Utrozhestan and menstruation: the effect of progesterone on MC. How many days after stopping utrozhestan do menstruation come? Is it possible to insert utrozhestan during menstruation?

One capsule contains 100 or 200 mg of yam extract progesterone (in micronized form), as well as peanut butter (Arachis hypogaea), (Lecithin) soy , (Glycerol), gelatin (Gelatin), additive E171 (titanium dioxide).

Release form

• Capsules Utrozhestan 100 mg, package No. 30;
• Utrozhestan capsules 200 mg, package No. 14.

pharmachologic effect

Progestogenic.

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

The effects of Utrozhestan are due to the properties of the substance it contains. progesterone , which is an analogue of natural biological progesterone , produced by the corpus luteum of the ovaries after ovulation, and also, in pregnant women, by the placenta.

Influenced progesterone The mucous membrane lining the uterine cavity thickens and becomes secretory, which contributes to the fixation of the fertilized egg in it and normal development in the future.

In pregnant women progesterone reduces contractility and excitability of the muscles of the uterus and fallopian tubes.

Blocks the secretion of the pituitary gland that regulates the release of FSH and LH, suppresses ovulation and the production of gonadotropins by the pituitary gland. Androgenic properties are not detected.

Pharmacokinetics when taken orally

Plasma concentration progesterone begins to increase from the first hour after taking the capsules and reaches maximum values ​​after 1-3 hours. After an hour, this figure is 4.25, after two hours - 11.75, after four hours - 8.37, after six hours - 2, and after eight hours - 1.64 ng/ml.

Two thirds of the dose taken progesterone metabolized in the liver. Found mainly in urine pregnenolone And pregnanediol (metabolites are identical to those formed during physiological secretion).

Specified derivatives progesterone play an important role in the education and exchange of others steroid hormones . From 15 to 60% of metabolic products are excreted by the kidneys, a little less than a third - with feces.

Pharmacokinetics for intravaginal use

Progesterone when administered parenterally, it is absorbed into the mucosa. Absorption is fast. Plasma concentration begins to increase from the first hour after administration of the drug. Its level reaches its highest values ​​after 1-3 hours.

The use of Utrozhestan 100 mg capsules at night allows you to achieve and maintain a stable and physiological concentration progesterone in plasma, which corresponds to that in the corpus luteum phase (luteal phase) of the cycle in women with normal ovulation.

Thus, the medicine stimulates adequate maturation of the internal mucous membrane of the uterus and promotes normal implantation of the embryo.

The use of a dose exceeding 200 mg/day, intravaginal use of Utrozhestan does not allow achieving plasma levels progesterone , which would be identical to that in the first 3 months of pregnancy.

About 95% of the dose is excreted in the form (main - pregnanediol ) with urine.

Indications for use

Utrozhestan: why is it taken orally?

In obstetric practice, Utrozhestan is used for threat warning or normal miscarriage against the background of luteal phase deficiency (LPF), as well as for prevention of the threat of premature birth .

Also, oral administration of the drug is indicated for those associated with deficiency progesterone gynecological disorders, including PMS, menstrual irregularities (dis- or anovulation), breast disease, premenopausal conditions; , the cause of which is luteal insufficiency; HRT in women with menopausal disorders (in combination with — containing drugs).

Indications for use of Utrozhestan vaginally

As a suppository, Utrozhestan is used:

• with hormone replacement therapy for non-functioning ovaries as part of the program oocyte donation ;
• with IVF (to maintain the corpus luteum phase in preparation for egg fertilization);
• to maintain the corpus luteum phase in the induced/spontaneous cycle;
• for the prevention of conditioned progestational insufficiency spontaneous/habitual miscarriage ;
• at endocrine infertility ;
• at ;
• at ;
• if there are restrictions for oral use of the drug or if it is not possible.

Contraindications

Contraindications to the use of Utrozhestan:

• severe liver dysfunction;
• vaginal bleeding of unknown origin;
• incomplete/failed ;
• cerebral hemorrhage;
• thromboembolic disorders;
• neoplasia of the genital organs/mammary glands (confirmed or suspected);
• porphyria;
• hypersensitivity to any of the substances contained in the capsules.

Side effects of Utrozhestan

Side effects of Utrozhestan when administered orally most often manifest themselves as:

• changes in the menstrual bleeding cycle;
• bleeding starting in the middle of the cycle;

Less commonly noted:

• transient;
• mammalgia ;
• vomit;
• cholestatic jaundice.

In rare cases, nausea may occur.

Also, the possibility of changes in libido, chest discomfort and/or symptoms characteristic of PMS, hyperthermia, , hirsutism , , venous thromboembolism , changes in body weight, gastrointestinal disorders, fluid retention, anaphylactic hypersensitivity reactions.

Transient dizziness and/or drowsiness are especially pronounced with concomitant hypoestrogenism . To eliminate these phenomena (without reducing the therapeutic effect), it is usually sufficient to increase the dosage estrogen or reduce the dose of the drug.

If treatment is started before the 15th day of the cycle, the cycle may be shortened. Occasional bleeding may also occur.

If Utrozhestan tablets are inserted into the vagina, side effects are expressed in the form of hypersensitivity reactions (hyperemia, itching, burning) and the appearance of oily discharge.

Reviews of the side effects of Utrozhestan (including during pregnancy) allow us to conclude that the greatest number of unpleasant phenomena occur after taking the capsules orally. To reduce their severity, capsules should be taken before bed or switch to intravaginal administration.

Utrozhestan capsules: instructions for use

The method of administration, as well as instructions on how best to take Utrozhestan, how long to continue treatment and how to discontinue the drug, depend on the indications for use and the clinical manifestations of the pathology.

Instructions for using Utrozhestan orally

Orally, as a rule, the drug is prescribed to be taken at a dose of 200-300 mg/day. The main dose (in the evening, before bed) is 200 mg, in the morning (if necessary) another 100 mg is taken.

At luteal insufficiency (PMS, FCD, premenopause, cycle disruptions) tablets are taken in ten-day courses, starting from the 17th day of the cycle.

With HRT in menopause due to the fact that separate therapy estrogen— containing drugs is not recommended. Utrozhestan is used as an addition to the main treatment.

You should start taking the drug 7 days after the start of each course of HRT. Duration of use - 2 weeks. It should be remembered that withdrawal bleeding is possible during HRT.

