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HRT Dosing
Changes to Micronised Progesterone dosing in HRT
This page relates to a specific change in guidance.
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.
Read the guidance online on the British Menopause Society (BMS) website
Important
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.
Below shows the levels of oestrogen that comprise different dosage regimes.
Oestrogel
- Ultra-low - 1/2 pump
- Low - 1 pump
- Standard - 2 pumps
- Moderate - 3 pumps
- High - 4 pumps
Sandrena
- Ultra-low - 0.25mg
- Low - 0.5mg
- Standard - 1mg
- Moderate - 1.5 to 2mg
- High - 3mg
Lenzetto Spray
- Ultra-low - 1 spray
- Low - 2 sprays
- Standard - 3 sprays
- Moderate - 4 to 5 sprays
- High - 6 sprays
Patch
- Ultra-low - 12.5mcg
- Low - 25mcg
- Standard - 50mcg
- Moderate - 75mcg
- High - 100mcg
Oral Estradiol
- Ultra-low - 0.5mg
- Low - 1mg
- Standard - 2mg
- Moderate - 3mg
- High - 4mg
Anyone on a HIGH dose HRT regime using oral or vaginal micronised progesterone needs to be on an adequate dose, which is 200mg every night if taken continuously or 300mg for 12 to 14 days per month if taken sequentially.
Micronised Progesterone
- Ultra/Low:
- Continuously - 100mg
- Sequentially - 200mg
- Standard:
- Continuously - 100mg
- Sequentially - 200mg
- Moderate:
- Continuously - 100mg
- Sequentially - 200mg
- High:
- Continuously - 200mg
- Sequentially - 300mg
Medroxy Progesterone
- Ultra/Low:
- Continuously - 2.5mg
- Sequentially - 10mg
- Standard:
- Continuously - 2.5 to 5mg
- Sequentially - 10mg
- Moderate:
- Continuously - 5mg
- Sequentially - 10mg
- High:
- Continuously - 10mg
- Sequentially - 20mg
Norethisterone
- Ultra/Low:
- Continuously - 5mg
- Sequentially - 5mg
- Standard:
- Continuously - 5mg
- Sequentially - 5mg
- Moderate:
- Continuously - 5mg
- Sequentially - 5mg
- High:
- Continuously - 5mg
- Sequentially - 5mg
LNG-IUD (52mg)
Up to 5 years – record fitting date on script.
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 contact reception to book a routine appointment to discuss this – when booking please specify it is to discuss the Mirena coil fitting.
People on Moderate dose HRT
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
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 online.
Ultra-Low / Low/ Standard dose HRT
Those on Ultra-Low / Low/ Standard dose HRT regimes should also contact us online if experiencing unscheduled bleeding.
Otherwise, please continue to attend annual HRT reviews with our Pharmacy team.