolerance is the main reason why women abandon HRT. Some gynaecologists, I’m thinking of Professor Studd in particular, advise their progesterone intolerant patients to take Utrogestan 100mgs for only 7 days a month. This is probably the lowest possible dose you could get away with without risking endometrial cancer as the recommended dosage is 200mg for 12 – 14 days a month. Women on the lower dosage have to be monitored regularly with vaginal ultrasound to check the thickness of their endometrial lining. I stopped taking HRT over a year ago now and I have to say, although I felt absolutely awful for the first 6 weeks or so, my mood has been so much better. I no longer have monthly PMS and feel on a more even keel. I also love not having periods regularly – I have had one in the past 7 months. These days I rely on exercise, walking mainly, to keep me happy. Let me know how you get on at the menopause clinic. I’m interested to hear what they recommend. Good luck!

  3. Bodil Mjoelkalid June 2, 2017 at 10:15 am #

    Hope this can be of help to people. It may not be the natural progesterone you react to, but the “extra” ingredients. They both contain soy (lecithin), peanut (oil) and yellow colouring (cyclogest). Even if you are not allergic to these ingredients, they can cause an elevation in histamine from mast cells. My experience with patients (working as a nutritionist) is that migraine is one of the very strong indicator of high histamine levels.

    • Angie Macdonald June 12, 2017 at 7:36 pm #

      Hi Bodil. Thanks for sharing this very interesting information. I had not made that connection before.

  4. Marie McNeil July 29, 2016 at 10:54 am #

    Angie, I’m just stopping by to see if you are ok? I notice you haven’t posted in a while. Did you decide to stop your HRT? I know you’ve been struggling. I’m in surgical menopause, aged 47 and managed 16 months post op. with no HRT at all. I was 3 years perimenopausal before this, again no HRT. I have just started the HRT but am going very slow with it. I’m using Estrogel to start, and reviewing after 6 months to maybe start the Testosterone. I just wanted you to know I’m thinking about you, after finding you blog some time back.

    • Angie Macdonald August 1, 2016 at 7:01 pm #

      Hi Marie. Thank you so much for your lovely message. How very thoughtful of you. I did indeed stop my HRT at the end of March. It was horrendous to begin with, especially the first six weeks. I have been meaning to write a blog post about my experience. The migraines have finally stopped and I am used to the hot flushes and night sweats now – although it does mean I haven’t had a decent night’s sleep in months. It has been a very ‘interesting’ experience this time round. Another reason I haven’t posted is that I’m working on a book about menopause so that is taking up all of my writing time and energy at the moment. I think it’s a good idea that you’ve started on the Estrogel and to take it at least until you are natural menopause age, around 51. I hope you get on well with it. Let me know how it goes. And thanks for the nudge – I do have a few blog posts that I have been wanting to write for a while so I need to just get on with it.

      • lorraine cartledge June 1, 2017 at 12:25 pm #

        Hello Angie, I am having the same problems as you but no bleeding! But have only used it for a couple of months. I am having blood tests again tomorrow. I split the dose because 2 pills at bedtime made me feel drunk and sickly! I use a little testosterone and used to use DHEA and felt fantastic but got hair shedding. Think I was taking too much! Getting back to normal but have read that you can use bio identical Estriol without progesterone and any problems, this is the gentle estrogen produced when women are pregnant. Maybe this is worth looking in to?

        • Angie Macdonald June 1, 2017 at 7:06 pm #

          Hi Lorraine. Thanks for this, I haven’t come across anyone who has been prescribed bioidentical Estriol without progesterone. Interesting! Will certainly look into it. Hope your blood tests uncover the reason why you haven’t had any bleeding.

    • Lily January 4, 2017 at 12:26 pm #

      You can take Utrofestan 100 vaginally too. In fact, the U.K. Is the only place it is taken orally. This is due to the licence but leading experts on HRT advise inserting it Vaginally.

      I would recommend the Studd protocol as it greatly reduces the suffering of those intolerant to Progesterone and achieves a satisfactory withdrawal bleed

      Hope this is helpful

  5. Susan McKenna February 18, 2016 at 12:17 am #

    Hi Angie

    I first started taking one pump Estrogel and 100mg three times a week when I lived in Switzerland and was 52. The gyno I had in Geneva was celebrated surgeon and told me that all over continental Europe, Utrogestan is taken either vaginally or orally and three times a week when on one or even two pumps Estrogel.

    Used this way, all is fine for me bar the weight gain. And there is no bleed. My lining was recently checked and remains thin. I would rather take 100mg Utrogestan three times a week – Tues, Thurs and Sunday is my regime, than Cyclogest, higher strength at 400mg.

