Utrogestan (micronised progesterone)

Utrogestan (micronised progesterone) is a medicine that contains a hormone called progesterone. Progesterone is a type of progestogen that's identical to the hormone your body produces.

Your ovaries produce progesterone and oestrogen 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 during the second half of your menstrual cycle. As you reach menopause, the amount of progesterone and oestrogen that your body produces falls.

Utrogestan is taken along with oestrogen as part of hormone replacement therapy (HRT) to relieve the menopause symptoms you may have when your body produces less of these hormones. Taking progesterone with oestrogen is known as combined HRT.

Oestrogen-based HRT can thicken the womb lining. This slightly increases the risk of womb cancer. Taking progesterone together with oestrogen reduces this risk.

Progesterone stops the womb lining from getting too thick, and when you stop taking it (usually for a few days each month) this causes the womb lining to be shed, like a period, which helps to protect you from womb cancer.

You'll need to take combined HRT if you still have a womb.

Utrogestan is only available on prescription. It comes as capsules that you swallow.

Utrogestan also comes as vaginal capsules but these are only used as part of fertility treatment (IVF).

You can usually can take Utrogestan if you're taking oestrogen and still have a womb.

It's not suitable if you've had a hysterectomy to remove your womb.

Utrogestan is not suitable for everyone. To make sure it's safe for you, tell your doctor before taking it if you:

• have ever had an allergic reaction to Utrogestan or any other medicine
• are allergic (hypersensitive) to soya, peanut, or any of the other ingredients in the capsules
• have ever had breast cancer, are having tests for breast cancer, or are considered high risk due to family history
• have a type of cancer that is sensitive to oestrogens, such as cancer of the womb lining (endometrium), or if you're having tests for this
• have any unexplained vaginal bleeding
• have ever had a blood clot in a vein (thrombosis), such as in the legs (deep vein thrombosis) or the lungs (pulmonary embolism)
• have a condition that affects how your blood clots, such as protein C, protein S, or antithrombin deficiency
• have or recently had a condition caused by blood clots in the arteries, such as a heart attack, stroke or angina
• have ever had liver disease and your liver function tests are not back to normal
• have a rare inherited condition called porphyria
• have bleeding on the brain (cerebral haemorrhage)
• are pregnant or breastfeeding

If you get any of these conditions after you start taking Utrogestan, stop taking it and speak to your doctor.

The usual dose of Utrogestan is 2 capsules (200mg) taken once a day, on days 15 to 26 of your 28-day HRT cycle.

You'll usually have vaginal bleeding for a few days each cycle after you stop taking Utrogestan. This is normal.

If you have not had a period for 6 to 12 months or more, your doctor may recommend that you take 1 capsule (100mg) once a day, on days 1 to 25 of your 28-day HRT cycle.

Sometimes, your doctor might advise you to take it every day, if they think it's OK for you not to have a period.

You may have less bleeding, or none at all, if you take Utrogestan on days 1 to 25 of your cycle. If you take it every day you will not usually have any bleeding once your body gets used to the medicine.

Take Utrogestan at bedtime, at least 2 hours after food.

Swallow the capsules whole with a drink of water.

You'll also be prescribed an HRT medicine containing oestrogen.

It's common to take HRT for 2 to 5 years to treat menopause symptoms, but sometimes you may need to take it for longer.

If you have premature menopause (where your periods stop before the age of 40) or early menopause (where your periods stop before the age of 45), you'll usually be advised to take HRT at least until you're 51 years old, which is the average age of menopause.

How long you take HRT for depends on the benefits and risks to you. Ask your doctor for advice.

If you have a hysterectomy to remove your womb, you'll need to stop taking Utrogestan.

If you forget to take your Utrogestan, take it as soon as you remember, unless it's nearly time for your next dose. In this case, skip the missed dose and take the next dose at your usual time.

Do not take 2 doses to make up for a missed dose.

It may help to write on the packet or use a calendar to help you remember which days to take Utrogestan.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicines.

Taking an extra dose of Utrogestan is unlikely to harm you. You may feel drowsy, dizzy, sleepy or tired.

If you're worried, talk to a doctor or pharmacist for advice.

Talk to your doctor if you're thinking of stopping taking HRT. They may suggest that you reduce your dose gradually, to help prevent your menopause symptoms coming back.

If you're having problems with side effects, your doctor might suggest changing your dose, or switching to another type of HRT.

It's important to keep taking Utrogestan or another type of progestogen if you're taking oestrogen. Taking oestrogen on its own could cause problems with the lining of your womb, such as womb cancer.