To prevent premature birth (PL), the drug is taken 3-4 times a day, at regular intervals. Single dose - 400 mg. After the disappearance of clinical manifestations of the threat of PR, the dose is gradually reduced to a maintenance dose of 600 mg/day: continue to take one capsule 3 times/day.

Regarding the week before which to take the drug, the instructions provide the following recommendations: during pregnancy at a dose of 600 mg/day. possible up to 36 weeks.

Apply progesterone for a period exceeding 36 weeks is not recommended.

How to properly administer Utrozhestan capsules intravaginally?

The capsules are inserted into the vagina as deeply as possible. The average daily dose of the drug for intravaginal use is 200 mg (1 capsule 200 mg 1 time / day or 2 capsules 100 mg 2 times / day). If necessary, you can use an applicator for greater convenience.

Depending on the woman's response to the prescribed treatment, the dose may be increased.

In case of partial NLF (“ovulation syndrome”, cycle disruptions), Utrozhestan is used for 10 days at a dose of 200 mg/day. Treatment begins on the 17th day of the cycle.

With complete NLF in women with absent (non-functioning) ovaries ( oocyte donation ) prescribe 100 mg of progesterone in the morning and evening from the 15th to the 25th day of the menstrual cycle.

If pregnancy is confirmed on the 26th day of the cycle, from that moment the dose is gradually increased by 100 mg/day, bringing it to a maximum of 600 mg/day. (one capsule 200 mg per dose).

At this dosage, Utrozhestan suppositories continue to be used until day 60.

During an IVF cycle, 1 capsule of 200 mg is administered once every 8 hours.

During pregnancy, when there is a possibility of its termination, as well as to prevent habitual miscarriage associated with progesterone deficiency, a woman up to 12 weeks should be administered 100 or 200 mg of progesterone every 12 hours.

It is very important to correctly insert the capsules into the vagina, especially when the drug is prescribed for hormonal support during IVF. Before inserting the capsule, you should lie on the bed, placing a pillow under your buttocks and lower back, spread your legs wide and place the tablet as deeply as possible into the vagina.

After this, in order for the active substance of the drug to be absorbed into the mucous membrane in the required volume, it is recommended to remain in bed in the same position for another 15 minutes to an hour.

Overdose

Symptoms of an overdose may include symptoms of side effects of the drug: drowsiness, euphoria, dizziness, metrorrhagia , reduction in cycle time, .

For some women, the standard dose may be too high due to existing or secondary endogenous secretion progesterone , hypersensitivity to Utrozhestan or a concomitant decreased level of.

If transient dizziness or drowsiness occurs, it is enough to reduce the dose progesterone or prescribe taking the drug in the evening (before bedtime).

When the cycle is shortened and metrorrhagia the start of treatment is postponed to a later day of the cycle (for example, from 17 to 19 days).

In premenopausal patients receiving HRT, estradiol levels should be monitored.

Interaction

Women who are prescribed treatment during menopause estrogen-containing medications , it is recommended to start taking it no later than the 12th day of the cycle progesterone .

If, when treating a threat of PR, the drug is combined with β-adrenergic agonists , the latter can be used in a smaller dose.

Concomitant use of other drugs may interfere with pharmacokinetics progesterone , causing an increase or, conversely, a decrease in its concentration in plasma and, thus, leading to a change in the effect of the drug.

Drugs that are potent liver inducers ( antiepileptic drugs , barbiturates , Phenylbutazone , , , ) contribute to strengthening progesterone in the liver.

Smoking reduces bioavailability progesterone , alcohol - it increases.

Terms of sale

On prescription.

Storage conditions

Capsules should be stored at a temperature not exceeding 25°C.

Best before date

Three years.

special instructions

Due to the possibility of metabolic disorders and thromboembolic complications it is necessary to discontinue the drug if:

• visual impairment, including loss of vision, double vision, vascular lesions of the retina , optic disc , proptosis ;
• thrombotic or thromboembolic venous complications (regardless of which area is affected);
• high intensity headache, .

Patients with thrombophlebitis history should be under constant medical supervision.

The absence of menstruation during treatment with Utrozhestan requires tests to confirm or exclude pregnancy, which may be the cause. amenorrhea .

More than 50% of spontaneous abortions in early pregnancy are caused by genetic complications. In addition, mechanical disorders and infectious diseases . In such cases, the use of drugs progesterone justified only in cases where there is a delay in the expulsion of the fertilized egg.

Based on this, the appointment of Utrozhestan on the recommendation of a gynecologist should be provided for cases when a woman’s body produces an insufficient amount progesterone .

Capsules should not be taken with food. The optimal time to take it is before bedtime. Simultaneous consumption of food increases the bioavailability of Utrozhestan.

Some women are interested in whether the drug affects hCG levels. Doctors say that Utrozhestan does not change the results.

Utrozhestan leaks - what to do?

All patients note that the drug leaks out when used intravaginally. The manufacturer and doctors say that this phenomenon is the norm. The appearance of oily discharge is associated with the dosage form of Utrozhestan and its composition, which contains fatty substances - vegetable oil and soy lecithin.

Some women worry that this may reduce the effectiveness of Utrozhestan. However, even here doctors rush to reassure, assuring that it is not the active substance that is leaking out, but only the capsule shell.

In some cases, when the drug is used several times a day, the doctor may recommend intravaginal administration only 1 time per day - before bed, and at other times - in the morning and afternoon - oral administration of capsules.

Utrozhestan and menstruation

Utrozhestan is prescribed for the correction of cycle disorders caused by endogenous progesterone deficiency , as well as to correct disorders caused by excessive production estrogen .

A delay in menstruation while using the medication may indicate pregnancy. In this case, the woman must donate blood to determine the level of hCG or have it done.

The situation when there are no periods after using the drug can also be a consequence of “blind” support for the 2nd phase of the cycle, when the time of ovulation is not taken into account.

For women planning a pregnancy, doctors recommend taking Utrozhestan not from the 16th day, but one day after ovulation.

Drugs progesterone can be used to induce menstruation. Menstrual bleeding is caused by the withdrawal effect of Utrozhestan. The onset of menstruation usually occurs 2-10 days after stopping taking the capsules.