    Anyone being told Estrogel and Utrogestan are not available on the NHS must fight for it. It is fully available from my GP in Acton and from the menopause clinic I attend at Hammersmith Hospital. The clinic is led by Dr Nick Panay, “Mr Menopause” in the UK as he and Dr Studd are considered the leading specialists on matters menopause.

    • Angie Macdonald February 18, 2016 at 6:44 pm #

      Hi Susan. Were you already postmenopausal when you started on the Utrogestan 3x a week? I have never heard of it being used this way before and I think there are different approaches for peri and postmenopausal women. I totally agree with you regards the availability of Estrogel and Utrogestan on the NHS. I think many doctors don’t realise that these are bioidentical hormones and are flummoxed when their patients ask for BHRT.

    • Catherine July 14, 2016 at 8:28 am #

      Hi Susan,

      may I ask when you first started this regime – how many years have you been on it and how often do you have scans? I have been on continuous utrogestan for 6 years now without major problems although low mood has dogged me for alot of this time but so much else was going on in my life I never made the connection with the utrogestan. I am now concluding that 100mg a day is just too much. Recently I have started to take the utrogestan vaginally – same pill just insert it in vagina at night – but I suspect this in fact means I get more progesterone because it doesn’t have to go through my digestive system. Last week I stopped altogether and had a wonderful week but then crashed on Sunday and panicked myself to going back to a daily dose. Since then Inhave had a migraine like headache, low energy and low mood. I am tempted to try your regimeand if necessary pay for scans myself. My GP is listening and I am fortunate in that to date I have no problem in being prescribed oestrogel and utorgestan on the nhs (I was referred to Nick Panay’s clinic in 2006 which is how I ended up on this regime). What I don’t understand is that if this is normal treatment in Europe why not here?

    • Sarah Martinez August 21, 2017 at 10:30 am #

      Hi Susan, I am responding to your information. I am under a nurse led clinic at Oxford but I am not happy (because I feel soooo shit). How easy was it to get a appointmentin Hammersmith? what is the procedure? Love to hear how you are a year and a bit down the line.

      • Karin September 10, 2017 at 1:36 pm #

        Hi Sarah Martinez, I recommend you visiting the NHS Jericho health centre in Oxford, and book an appointment with dr S Harper. She researches in this area and has helped me survive my peri-menopause and I cannot recommend her enough!
        She prescribes bio-identical HRT on the NHS.

    • Dee November 12, 2017 at 8:50 am #

      Thanks Susan, your letter really answers a lot of my questions.

  6. R February 8, 2016 at 6:56 pm #

    Interesting. I was told @ Kings that bio-identical hrt was too expensive, no proof it works & that so it wouldn’t be prescribed on the NHS! I specifically asked my GP to refer me to Kings due to the articles about bio-identical hrt being prescribed there! Thankfully I’d bn tinkering with homemade herbal infusions but that’s not an exact science. Do I make a formal writing complaint now or what please?

    • Angie Macdonald February 8, 2016 at 7:13 pm #

      How mysterious! I was prescribed bioidentical HRT at King’s without even asking for it. The bioidentical HRT prescribed on the NHS is still made by fairly large pharmaceutical companies and it comes in the form of Oestradiol patches or gel such as Evorel patches or EstroGel, micronised progesterone such as Utrogestan capsules or Cyclogest pessaries and Testim testosterone gel, if you are prescribed it. Did they think you were asking for the bioidentical HRT that is in the form of a cream usually and made up by a compounding pharmacy? Personally, I think there is so much ignorance around bioidentical HRT that many doctors don’t even realise that the patches and gels they’re prescribing are bioidentical. If I were you I would either ask your GP to prescribe the HRT in the forms I mentioned or go back to King’s and have another chat. Were you referred to the Gynae-Endocrine clinic? That’s where you want to go. They are very good there.

      • Kate S February 8, 2016 at 8:07 pm #

        Interestingly my GP (in Herts) refused to prescribe it on the NHS. He said he didn’t think the trust would pay for it! However, I have a friend who also lives in Herts, but a different GP who gets it on the NHS. Not without a lot of fuss and bother first, I might add! As it isn’t hugely expensive, I’ve decided just to pay for it myself. However, I don’t really see why I shouldn’t be entitled like others.

        • Angie Macdonald February 9, 2016 at 9:43 am #

          Hi Kate. It sounds like your GP fobbed you off. It isn’t fair that you are denied something that is approved by NICE and is regularly prescribed to other women. You could try and do some digging, aka Googling, and see if you can find out if your GP was correct. Find out the name of the Clinical Commissioning Group for your area. These replaced Primary Care Trusts. Some of these CCG’s publish notes of decisions online so you will be able to see if certain drugs are ‘blacklisted’. Testim testosterone gel is often blacklisted as are Intrinsa testosterone patches for women. If there is nothing online, you could try contacting them directly. If Sandrena, Utrogestan and Testim are not blacklisted then your GP should be able to prescribe them for you. Also, if your consultant originally prescribed this combination for you, I presume he would have written to your GP asking him to prescribe this for you?

