Utrogestan

1. Introduction

Utrogestan is a micronised progesterone derived from plant sources, used in hormone replacement therapy (HRT), fertility treatments, and pregnancy support. It mimics the body’s natural progesterone and is preferred over synthetic progestins due to its favourable safety profile.

2. Indications

  • Hormone Replacement Therapy (HRT) in postmenopausal women
  • Luteal Phase Support in assisted reproduction (IVF)
  • Progesterone Deficiency leading to menstrual irregularities
  • Threatened or Recurrent Miscarriage
  • Prevention of Preterm Birth (off-label use)

3. Dosage

Adults:

  • Hormone Replacement Therapy (HRT) (with Oestrogen):
    • 200 mg daily for 12–14 days per cycle, or
    • 100 mg daily continuously if combined with oestrogen therapy.
  • Luteal Phase Support (IVF / Assisted Conception):
    • 200–300 mg daily (vaginal or oral) from the day of ovulation or embryo transfer until 12 weeks of pregnancy.
  • Threatened Miscarriage:
    • 400 mg twice daily (vaginally) until symptoms resolve.
  • Recurrent Miscarriage Prevention:
    • 400 mg twice daily (vaginally) until 12–16 weeks of pregnancy.
  • Preterm Birth Prevention (Off-Label):
    • 200 mg vaginally at bedtime from 16–24 weeks until 34 weeks gestation.

Elderly:

  • No dose adjustment required.

Renal Impairment:

  • No specific adjustments, but use cautiously in severe renal impairment.

Hepatic Impairment:

  • Avoid in severe liver disease due to hepatic metabolism.

4. Administration

  • Oral: Take at bedtime to reduce dizziness and drowsiness.
  • Vaginal: Insert deeply into the vagina, preferably at night.
  • Avoid alcohol to reduce dizziness risk.

5. Forms Available

  • Capsules: 100 mg, 200 mg (oral & vaginal use)
  • Vaginal Pessaries (some regions)

6. Side Effects

6.1 Common Side Effects:

  • Drowsiness
  • Dizziness
  • Bloating
  • Breast tenderness

6.2 Less Common Side Effects:

  • Mood changes
  • Nausea
  • Headache

6.3 Rare but Serious Side Effects:

  • Deep vein thrombosis (DVT)
  • Severe allergic reaction (anaphylaxis)
  • Hepatic dysfunction (jaundice, elevated liver enzymes)

7. Warnings

  • Risk of Drowsiness: Take at night to minimise sedation.
  • Avoid in Severe Liver Disease: Due to hepatic metabolism.
  • Thrombosis Risk: Use with caution in patients with a history of DVT or stroke.
  • Irregular Bleeding: Possible in HRT users—monitor cycles.

8. Precautions

  • Not a contraceptive: Must be combined with oestrogen for HRT.
  • Monitor mood changes: Can worsen depression in some patients.
  • Caution in asthma and epilepsy due to potential hormone-related effects.

9. Interactions

  • CYP3A4 Inducers (e.g., carbamazepine, rifampin): May reduce Utrogestan efficacy.
  • CYP3A4 Inhibitors (e.g., ketoconazole, erythromycin): May increase progesterone levels.
  • Antihypertensives: Can enhance blood pressure-lowering effects.

10. Monitoring Parameters

  • Menstrual Cycle Regularity: In HRT use.
  • Pregnancy Viability: If used for miscarriage prevention.
  • Liver Function: In long-term users.

11. Use in Children

  • Not indicated for use in children.

12. Use in Pregnancy

  • Safe for luteal support, miscarriage prevention, and preterm birth prevention.
  • Category B (no evidence of fetal harm in human studies).

13. Use in Elderly

  • Safe in postmenopausal women on HRT.

14. Use in Kidney Disease

  • No dose adjustment needed.

15. Use in Liver Disease

  • Avoid in severe hepatic impairment.

16. Patient Counselling Points

  • Take at night to reduce dizziness.
  • If using vaginally, insert deep into the vagina before bedtime.
  • Not a contraceptive—use additional birth control if required.
  • Monitor for abnormal bleeding or mood changes.

17. Table of Brand Names, Manufacturer, and Prices in USD

Brand NameManufacturerStrength/Dosage FormPrice (USD)
UtrogestanBesins Healthcare100 mg, 200 mg Capsules$50 (30 caps)
Generic ProgesteroneVarious100 mg, 200 mg Capsules$30 (30 caps)

18. 15 FAQs (Frequently Asked Questions)

1. What is Utrogestan used for?
It is used in HRT, fertility treatments, and pregnancy support.

2. How does Utrogestan work?
It mimics natural progesterone, regulating the menstrual cycle and supporting pregnancy.

3. How long does it take for Utrogestan to work?
Effects on the cycle start within days; full benefits in a few weeks.

4. Can Utrogestan be taken orally and vaginally?
Yes, but vaginal use is preferred for pregnancy support.

5. Does Utrogestan cause weight gain?
Weight gain is not common, but bloating may occur.

6. Can I take Utrogestan with food?
Yes, but it is best taken at bedtime to reduce dizziness.

7. Can Utrogestan be stopped suddenly?
No, it should be gradually reduced in long-term use.

8. Is Utrogestan safe in pregnancy?
Yes, it is used to prevent miscarriage and preterm birth.

9. Can I drink alcohol while taking Utrogestan?
Yes, but avoid excessive alcohol due to sedation risk.

10. Can Utrogestan affect mood?
Yes, it may cause mild mood swings.

11. Does Utrogestan delay periods?
Yes, it can alter cycle timing in some women.

12. Can Utrogestan be taken with HRT?
Yes, it is used to protect the uterus from oestrogen effects.

13. Does Utrogestan increase blood clot risk?
Slightly, but lower than synthetic progestins.

14. Can Utrogestan be used for menopause?
Yes, it is a key component of HRT regimens.

15. How should Utrogestan be stored?
Store at room temperature, away from moisture and heat.