Analogues of Utrozhestan

Analogs with a similar mechanism of action: Oxyprogesterone capronate , Medroxyprogesterone-LENS .

Prajeesan and Utrozhestan - difference?

Prajeesan belongs to the group of drugs progesterone and is a generic version of Utrozhestan. Therefore, the difference between these means is small.

Prajeesan , unlike its structural analogue, is available not only in the form of capsules for oral and intravaginal use, but also in the form of a gel, which is inserted into the vagina using a disposable applicator.

Which is better - Crinon or Utrozhestan?

A drug Crinon is a vaginal gel produced by the manufacturer in disposable applicators. Active substance - progesterone , which is contained in the medicine at a concentration of 90 mg/dose (1 dose = 1.125 g of gel).

A special feature of the drug is that the gel is placed in a polymer delivery system, which ensures a high degree of binding to the vaginal mucosa and continuous release of the active substance for at least three days.

Iprozhin or Utrozhestan - which is better?

Iprozhin - these are capsules containing 100 or 200 mg progesterone (micronized). The main difference between the drug and Utrozhestan is that when used intravaginally, it practically does not flow out of the vagina, which, according to many women, is more convenient.

In the annotation to Iprozhinu it is indicated that it can enhance the effect immunosuppressants , diuretics , anticoagulants And antihypertensive drugs , and also reduce the lactogenic effect .

Alcohol compatibility

Alcohol increases the bioavailability of the drug.

Utrozhestan during pregnancy

Does Utrozhestan help you get pregnant?

When planning pregnancy, Utrozhestan is necessary when tests reveal insufficiency of the 2nd phase of the cycle.

The use of the drug stimulates the formation of the secretory type endometrium, promotes the transition of the uterine mucosa from the proliferative to the secretory phase, and then, when fertilization occurs, its transition to a state optimal for the development of the fertilized egg.

The endometrium, which swells under the influence of Utrozhestan, becomes loose, making it easier for the egg to attach to the wall of the uterus.

Additionally, Wikipedia states that progestins also help reduce the excitability and contractility of the muscles of the uterus and fallopian tubes, prevent an increase in concentration estrogen in phase 2 of the cycle and promote nervous relaxation, thus creating conditions favorable not only for conception, but also for maintaining the normal course of pregnancy.

Analyzing reviews of those who were helped to get pregnant by Utrozhestan, we can conclude that the drug is effective in situations where the cause of infertility is low levels endogenous progesterone . If there are no other obstacles to conception, pregnancy occurs quite quickly with the use of the medicine.

How to take the drug when planning pregnancy?

As a rule, when trying to get pregnant, the drug is taken for ten days in each cycle, starting from the 16th day. On days 25-26, you should take a pregnancy test or donate blood to determine the level of hCG.

If pregnancy is not confirmed, the drug is stopped and resumed in a new cycle, adhering to the same dosage regimen.

If there is reason to suspect pregnancy, you should not stop taking Utrozhestan - abrupt withdrawal during pregnancy can cause spontaneous abortion. If the test is positive, use of the drug is continued for up to 12-16 weeks.

Women whose ovaries do not produce progesterone , Utrozhestan is prescribed intravaginally according to the following scheme:

• 100 mg/day. on days 13 and 14 of the cycle;
• 200 mg/day, divided into 2 doses, from days 15 to 25;
• from 200 to 800 mg/day. (the dose is increased daily by 100 mg to the maximum) - from day 26 (provided that pregnancy is confirmed).

How to take Utrozhestan during pregnancy?

The use of Utrozhestan during pregnancy does not have a negative effect on the fetus. If it is necessary to use it after the third month of pregnancy, monitoring the functional state of the liver is necessary.

There is evidence that the use progestogens in pregnant women in order to prevent habitual/spontaneous miscarriage against the background of NFL can lead to the development hypospadias .

In the early stages, if there is a threat of miscarriage, it is recommended to use the drug vaginally, since with this method the therapeutic effect develops faster, and the load on the liver is minimal. It is also recommended to prescribe suppositories to women who suffer from severe .

The treatment regimen and dosage for each specific patient are selected individually by the doctor.

When it comes to maintaining pregnancy, the initial dose is usually between 400 and 600 mg. Subsequently, the woman is transferred to maintenance treatment at a dose of 200 mg/day. up to 600 mg/day. If therapy is ineffective, the dose can be increased to 0.8-1 g/day. Treatment usually lasts up to 18-20 weeks.

In the 2nd and 3rd trimester, the use of Utrozhestan is advisable when resuming the clinic for the threat of termination of pregnancy, as well as in a situation where a woman develops ICI ( isthmic-cervical insufficiency ).

The method of administration does not matter at this time. Feedback from doctors and their patients allows us to conclude that the use of the drug in a daily dose of up to 300 mg up to 36 weeks inclusive is equally effective both when taking capsules orally and when inserting them into the vagina.

Until 34-36 weeks, until the uterine tone is relieved, 1 capsule is taken orally every 8 hours. Then the woman is prescribed maintenance treatment at a dose of 200 mg.

Side effects of the drug

The most common side effects of Utrozhestan are drowsiness, lethargy and dizziness. However, these unpleasant symptoms occur exclusively when taking capsules orally.

Since Utrozhestan is a hormonal drug, the question naturally arises: is it possible to recover from it? Doctors say that taking the capsules does not cause changes in body weight. This is due to the fact that the drug does not affect carbohydrates and lipids, and also does not retain fluid in the body.

Discharge during pregnancy after the drug (with intravaginal administration) is not a side effect if it does not contain bloody impurities - it is simply a melted capsule shell. The appearance of bleeding requires dose adjustment.

How much to take Utrozhestan during pregnancy?

Only a doctor can say exactly until what time Utrozhestan should be taken during pregnancy in a particular case. If pregnancy occurs during treatment progesterone , capsules continue to be taken for an average of 2 months, starting from the 26th day of the cycle in which conception occurred.

How to stop taking medication during pregnancy?

During pregnancy, Utrozhestan is discontinued by gradually reducing the dose, since sudden cessation of treatment is fraught with spontaneous termination of pregnancy.

The withdrawal regimen may include a dose reduction every three days by 50 mg or a weekly reduction by 100 mg.

What is better - Duphaston or Utrozhestan during pregnancy?

Like its analogue, it is used to compensate for the deficiency endogenous progesterone .

