Cyclogest: what you need to know

How progesterone pessaries can be used to help treat PMS and PMDD

Cyclogest pessaries are small progesterone capsules that are inserted into your vagina or used as a rectal suppository. Cyclogest is identical in structure to the progesterone produced in your body, which is why it’s known as a body identical hormone.

What is Cyclogest used for?

Cyclogest is a very safe drug, which is commonly used in pregnancy for recurrent miscarriage and early pregnancy bleeding. Although it’s licensed for use during IVF treatment, the pessaries can also be used as an ‘off-label’ treatment for PMS and PMDD. It is sometimes prescribed as an alternative to oral progesterone for perimenopausal and menopausal women.

Since the 1980s, Cyclogest has been used to treat premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD) and postnatal depression (PND) with good effect.

How does Cyclogest work?

When used to treat PMS, PMDD or PND, Cyclogest works by increasing levels of progesterone in your body. The natural drop in progesterone during the second half of your menstrual cycle is usually the underlying cause for PMS symptoms, so using Cyclogest can help to balance out these fluctuations. Similarly, the huge drop in progesterone levels after childbirth can be the underlying cause of PND, and Cyclogest is licensed to top-up natural levels and alleviate symptoms.

When progesterone is taken orally as a capsule, it is broken down (metabolised) in your body into other types of progesterone. However, when used as a pessary, the progesterone is simply absorbed from the mucous membranes of your vagina or rectum into your bloodstream as pure progesterone. It can be useful for women who are intolerant to either synthetic progesterone (progestogen, the types in contraceptives) or oral progesterone.

If you still have your womb, it’s important to take a progesterone or progestogen as part of your HRT. This is because taking oestrogen can cause the cells in the lining of your womb (the endometrium) to thicken, and there’s a small risk of them turning cancerous. There’s no increased risk of this happening when you also take a progesterone or progestogen, as it helps to keep the lining of the womb thin and healthy.

PMS, PMDD and hormones

What doses does Cyclogest come in?

Cyclogest pessaries are available in 200mg and 400mg of progesterone. Your healthcare professional will decide on the correct dosage for you, as it’s possible to use more or less than one pessary.

Cyclogest should be inserted into your vagina or rectum as far as it will comfortably go. It’s usually best to insert the pessary just before bed, as this reduces the likelihood of leakage.

If you’re using it for HRT, there are two main ways of taking Cyclogest:

If you’re still having periods, it is usually prescribed each night for two out of every four weeks, on a repeating basis. This will create a withdrawal bleed each month. The dose may vary depending on the individual.
If you haven’t had a period for over a year, and are taking continual HRT, you should usually insert the pessary each night, without a break. The dose may vary depending on the individual.

RELATED: HRT doses explained

What are the benefits?

Cyclogest can be a good alternative to Utrogestan, especially if you’re sensitive to progesterone when taken orally. Unlike some synthetic progestogens such as Provera or Utovlan, Cyclogest contains body identical progesterone. As a result, most people experience fewer side effects than they do with synthetic forms of progestogens, which are also associated with a slightly increased risk of blood clot and heart disease. There’s no increased risk of clot or heart disease when using Cyclogest.

RELATED: Progesterone intolerance

You should also be aware that the fat inside the Cycolgest pessary can interfere with barrier methods of contraception, such as a diaphragm or condoms.

Are there side effects with Cyclogest?

You can expect some vaginal discharge as the pessaries dissolve. When you first start using Cyclogest, you may notice some side effects including vaginal bleeding, abdominal bloating and breast tenderness. Some people also experience abdominal pain or discomfort and constipation. These symptoms can be continuous or intermittent but speak to your healthcare professional if they don’t improve after three to six months.

Resources

British National Formulary (BNF): Progesterone

Electronic Medicines Compendium (EMC)

NHS.uk: Utrogestan

Key to Life: Physiological Role and Clinical Implications of Progesterone