There are things you can do to help cope with these common side effects of Utrogestan:

This is common for the first 3 to 6 months after starting HRT, but usually settles down.

If you get heavy bleeding or unexpected bleeding after you've been taking HRT for 6 months, talk to your doctor.

Headaches usually only last for a few days after you start treatment as your body gets used to the medicine. Try taking a painkiller such as ibuprofen or paracetamol.

If headaches last longer than a week or are severe, speak to your doctor. You may need to change your dose or switch to a different type of progestogen.

This usually improves after a few weeks as your body gets used to the medicine. Speak to a doctor if it bothers you or does not go away.

If you notice a lump or changes in your breasts after a few months of taking HRT, contact your doctor for advice.

Stop what you're doing and sit or lie down until you feel better. Do not drive, cycle or use tools or machinery if you're feeling tired or dizzy. Do not drink alcohol as it will make you feel worse.

Talk to your doctor if you have problems with mood changes and it does not improve. You may need to change your dose or switch to a different type of progestogen.

Other possible side effects may include:

Stick to simple meals and do not eat rich or spicy food. Speak to a doctor if it bothers you or does not go away.

This will usually only last for about a week as your body gets used to the medicine.

It may help to take an antihistamine which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.

If it does not go away after about a week, talk to your doctor, as you may need a different treatment.

Wash with a mild soap or cleanser and lukewarm water. Avoid using too much make-up and cosmetics. Speak to a pharmacist for advice about treating acne.

Speak to a pharmacist or doctor if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects from Utrogestan are rare.

Call a doctor or call 111 for advice now if you have:

• pain, redness or swelling in one of your legs, usually in your calf – this could be a sign of deep vein thrombosis (DVT)
• yellowing of the whites of the eyes, or the skin although this may be less noticeable on brown or black skin – this could be a sign of liver problems

Speak to a GP if:

• you have a lump or changes in your breasts, especially dimpling of the skin, changes in the nipple or any lumps you can see or feel – this could be a sign of breast cancer
• you have any changes in vaginal bleeding after you have been taking Utrogestan for more than a few months – this could be a sign of womb cancer

It's important to attend your breast screening (mammogram) appointments while you're taking HRT.

• you have pain in your chest and breathlessness – this could be a sign of a blood clot in your lungs (pulmonary embolism) or heart problems
• you have difficulty speaking or moving your arm or leg, or your face has dropped on one side – this could be a sign of a stroke

Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.

Bring all the medicines you take with you.

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to Utrogestan.

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of Utrogestan. For a full list see the leaflet inside your medicines packet.

Utrogestan is not known to be harmful in pregnancy, but if you get pregnant or think you might be pregnant, stop taking it and speak to your doctor.

If you're pregnant, then your levels of oestrogen and progesterone will be high and you will not need to take HRT.

There is not much information on taking Utrogestan while breastfeeding. Most of the information comes from other forms of progestogen when used as a contraception.

Utrogestan is not usually prescribed if you're breastfeeding, unless a specialist recommends it.

Taking Utrogestan as HRT is unlikely to affect your fertility.

Although Utrogestan contains progesterone it does not act as contraception.

Even if you think that you've gone through the menopause, there's a small chance that you could still get pregnant. You're advised to use contraception for at least 1 year from your last period if you're over 50 years old and for 2 years if you're under 50 years old. Discuss this with your doctor or family planning practitioner.

Tell your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

There are some medicines that may affect how Utrogestan works.

Tell your doctor or pharmacist if you're taking any other medicines, including:

• epilepsy medicines such as phenytoin or carbamazepine
• ampicillins or tetracyclines, types of antibiotic
• medicines for HIV, such as ritonavir
• medicines for tuberculosis, such as rifampicin
• ciclosporin, an immunosuppressant
• antifungal medicines such as ketoconazole or terbinafine
• spironolactone, a medicine to make you pee more (diuretic)
• medicines for diabetes
• warfarin, a medicine to help prevent blood clots
• diazepam, a medicine for anxiety and seizures or fits
• tizanidine, a medicine for multiple sclerosis

There are several different herbal products sold to help relieve menopause symptoms. These include evening primrose oil, soya, red clover, black cohosh, ginseng and St John's wort.

St John's wort may stop Utrogestan from working as well.

It's not possible to say that other herbal remedies and supplements are safe to take with Utrogestan. They are not tested in the same way as pharmacy or prescription medicines. They're generally not tested for the effect they can have on other medicines.

All of these products might affect other medicines you're taking, so it's important to check with your doctor or pharmacist before starting to take them.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.