The main difference between the drugs is that the first is a synthetic analogue progesterone , and the second is the only one to date progesterone which is obtained from plant materials.

Efficiency Duphaston and Utrozhestan when planning pregnancy and in pregnant women is comparable.

The advantages of Duphaston are the absence of sedation, which when using Utrozhestan is manifested by drowsiness and lethargy, as well as long-term experience with use.

The advantages of Utrozhestan are the ability to influence androgen metabolism and suppress the effects oxytocin , thus improving the course of pregnancy.

Use during lactation

Ability progesterone penetration into breast milk has not been studied, and therefore the use of the drug should be avoided during the period.

Minasyan Margarita

Hormonal levels are one of the most delicate and complex systems in the body, the violation of which leads to problems with women’s health. Advances in modern medicine and pharmacology make it possible to adjust hormone levels using various drugs, one of which is Utrozhestan. What are its features, how does Utrozhestan work to induce menstruation, and when do they begin after discontinuation of the drug, this article will answer.

Features, functions, mechanism of action of the drug

Utrozhestan is one of the most effective drugs in its group. Its main component is progesterone.

There are such forms of its administration: oral (capsules) and intravaginal (suppositories). Often, experts prescribe the use of these two forms in parallel for the desired effect.

About the hormone

Progesterone is one of the main female sex hormones, regulating the course of menstruation, normal fetal development and the course of pregnancy. The first half of the menstrual cycle is regulated by the hormone estrogen. During this period, the egg matures, which, during ovulation, leaves the burst follicle to connect with the sperm.

When the follicle ruptures, a permanent gland called the “corpus luteum” is formed, which produces progesterone. That is, in the second (luteal) phase there is an increase in the level of this hormone, the role of which at this stage is to give the endometrium such a shape, structure and quality that would contribute to the favorable fixation of the fertilized egg in it.

If fertilization does not take place, this substance transforms the endometrium into a secretory type and provokes its detachment - menstruation.

Once conception has taken place, the hormone helps secure the fertilized egg in the walls of the uterus and prevents the detachment of its inner lining. One of the important functions of this substance is to reduce the tone of the uterus during pregnancy and provide favorable conditions for the development of the fetus. For these properties, progesterone is rightly called the pregnancy hormone.

In gynecology and obstetrics it is used for the following purposes:

1. Elimination of menstrual irregularities. Utrozhestan is most often prescribed for delayed menstruation. This phenomenon occurs due to various factors: stress, physical activity, poor lifestyle, low weight, endocrinological and hormonal disorders. These reasons may delay your critical days by 2–5 days, but if they do not last longer than the specified period, you should consult a doctor and use the remedy as prescribed.
2. Treatment of menopausal syndrome. During menopause, when the body itself is not able to cope with hormonal imbalance, this drug helps to cope with the symptoms of menopause.
3. Reducing the manifestations of PMS (premenstrual syndrome, indicated 2-5 days before the onset of critical days).
4. Planning pregnancy and during IVF (in vitro fertilization). In these situations, stable hormonal levels are the main guarantee of a successful pregnancy.
5. Preservation of the fetus and prevention of miscarriage when endometrial detachment begins or increased uterine tone.
6. Treatment of endometrial pathologies (hypoplasia, hyperplasia, polyps).

How to use the drug

Only the attending physician can tell you how to take Utrozhestan if your scheduled menstruation is delayed, taking into account the characteristics of menstruation, the state of health and other individual factors of the patient. But there are general rules of treatment recommended by its developers.

If pregnancy is excluded, the drug should be used in the second phase of the cycle. It is during this period that the body urgently needs progesterone. It should be borne in mind that the medication does not replace existing hormones, but complements them. Since this phase begins after ovulation, Utrozhestan is taken from the 16th to the 25th day of the cycle in a dosage individually selected by the doctor. Depending on the characteristics of the menstrual mechanism, use can last from 17 to 26 days.

Capsules are used orally and have a systemic effect, suppositories are used topically, and the active substance, accumulating in the tissues of the uterus, begins to work a few hours after administration. Experts note that if you drink 2 capsules or insert 2 suppositories per day, then progesterone acts continuously. Sometimes the doctor may decide to use both forms of the drug in parallel.

These rules apply to how to take Utrozhestan to induce delayed periods. The correct course of taking a hormone analogue to maintain pregnancy is determined by the patient’s doctor. The use of the drug is permissible at any time, sometimes it extends over several trimesters.

If the medication is used to restore the cycle and the fact of pregnancy was established during the course, you need to continue its use until the end of the first trimester to avoid miscarriage. Utrozhestan should be discontinued gradually, in consultation with a specialist.

Menstruation after taking the drug

To figure out how many days after stopping utrozhestan the next period comes, you need to know what can happen to the menstrual cycle after this correction:

1. The cycle returns to normal. Menstruation occurs regularly every month with the same duration, a moderate amount of blood is released, there are no delays.
2. Critical days came earlier, which indicates a shortening of the cycle. In this case, the first dose of tablets or suppositories is postponed to a later date. (i.e., the scheme from days 16 to 25 changes to another: from days 18 to 27 or from days 19 to 28).
3. My period is late. If after Utrozhestan there are no menstruation for more than 10 days, the first thing you should do is take a pregnancy test.

When a woman discontinued Utrozhestan, the test gave a negative result, and she was completely convinced that there was no pregnancy, then the reason may be a complex hormonal disorder, or the drug was discontinued early. When it comes to a serious lack of progesterone, the doctor increases the dose of the substance.

Menstrual flow has changed its character: now it is scarce or profuse, and painful sensations have begun to bother me, which was not observed before.

Many women are interested in the question: can menstruation begin when taking Utrozhestan. This is acceptable, and in this case you need to stop treatment and consult a specialist.

Similar options for the influence of a hormonal substitute on menstruation are possible in the first months, since adaptation to artificial replenishment of progesterone is individual for each organism.

When does your period come?

To be sure that the treatment is working, you need to pay attention to when your periods come after stopping Utrozhestan. This time frame is different for each woman, but there are general time frames that should be taken into account.

Ideally, menstruation returns one day after the patient stops treatment. But this is usually observed 3-5 days after stopping therapy. Every fifth case of progesterone treatment shows that the cycle began to return after exactly that number of days.

