Changes to Micronised Progesterone dosing in HRT

This page relates to a specific change in guidance. For more information about HRT, please see: www.nhs.uk/medicines/hormone-replacement-therapy-hrt/

A recent guideline from the British Menopause Society recommends increased doses of oral or vaginal micronised progesterone (brand name Utrogestan) when used as protection against endometrial cancer in HIGH dose HRT regimes. This is because there is an increased risk of endometrial thickening, changes and cancer in those on high dose oestrogen with inadequate progesterone dosing. The guidance can be found here

Please note this guidance does NOT apply to combined oestrogen and progesterone patches or tablets. It also does NOT apply to women who do not need progesterone because they have had a total abdominal hysterectomy.

The table below shows the levels of oestrogen that comprise different dosage regimes.

Anyone on a HIGH dose HRT regime using oral or vaginal micronized progesterone needs to be on an adequate dose, which is 200mg every night if taken continuously or 300mg for 12-14 days per month if taken sequentially. Please see table below:

Please be aware that there is currently no data to show whether the increased dose of micronized progesterone will affect your breast cancer risk, however under-dosing will definitely affect your endometrial cancer risk. If you are not comfortable increasing your micronised progesterone dose you may wish to consider a Mirena coil. If interested, please book a routine telephone appointment with Practice Nurses Sarah Senior or Rosie Humphries or GP Dr Lucy Bell to discuss this further.

People on MODERATE dose HRT regimes with oral or vaginal micronized progesterone who experience unscheduled bleeding should also be moved onto increased micronized progesterone and may need further investigation.

UNSCHEDULED BLEEDING is any bleeding on a continuous regime, or bleeding between periods on a sequential regime, that continues six months after starting HRT or three months after a dose change.  If you are experiencing unscheduled bleeding, please contact us via e-consultation directly.

Those on ULTRA-LOW/ LOW / STANDARD dose HRT regimes should also make contact via e-consultation if experiencing unscheduled bleeding. Otherwise please continue to attend annual HRT reviews with our Pharmacy team.