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HRT Dosing

Changes to Micronised Progesterone dosing in HRT

This page relates to a specific change in guidance.

Find more information about HRT on the NHS website

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.

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