A delay of up to 10 days is allowed. But if endometrial rejection does not begin after this period, you should look for the cause with your doctor.

Often on websites and forums, women ask the question of whether Utrozhestan can cause such a delay in menstruation. This is only permissible if you are pregnant. If this factor is excluded, we are talking about certain violations, such as:

1. Hypomenstrual syndrome.
2. Insufficient production of hormones of the first phase or its excess.
3. Pathological changes in the endometrium (hyperplasia, hyperplasia, polyposis).
4. Functional cyst.

Read about why it occurs in the article at the link.

1. Malignant neoplasms.
2. Endocrinological disorders that prevent the correction of hormonal levels.

For several months after a course of treatment with Utrozhestan, instead of menstruation, brown spotting or the opposite situation may be observed - brown, bloody, heavy discharge. Such manifestations are acceptable, but only in the first months of the body’s adaptation to the new cycle.

The first day of menstruation, which began after the abolition of Utrozhestan, is characterized by the beginning of a new menstrual cycle.

Contraindications and side effects

This remedy is effective, but, like any hormonal drug, it has some contraindications:

1. High blood clotting.
2. Liver related disorders.
3. Uterine bleeding of unknown etymology.
4. Suspected symptoms or existing malignant neoplasms.
5. Individual intolerance to components.

That is why it is important to undergo a complete diagnosis before starting treatment, because such contraindications are incompatible with progesterone therapy.

Utrozhestan can also cause the following side effects:

1. Spotting brown discharge in the middle of the cycle, which is easily confused with ovulation. But unlike the latter, they go on for several days.
2. Sometimes the medication causes changes in menstrual flow. Do not forget that Utrozhestan does not delay menstruation. In case of delay, you need to look for other reasons.
3. Headache, dizziness.
4. Increased fatigue, drowsiness.
5. Abnormal stool.

Utrozhestan acts on the endometrium, preparing it to receive the fertilized egg, reduces the contractility of the uterus and tubes, and affects the mammary glands. The fairly large popularity of this remedy makes it relevant to the question of whether Utrozhestan can cause a delay in menstruation, which we will try to answer in our article.

When is Utrozhestan used for treatment?

This hormonal drug is used in the second phase of the menstrual cycle, since its active ingredient is progesterone, which is produced in the woman’s body by the corpus luteum, which appears after the release of the germ cell.

Utrozhestan is indicated for use in many situations:

• In cases of correction of progesterone levels due to its deficiency;
• In case of infertility due to insufficiency of the corpus luteum;
• When there is a disturbance in the menstrual cycle due to the absence of ovulation or its disturbance;
• With premenstrual syndrome;
• In combination with estrogen during menopause.

Delayed menstruation when taking Utrozhestan

The drug is available in the form of capsules taken orally and vaginally. Doses and course of treatment are prescribed by a doctor. With the right regimen, a delay in menstruation after Utrozhestan is very rare. However, every woman reacts to any medicine differently, so exceptions do occur.

If such a deviation occurs, then the delay in menstruation when taking Utrozhestan for the treatment of the above disorders should not exceed 5 days. When the failure lasts longer than this period, a doctor's consultation is necessary.

Vaginal Utrozhestan and delayed menstruation

The vaginal use of capsules of this progesterone substitute distinguishes it from its analogues produced in tablets. Its use is indicated for maintaining the luteal phase in preparation for IVF and for successful implantation of the embryo. For this purpose, on the day of the hCG injection, vaginal Utrozhestan is prescribed and a delay in menstruation, indicating pregnancy, is not a reason to cancel it. Reception lasts up to 8 weeks.

Treatment regimens

For progesterone deficiency

The course of treatment for irregular menstruation and infertility due to progesterone deficiency begins on the 17th day of the cycle and lasts 10 days. The occurrence of a delay in menstruation after taking Utrozhestan, with a positive pregnancy test, does not affect the dosage regimen in any way. According to the doctor's decision, the drug can be used both in the first and second trimester.

Utrozhestan when menstruation is delayed to call them

Since the main effect of this hormonal drug is based on stimulating the development of the endometrium and suppressing the production of estrogen, which interferes with the regularity of the cycle, Utrozhestan is sometimes used when menstruation is delayed to induce them. In this case, the gynecologist prescribes taking capsules in the second half of the cyclic period from days 16 to 25, or vaginally for 10 days, to force the mucous layer of the uterus to be rejected. When administered intravaginally, progesterone begins to accumulate in the uterus within a few hours after using the Utrozhestan capsule.

Side effects

Although Utrozhestan sometimes causes a delay in menstruation, this condition is not a side effect. These may include:

• Intermenstrual bleeding;
• Dizziness, drowsiness;
• Individual hypersensitivity.

Contraindications for taking Utrozhestan

Before taking the drug, you must carefully study the instructions. Under no circumstances should you start treatment on your own; only a doctor can draw up a regimen that is acceptable to you and calculate an individual dose. Whether there will be a delay in menstruation after taking Utrozhestan largely depends on the optimal dose and course of use of the medicine.

You should not take these capsules if you have:

• Frequent bleeding from the genital tract;
• Tendency to thrombosis;
• Tumor in the genitals or breast;
• Severe liver dysfunction.

Hormonal imbalances in a woman’s body are the cause of gynecological diseases and infertility. Utrozhestan is often prescribed to induce menstruation and normalize the menstrual cycle. The active component of the drug replenishes progesterone deficiency, helping to stabilize the balance. If this medication is taken incorrectly, side effects may occur and existing hormonal imbalances may worsen.

Mechanism of action of Utrozhestan during delay

A regular menstrual cycle indicates the normal functioning of a woman’s reproductive system and is based on the balance of sex hormones.

Of particular importance for women is progesterone, the pregnancy hormone that ensures its preservation and normal course.

Intensive synthesis of progesterone occurs in phase II of the menstrual cycle. Before pregnancy and in the first trimester, the ovaries and the corpus luteum are responsible for its production, formed after the rupture of a mature follicle and the release of the egg into the uterine cavity. After 14 weeks and until the end of the third trimester, the placenta is connected to its production.

Insufficient levels of progesterone in a woman’s body disrupt the functioning of the reproductive system: the menstrual cycle is disrupted, gynecological diseases appear, which are the cause of natural abortion and infertility.

