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Alternatives to micronised progesterone (Utrogestan) for use in HRT

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Alternatives to micronised progesterone (Utrogestan) to use in HRT

  • micronised progesterone (Utrogestan) 100 mg capsules
    • is identical to the naturally occurring hormone, progesterone, produced by the ovaries following ovulation
    • may be less associated risk of venous thromboembolism and breast cancer in women using micronised progesterone for endometrial protection, when compared with other available synthetic progestogens, including norethisterone and medroxyprogesterone acetate, but the difference in risk is very small, particularly for short term substitution (1)

Alternative options for endometrial protection, in women using estrogen replacement therapy include (3):

  • an intrauterine system with 52 mg of the progestogen levonorgestrel in its core (LNG-IUD)
    • is a very good method of providing endometrial protection, with potential added benefits, including contraceptive cover and control of heavy menstrual bleeding, both of which may be indicated for perimenopausal women

  • oral progestogens such as:
    • norethisterone, for women with a BMI less than 30 or
    • medroxygesterone acetate (MPA)
    • exact dose of either drug will depend on the dose of estrogen prescribed and recommendations can be found in the BMS Tools for Clinicians on progestogens and endometrial protection (2)

  • an alternative option is to switch women to Evorel Sequi/Conti or FemSeven Conti or to change eligible, otherwise healthy women, to oral HRT
    • will allow access to micronised progesterone in Bijuve (R) and dydrogesterone in the Femoston (R) product range, which comes in different doses and both sequential and continuous combined preparations

  • Cyclogest (R) 200 mg, Utrogestan vaginal pessaries 200 mg or Lutigest 100 mg vaginal pessaries are not licensed for endometrial protection and may not be available from the majority of NHS GPs

Reference:

  • 1) Canonico M et al BMJ. 2008 May; 336(7655): 1227-31
  • 2) Hamoda, H. Progestogens and endometrial protection. British Menopause Society, Tools for Clinicians. October 2021
  • 3) British Menopause Society (June 2023). Statement regarding progestogens

 


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