Cyclogest: What you need to know

Cyclogest pessaries are small progesterone capsules that are inserted into your vagina.

Like Utrogestan, Cyclogest is progesterone, which is identical in structure to the progesterone produced in our bodies, 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’ alternative to Utrogestan capsules.

Since the 1980s, high doses of Cyclogest have been used to treat premenstrual syndrome (PMS) and postnatal depression (PND), although it is no longer offered as a first-line treatment. However, some people do benefit from this treatment as it can ease symptoms such as irritability, depression, headache, breast tenderness and bloating.

RELATED: Progesterone intolerance

How does Cyclogest work?

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 the 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.

When used to treat PMS or PND, Cyclogest works by increasing levels of progesterone in the body. The natural drop in progesterone during the second half of the menstrual cycle is 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.

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.

How do I use Cyclogest?

Progesterone is usually given as a tablet or via the Mirena coil, but sometimes people may be advised by their healthcare professional to insert progesterone vaginally or rectally.

Cyclogest should be inserted into your vagina 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, insert one pessary each night for two out of every four weeks, on a repeating basis. This will create a withdrawal bleed each month and is usually the equivalent to taking two capsules of Utrogestan orally.
If you haven’t had a period for over a year, and are taking continual HRT, you should cut the pessary in half lengthways, and insert half of the pessary into your vagina each night, without a break. This will usually provide an equivalent dose of 100mg daily. Your doctor may recommend using an entire pessary daily if some cases.

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. It can also have a natural sedative effect, so it may improve your sleep.

Unlike some of the other synthetic progestogens like 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 when using Cyclogest. Studies have also shown that progesterone isn’t associated with an increased risk of heart disease, clot or breast cancer.

Who is Cyclogest suitable for?

For most people, the benefits of HRT outweigh any risks. Cyclogest can be particularly beneficial for anyone whose sensitivity to progesterone means they experience side effects such as low mood, bloating and irritability. This is because it acts locally and bypasses the digestive system.

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. As Cyclogest can cause drowsiness, it may not be suitable for you if you work night shifts.

Can I expect any side effects?

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): Cyclogest 200mg pessaries

NHS.uk: Utrogestan