Utrozhestan is a drug containing a natural hormone, identical in composition and action to natural progesterone produced by a woman’s body. Thanks to the active substance - gestagen, it equalizes the hormonal balance, helping to restore the cycle, eliminate PMS symptoms, maintain pregnancy and normal development of the embryo.

This drug is prescribed not only to compensate for the lack of progesterone, but also for elevated estrogen levels. Utrozhestan does not replace hormones synthesized by the body independently, but is added to them.

How is Utrozhestan used to normalize the cycle?

Numerous reasons can provoke disruption of the menstrual cycle: stressful situations, gynecological diseases, hormonal imbalance during pregnancy, menopause, adolescence, etc.

To restore the cycle, Utrozhestan is prescribed in cases where the examination reveals:

• lack of progesterone in phase II;
• excess estrogen and male sex hormones.

To induce menstruation, the drug must be taken from the 16th to 25th day of the cycle (ovulatory phase), since progesterone synthesis peaks during this period of time.

For women who want to normalize their cycle for subsequent pregnancy, Utrozhestan should be used only after ovulation, as it has the ability to suppress it, so the first day of use may not coincide with standard recommendations.

Ways to use the drug to induce menstruation:

The active substance of Utrozhestan accumulates in the body and acts for 24 hours if the drug is taken 2 times a day. Progesterone concentrates in the walls of the uterus, promoting the growth of the endometrium and its rejection, as a result of which menstruation comes on time. After stopping Utrozhestan, your period should come in 2-7 days.

When taking Utrozhestan in order to restore the cycle for further conception, on day 26 you should be tested for hCG levels, which is necessary for early detection of pregnancy. If a positive result is obtained, then the drug should be used until the end of the first trimester (12-14 weeks) at the same dosage in order to prevent natural abortion due to progesterone deficiency. Utrozhestan is discontinued gradually with a gradual dose reduction. Abruptly stopping the drug may lead to miscarriage.

The typical regimen for using the drug is calculated on the condition that the menstrual cycle is 28 days. In other cases, the duration of treatment and dosage is determined by the doctor, taking into account the individual characteristics of the body.

Failure of the menstrual cycle after taking Utrozhestan

Each woman’s body has its own individual characteristics, therefore, after taking Utrozhestan to normalize the cycle, periods do not always come or their character changes.

Registration number: No. JIC-000186

TradeName: Utrozhestan ®

International nonproprietary name: progesterone

Dosage form: capsules

Compound for 1 capsule:

Active substance: micronized progesterone 100 or 200 mg.

Excipients: sunflower oil 149 mg/298 mg, soy lecithin 1 mg/2 mg; capsule - gelatin 76.88 mg/153.76 mg, glycerin 31.45 mg/62.9 mg, titanium dioxide 1.67 mg/3.34 mg.

Description: 100 mg capsules are round, 200 mg capsules are oval, soft, shiny yellowish gelatin capsules containing an oily whitish homogeneous suspension (without visible phase separation).

Pharmacotherapeutic group: gestagen

CodeATX: G03 D.A.04

PHARMACOLOGICAL PROPERTIES

Pharmacodynamics

The active ingredient of the drug Utrozhestan ® is progesterone, which is identical to the natural hormone of the corpus luteum of the ovary. By binding to receptors on the surface of cells of target organs, it penetrates into the nucleus, where, activating DNA, it stimulates RNA synthesis. Promotes the transition of the uterine mucosa from the proliferation phase caused by the follicular hormone estradiol to the secretory phase, and after fertilization - to the state necessary for the development of the fertilized egg. Reduces the excitability and contractility of the muscles of the uterus and fallopian tubes. Promotes the formation of normal endometrium. Stimulates the development of the end elements of the mammary gland and induces lactation.

By stimulating protein lipase, it increases fat reserves; increases glucose utilization; increasing the concentration of basal and stimulated insulin, promotes the accumulation of glycogen in the liver; increases the production of gonadotropic hormones of the pituitary gland; reduces azotemia, increases nitrogen excretion by the kidneys.

Pharmacokinetics

When taken orally

Suction

Micronized progesterone is well absorbed from the gastrointestinal tract (GIT). The concentration of progesterone in the blood plasma gradually increases during the first hour, the maximum concentration in the blood plasma (Cmax) is observed 1-3 hours after administration. The concentration of progesterone in the blood plasma increases from 0.13 ng/ml to 4.25 ng/ml after 1 hour, to 11.75 ng/ml after 2 hours and is 8.37 ng/ml after 3 hours, 2 ng/ml after 6 hours and 1.64 ng/ml after 8 hours after administration.

Metabolism

The main metabolites that are detected in blood plasma are 20-alpha-hydroxy-delta-4-alpha-pregnanolone and 5-alpha-dihydroprogesterone.

Removal

It is excreted by the kidneys in the form of metabolites, 95% of which are glucurone-conjugated metabolites, mainly 3-alpha, 5-beta-pregnanediol (pregnandione). These metabolites, which are determined in blood plasma and urine, are similar to substances formed during the physiological secretion of the corpus luteum.

For vaginal insertion

Suction and distribution

Absorption occurs quickly, a high concentration of progesterone in the blood plasma is observed 1 hour after administration. Cmax of progesterone in blood plasma is achieved 2-6 hours after administration. When administered 100 mg 2 times a day, the average concentration in blood plasma remains at the level of 9.7 ng/ml for 24 hours. When administered in doses of more than 200 mg/day, the concentration of progesterone corresponds to the first trimester of pregnancy. Communication with plasma proteins - 90%. Progesterone accumulates in the uterus.

Metabolism

Metabolized to form predominantly 3-alpha, 5-beta-pregnanediol. The concentration of 5-beta-pregnanolone in the blood plasma does not increase.

Removal

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It is excreted by the kidneys in the form of metabolites, the main part being 3-alpha, 5-beta-pregnanediol (pregnandione). This is confirmed by a constant increase in its concentration (C max 142 ng/ml after 6 hours).

INDICATIONS FOR USE

Progesterone deficiency conditions in women:

For oral administration:

■ threatened abortion or prevention of habitual abortion due to

progesterone deficiency;

■ infertility due to luteal insufficiency;

§ premenstrual syndrome;

§ menstrual cycle disorders due to ovulation or anovulation disorders;

§ fibrocystic mastopathy;

§ period of menopausal transition;

§ menopausal (replacement) hormone therapy (MHT) in peri- and postmenopause (in combination with estrogen-containing drugs).