          • Mags February 20, 2016 at 4:35 pm #

            Hi, Angie, sorry to bother/hijack, but you seem to be having no problems getting testosterone. My GP, although she admits that my distinct lack of libido should be treated, is refusing to prescribe it because she insists that it’s not licensed for women? She’s not happy about referring me to the menopause clinic either? Any suggestions?

            • Angie Macdonald February 20, 2016 at 6:30 pm #

              Hi Mags. Your GP is right, testosterone gel is only licensed for use by men so doctors have to prescribe it ‘off-label’but I gather that this is a fairly common practice. I had no problem being prescribed testosterone in a menopause clinic probably because the doctors there are used to dealing with women with low libido and other symptoms of hormone imbalance all the time. It’s a bit odd that even though your GP says your low libido should be treated she is not prepared to do anything to help you and refer you to a menopausal clinic. If I were you I would insist on being referred to a menopause clinic, if you are of menopausal age (between 40 and 60). You could also point out to her that the recent NICE Menopause Guideline states that doctors should ‘consider testosterone supplementation for menopausal women with low sexual desire if HRT alone is not effective.’ http://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms Are you on HRT? If you’re not menopausal, then perhaps a referral to a sexual medicine clinic to see if you can be diagnosed with Hypoactive sexual desire disorder (HSDD). Also, has your GP had you tested for other things that can cause low libido such as low thyroid and iron deficiency anaemia? If your low libido is causing you distress then it needs to be treated and your GP is the first person who needs to decide on a proper course of action. You could also try asking her if she would be prepared to prescribe it for a trial 6 month period to see if it does in fact make any difference to your libido, but bear in mind that it is normally only prescribed in conjunction with oestrogen and progesterone (if you still have a womb) to ensure hormonal balance.

  7. Kate S February 8, 2016 at 11:30 am #

    I have now been on Utrogestan, Sandrena and Testim for around two years. Like yourself, I also could not tolerate synthetic hormones. Initially the bio identical hormones seemed to work very well, but after a few months, it was discovered my uterine lining was too thick. This would not shed and eventually it was found I had a polyp – also like yourself, this was removed. I regularly have blood tests to check on my hormone levels. I am now on 200 utro, 200 Sandrena (2 sachets) and the tiniest amount of Testim. Things seemed to have settled, but over Christmas I experienced the most terrible ‘period pains’. I am on the hormones continuously with no break, so never have a period – so this was extremely strange. Since then I have had these pains a few times (spreading down my legs) and very bloated. I am also worried that my lining may be thickening again. I am also due to have an op this week to remove a fybroadenoma from my breast. My consultant (who is eminent in this field) assured me this is unlikely to be due to the hormones. However, after the polyp experience, I am not convinced. At the moment I am not sure what to do. I’m beginning to think I may too have an intolerance as I had huge bloating problems whilst on synthetic hormones. I will have to discuss this with the consultant, but trying to get to see him is a nightmare as he is always so booked up for months. I may have to simply write an e-mail to him. At the moment, I just hope I am going to keep well enough for my op later in the week. I’m feeling so dismayed, as I felt so good on these hormones before – aches and pains gone, no more palpitations or hot flushes and before the daily bloating, I was able to sleep well at night. Now I am so full of ‘wind’ it’s painful! I am also worried to come off HRT because of the palps – my mother had heart problems and osteoporosis as she got older, and I don’t want the same!

    • Angie Macdonald February 8, 2016 at 1:53 pm #

      Hi Kate. Thanks for getting in touch and I’m sorry to hear that the bioidentical hormones are no longer working so well for you. It sounds like the sooner you see your consultant the better. From what you say it may be worthwhile discussing reducing your oestrogen dosage as this may be affecting the thickness of your endometrial lining or experimenting with the Utrogestan so that you do have a period. I don’t know what the answer is, but it’s worth discussing options. I hope your fybroadenoma op later this week goes well. Good luck.

      • Kate S February 8, 2016 at 8:13 pm #

        I think you could be right re. the oestrogen. I was originally using only one sachet per day. However, I was having a lot of skin problems so after blood tests which showed my oestrogen to be on the lower side, my consultant doubled it. I do still have skin issues, so it hasn’t really helped there, so I think I may try reducing it before I see him. I’m also not happy about taking two progesterone tablets daily without any break. However, on one tablet only I was getting some break through bleeding. I am surprised to hear that side effects can be the same whether taken orally or vaginally. I thought that by avoiding the liver and gut, it may be a preferable way to take it. As you say, I will have to discuss all this at my next appointment – I’ll let you know the outcome!

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