Consultant advise to halve progesterone

[Just1morecupoftea]

I have been having a nightmare with HRT for about 6 months now with anxiety through the roof and moods all over the place. I went to see a private consultant and he recommended increasing my oestrogen patch, Everol up to 75 and decreasing my progesterone tablet from 2 tablets for 12 days down to only 1 tablet for 12 days. When I googled this I discovered that the recommendation from NICE is to have 2 tablets in order to prevent thickening of the lining and possible cancer. This has totally freaked me out. I have been searching and not found anyone else that takes only 1 tablet. Anyone else take only 1 tablet for 12 days of the month and been fine? Thanks

Anyone?! Is taking half the recommended dose of progesterone safe?

I'd go on the advice of a private consultant tbh rather anything folk may suggest on here.
From what I understand the dose is 200mg/12 days for peri and 100mg/continuous for post meno but some hcps do seem to suggest different utrogestan doses. Dr Newson prescribes half doses for example if taken vaginally.
The difference is private hcps can do scans to check the lining whereas while this is possible on the nhs it isn't routine.
As you have a private consultant I'd go with what he suggests.

As above - definitely take the advice of your highly trained and experienced consultant, not a bunch of random people on the internet. NICE guidance is just that - guidance - and a consultant will be able to take your specific needs into account.

FWIW upping my patches made a massive difference to my mood.

I'm sure the consultant knows more than Dr Google or Mumsnet members. If you have a concern maybe you could ask for a further consultation with him/her to discuss your worries.

As others have said, you take the advice of your specialist. You won’t suddenly develop a thickened womb lining. The consultant will monitor how you’re doing on the increased oestrogen and reduced progesterone and tailor accordingly. It may be a temporary reduction. I would discuss this at next review, express your concerns then your consultant can explain and hopefully reassure you.

Hi @Just1morecupoftea A lot depends on who the consultant is. Just because they work privately doesn't mean they are an expert because experience varies hugely.

Unfortunately at the moment, owing to the demand for HRT, many drs are offering private appts and jumping on the bandwagon. Some are simply GPs with a minimum amount of HRT training. BUT if you look at their qualifications and experience (which you really ought to, in choosing a dr) some are not especially well-qualified.

There was a trend until very recently, to allow half doses of Utrogestan when it's used vaginally (has he suggested that?) However, in January the BMS updated guidance on this and said no, stick to the oral dose, (200mgs) whatever route is used.

However as PPs have said, part of any variation should be the guidance to include a vaginal scan (to check the womb lining) annually and you'd have to pay for this through your consultant. (I have had a different dose of progesterone for many years, but part of that regime includes scans.)

Just talk to your dr about it and make sure they are telling you things that make sense!

I was going to ask about using it vaginally. Has he suggested that?

It is half dose orally. Thanks very much for the reassurance everyone. The consultant is experienced and I am sure that it’s all fine but as I haven’t read of anyone doing the same thing, it worries me. Also, he didn’t mention having scans. I’m wondering whether perhaps he was thinking see if i feel better and then if i do, we know it’s the progesterone making me feel worse. Then we can go from there.

Thank you! I know it’s silly but seeing it in black and white that my womb won’t thicken suddenly has helped! I suspect you’re right and this is perhaps a temporary reduction. I have a follow up apt in 2 months time so I will ask him then.

That’s fantastic to hear that increasing the patches helped. I’m crossing my fingers that it does for me too.

@Just1morecupoftea You would possibly not be safe, long term, using that amount of Utrogestan with a relatively high dose of patch, although vaginal use may be ok depending on how much your body absorbs.

This is the advice of the British Menopause Society, having reviewed the rise in cases of endometrial hyperplasia and cancer. There is a report/paper available online with this in it. (I did link to it in January when it came out.)

It's not NICE who write prescribing guidance, (in terms of dosage) it's the pharmaceutical companies, after research trials.

NICE' s role is to permit the use of prescribed drugs on the NHS when they are shown to give value for their cost, at a population level.

One way that some consultants prescribe HRT, off licence, is to omit the use of a progestin for a month or two, to get the estrogen dose right for you. There is no risk in having a long first cycle of 2-3 months, then introducing a progestin slightly later.

(This is because many women in peri have long cycles anyway, going months between periods.)

That would be another option for you to consider with your dr but also the vaginal use. I'm wondering why they didn't suggest that now? It's the 'classic way' to avoid the psychological symptoms that often go with Utrogestan.

I hope you get it sorted and if you don't feel happy, you can always choose another consultant for a 2nd opinion.

Thanks so much for your reply and helpful information. I feel a lot more confident that I know what I’m doing now 😊