For intravaginal use:

§ MHT in case of progesterone deficiency with non-functioning (absent) ovaries (egg donation);

§ prevention (prophylaxis) of premature birth in women at risk (with shortening of the cervix and/or anamnestic data of premature birth and/or premature rupture of membranes);

§ support of the luteal phase during preparation for in vitro fertilization;

§ support of the luteal phase in a spontaneous or induced menstrual cycle;

§ premature menopause;

§ MHT (in combination with estrogen-containing drugs);

§ infertility due to luteal insufficiency;

§ threatened abortion or prevention of habitual abortion due to progesterone deficiency.

CONTRAINDICATIONS

Hypersensitivity to progesterone or any of the excipients of the drug; deep vein thrombosis, thrombophlebitis; thromboembolic disorders (pulmonary embolism, myocardial infarction, stroke), intracranial hemorrhage or a history of these conditions/diseases; bleeding from the vagina of unknown origin; incomplete abortion; porphyria; established or suspected malignant neoplasms of the breast and genital organs; severe liver diseases (including cholestatic jaundice, hepatitis, Dubin-Johnson syndrome, Rotor syndrome, malignant liver tumors) currently or in history; children under 18 years of age (efficacy and safety have not been established); breastfeeding period.

CAREFULLY

Diseases of the cardiovascular system, arterial hypertension, chronic renal failure, diabetes mellitus, bronchial asthma, epilepsy, migraine, depression, hyperlipoproteinemia, mild to moderate liver dysfunction; photosensitivity.

The drug should be used with caution in the second and third trimesters of pregnancy.

USE IN PREGNANCY AND BREASTFEEDING

The drug should be used with caution in the second and third trimesters of pregnancy due to the risk of developing cholestasis.

Progesterone passes into breast milk, so the use of the drug is contraindicated during breastfeeding.

METHOD OF APPLICATION AND DOSES

Orally

The drug is taken orally in the evening before bedtime with water.

In most cases, with progesterone deficiency, the daily dose of Utrozhestan ® is 200-300 mg, divided into 2 doses (200 mg in the evening before bed and 100 mg in the morning, if necessary).

§ For threatened abortion or to prevent habitual abortion due to progesterone deficiency : 200-600 mg per day daily in the first and second trimesters of pregnancy. Further use of the drug Utrozhestan ® is possible as prescribed by the attending physician based on an assessment of the clinical data of the pregnant woman.

§ For luteal phase deficiency (premenstrual syndrome,

fibrocystic mastopathy, dysmenorrhea, menopausal transition) the daily dose is 200 or 400 mg, taken for 10 days (usually from the 17th to the 26th day of the cycle).

§ At MHT in perimenopause while taking estrogen, the drug Utrozhestan ®

used 200 mg per day for 12 days.

§ At MHT in postmenopause in continuous mode the drug Utrozhestan ®

used in a dose of 100-200 mg from the first day of taking estrogen-containing drugs. Dose selection is carried out individually.

Intravaginally

Capsules are inserted deep into the vagina.

§ Prevention (prevention) of premature birth in women

from the group risk (with shortening of the cervix and/or history of preterm labor and/or premature rupture of membranes): the usual dose is 200 mg at bedtime, from the 22nd to 34th weeks of pregnancy.

§ Complete absence of progesterone in women with non-functioning

(missing ) ovaries (egg donation): against the background of estrogen therapy, 100 mg per day on the 13th and 14th days of the cycle, then 100 mg 2 times a day from the 15th to 25th day of the cycle, from the 26th day, and on If pregnancy is determined, the dose increases by 100 mg per day every week, reaching a maximum of 600 mg per day, divided into 3 doses. The indicated dose can be used for 60 days.

§ Luteal phase support during an extracorporeal cycle

§ Luteal phase support in spontaneous or induced menstrual periods

cycle for infertility associated with dysfunction of the corpus luteum : It is recommended to use 200-300 mg per day, starting from the 17th day of the cycle for 10 days; in case of delayed menstruation and diagnosis of pregnancy, treatment should be continued.

§ In cases of threatened abortion or to prevent habitual abortion ,

arising from progesterone deficiency: 200-400 mg per day in 2 divided doses daily in the first and second trimesters of pregnancy.

SIDE EFFECT

The following adverse events noted for oral administration drug, are distributed according to the frequency of occurrence in accordance with the following gradation: often: > 1/100,< 1/10; нечасто: > 1/1000, < 1/100; редко: > 1/10000, < 1/1000; очень редко: < 1/10000.

These undesirable reactions are usually the first signs of an overdose. Drowsiness and transient dizziness are possible, as a rule, 1-3 hours after oral administration of the drug. These adverse reactions can be reduced by reducing the dose, using the drug at bedtime, or switching to the vaginal route of administration.

Drowsiness and/or transient dizziness are observed, in particular, in the case of concomitant hypoestrogenism. Reducing the dose or restoring higher estrogenization immediately eliminates these effects without reducing the therapeutic effect of progesterone.

If the course of treatment begins too early (in the first half of the menstrual cycle, especially before the 15th day), a shortening of the menstrual cycle or acyclic bleeding is possible.

Recorded changes in the menstrual cycle, amenorrhea or acyclic bleeding are characteristic of all gestagens.

Application in clinical practice

When used in clinical practice, the following adverse events were noted: when administered orally progesterone: insomnia; premenstrual syndrome; tension in the mammary glands; vaginal discharge; joint pain; hyperthermia; increased sweating at night; fluid retention; change in body weight; acute pancreatitis; alopecia, hirsutism; changes in libido; thrombosis and thromboembolic complications (when performing MHT in combination with estrogen-containing drugs); increased blood pressure.

The drug contains soy lecithin, which can cause hypersensitivity reactions (urticaria and anaphylactic shock).

For vaginal use

Isolated cases of local intolerance reactions to the components of the drug (in particular, soy lecithin) have been reported in the form of hyperemia of the vaginal mucosa, burning, itching, and oily discharge.

Systemic side effects with intravaginal use of the drug in recommended doses, in particular drowsiness or dizziness (observed with oral administration of the drug), were not observed.

OVERDOSE

Symptoms: drowsiness, transient dizziness, euphoria, shortening of the menstrual cycle, dysmenorrhea.

In some patients, the average therapeutic dose may be excessive due to existing or emerging unstable endogenous secretion of progesterone, special sensitivity to the drug, or too low concentration of estradiol.

Treatment:

If drowsiness or dizziness occurs, it is necessary to reduce the daily dose or prescribe the drug before bedtime for 10 days of the menstrual cycle;

In case of shortening of the menstrual cycle or spotting, it is recommended to postpone the start of treatment to a later day of the cycle (for example, on the 19th instead of the 17th);

In perimenopause and postmenopausal MHT, it is necessary to ensure that the concentration of estradiol is optimal.

In case of overdose, symptomatic treatment is carried out if necessary.

INTERACTION WITH OTHER MEDICINES

When administered orally

Progesterone enhances the effect of diuretics, antihypertensive drugs, immunosuppressants, and anticoagulants. Reduces the lactogenic effect of oxytocin. Concomitant use with drugs that induce microsomal liver enzymes CYP3A4, such as barbiturates, antiepileptic drugs (phenytoin, carbamazepine), rifampicin, phenylbutazone, spironolactone, griseofulvin, is accompanied by acceleration of progesterone metabolism in the liver.

Simultaneous use of progesterone with some antibiotics (penicillins, tetracyclines) can lead to a decrease in its effectiveness due to disruption of the enterohepatic recirculation of sex hormones due to changes in the intestinal microflora.

The severity of these interactions may vary in different patients, so predicting the clinical effects of these interactions is difficult.

Ketoconazole may increase the bioavailability of progesterone.

Progesterone may increase the concentration of ketoconazole and cyclosporine.

Progesterone may reduce the effectiveness of bromocriptine.

Progesterone can cause a decrease in glucose tolerance, resulting in an increase in the need for insulin or other hypoglycemic drugs in patients with diabetes.

The bioavailability of progesterone may be reduced in patients who smoke and with excessive alcohol consumption.

For intravaginal use

The interaction of progesterone with other drugs when administered intravaginally has not been assessed. The simultaneous use of other drugs used intravaginally should be avoided to avoid interfering with the release and absorption of progesterone.

SPECIAL INSTRUCTIONS

The drug Utrozhestan ® cannot be used for the purpose of contraception.

The drug should not be taken with food, since food intake increases the bioavailability of progesterone.

The drug Utrozhestan ® should be taken with caution in patients with diseases and conditions that may be aggravated by fluid retention (arterial hypertension, cardiovascular diseases, chronic renal failure, epilepsy, migraine, bronchial asthma); in patients with diabetes mellitus; liver dysfunction of mild to moderate severity; photosensitivity.

Patients with a history of depression should be monitored, and if severe depression develops, the drug should be discontinued.

Utrozhestan ® contains soy lecithin, which can cause hypersensitivity reactions (urticaria and anaphylactic shock).

Patients with concomitant cardiovascular diseases or a history of them should also be periodically observed by a doctor.

The use of the drug Utrozhestan ® after the first trimester of pregnancy can cause the development of cholestasis.

During long-term treatment with progesterone, regular medical examinations (including liver function tests) are necessary; Treatment should be discontinued if abnormal liver function tests or cholestatic jaundice occur.

When using progesterone, it is possible to reduce glucose tolerance and increase the need for insulin and other hypoglycemic drugs in patients with diabetes mellitus.

If amenorrhea occurs during treatment, pregnancy must be excluded.

If the course of treatment begins too early in the menstrual cycle, especially before the 15th day of the cycle, shortening of the cycle and/or acyclic bleeding is possible. In case of acyclic bleeding, the drug should not be used until the cause is determined, including a histological examination of the endometrium.

If there is a history of chloasma or a tendency to develop it, patients are advised to avoid UV irradiation.

More than 50% of spontaneous abortions in early pregnancy are caused by genetic disorders. In addition, the cause of spontaneous abortions in early pregnancy can be infectious processes and mechanical damage. The use of the drug Utrozhestan ® in these cases can only lead to a delay in rejection and evacuation of a non-viable ovum. The use of the drug Utrozhestan ® to prevent threatened abortion is justified only in cases of progesterone deficiency.

When conducting MHT with estrogens during perimenopause, it is recommended to use the drug Utrozhestan ® for at least 12 days of the menstrual cycle.

With a continuous MHT regimen in postmenopause, it is recommended to use the drug from the first day of taking estrogen.

When conducting MHT, the risk of developing venous thromboembolism (deep vein thrombosis or pulmonary embolism), the risk of developing ischemic stroke, and coronary heart disease increases.

Due to the risk of developing thromboembolic complications, the use of the drug should be discontinued if: visual disturbances such as loss of vision, exophthalmos, double vision, vascular lesions of the retina occur; migraine; venous thromboembolism or thrombotic complications, regardless of their location.

If there is a history of thrombophlebitis, the patient should be closely monitored.

When using the drug Utrozhestan ® with estrogen-containing drugs, you must refer to the instructions for their use regarding the risks of venous thromboembolism.

The results of the Women Health Initiative Study (WHI) clinical study indicate a slight increase in the risk of breast cancer with long-term, more than 5 years, combined use of estrogen-containing drugs with synthetic gestagens. It is unknown whether there is an increased risk of breast cancer in postmenopausal women when undergoing MHT with estrogen-containing drugs in combination with progesterone.

The WHI study also found an increased risk of dementia when starting MHT after age 65 years.

Before starting MHT and regularly during it, a woman should be examined to identify contraindications to its implementation. If clinically indicated, a breast examination and gynecological examination should be performed.

The use of progesterone may affect the results of some laboratory tests, including liver and thyroid function tests; coagulation parameters; pregnanediol concentration.

Impact on the ability to drive vehicles and machinery

When using the drug orally, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

RELEASE FORM

Capsules 100 mg

14 capsules in a blister made of PVC/aluminum foil or PVC/PVDC/aluminum foil. 2 blisters with instructions for use in a cardboard box (28 capsules in consumer packaging).

Capsules 200 mg

7 capsules in a blister made of PVC/aluminum foil or PVC/PVDC/aluminum foil. 2 blisters with instructions for use in a cardboard box (14 capsules in consumer packaging).