Cyclical HRT - think my gp has this wrong

[Maltester71]

My GP has prescribed cyclical HRT - 25 days of progesterone and 14 days of oestrogen.

he says this is what the BNF says. I’m still having periods.

it doesn’t tally with what everyone else is taking, dose wise. Everyone else seems to take it for 12 days.

I made a phone appointment to discuss it but they gave me no choice of date/time - basically booked me the appointment and left a message. I was on a university open day with DD and couldnt hear the (male) GP on the phone. Felt like I was being fobbed off.

so! Please can you tell me exactly what you take, and for how long, if your HRT is cyclical.

thank you

Personally, due to experience, I would not trust any gp in regards to HRT. If you can go to a Peri/menopause clinic, I highly recommend it.

www.gp-update.co.uk/SM4/Mutable/Uploads/pdf_file/HRT-GEMS-May-2022.pdf

Hope helps

Thank you

This sounds wrong to me. I think it should be continuous oestrogen (if it’s topical) and 12-14 days of progesterone.

Sequential HRT for women still having periods is usually continuous oestrogen (as gel, patch or spray) with micronised progesterone capsules 2 daily on days 15-26 of 28 day cycle

Yes it’s topical oestrogen plus the progesterone brand beginning with U (I can’t remember how it’s spelled).

I need to see somebody else don’t I?

so I should be on oestrogen every day?

Hi, it sounds as though he has made an error. It should be continuous oestrogen with 12-14 days progesterone.
www.cks.nice.org/topics/menopause
Then see the prescribing information for HRT

It's terrible how these GPs get HRT etc so wrong.

Imagine if this was medicine for the heart or something very serious.

Thank goodness they are now going to be trained at med school on women's health- but sounds too late for this dr!

@Maltester71 All HRT is estrogen every day.

Then sequential- for women with periods - is estrogen + progesterone for part of the month.

As PPs have said, use estrogen daily and take 2 capsules of Utrogestan for 12 days per calendar month.

When you start, you can either choose a day to start the capsules, like 1st of every month, (just to make it easy to remember), or you can take them from roughly the middle of your cycle (day 14-15 of your cycle) and stick to that date on the calendar every month.

Don't try to schedule them by your own periods every month, or you will get in a muddle. Just stick with the same DATE each month.

Thank you!

I think it's the progesterone that should be cyclical, not the oestrogen part. Definitely go back and query it.

Mine did the same and I ignored them and just followed the info on the packet - 12 days 200mg progesterone a month if you have had a period in the last year. My GP also me to put my oestrogen patch in my arm despite the packet saying below the waist. Most GPs really don't seem to have a clue about hrt.

I have gone back, that’s the problem. The doctor rang me when I was at a university open day and couldn’t really talk, he was adamant that he was right 🙄

The BNF should be clear and I'd assume he has misread it.

The 25 days is ONE option for women post menopause, but it also will give the cyclical dose. I think he's skim read it. The leaflet in the pack covers both options.

So if I go back, will he say ‘well that’s the option I’ve chosen?’

No because he's incorrect on a basic point.

ALL HRT is estrogen daily. You posted that he said use estrogen for 14 days.
That's absolutely wrong.

The 25 days of Utrogestan is on the leaflet / prescribing guidance for Utrogestan. It doesn't include prescribing guidance for estrogen as it's assumed the Dr is already aware of that.

From the patient leaflet (you can google and find it.)

How to take Utrogestan

The recommended dose is 200 mg daily at bedtime, for twelve days in the last half of each therapeutic cycle (beginning on Day 15 of the cycle and ending on Day 26).

Alternatively, 100 mg can be given at bedtime from Day 1 to Day 25 of each therapeutic cycle.

Taking this medicine

Take this medicine by mouth.

Swallow the capsule whole with a glass of water.
Take this medicine at bedtime.

Do not take this medicine with food.

Take your estrogen HRT at the same time as Utrogestan

How much to take
Take two capsules at bedtime on days 15 to 26 of your 28- day cycle.

You will usually have a few days withdrawal bleeding (like a period) after this time.

Continue to take your estrogen HRT every day.

If you have any problems with the withdrawal bleed, your doctor may change the way that you take Utrogestan. This will help to reduce the amount of withdrawal bleeding.

The 25 day regime is for post menopausal women- that's not you. And they still use estrogen every day.

I’m so annoyed by his incompetence

Very disappointing.

Thank goodness for MN.

Finding this interesting as I have been given 25 out of 28 days of utrogetsan and daily oestrogen gel. I also take cerazette. I am peri, no idea of period status as I’ve been on cerazette for years. Now I am worrying as everyone is talking 12 days!

In your shoes OP, I'd complain. To the practice manager.
How many women has he given the wrong advice to?
He needs retraining.

Thanks, im
Going to make an urgent appointment and write to them

He has the oestrogen & the Utrogestan mixed up.

It's oestrogen every day progesterone for 2 weeks a month.

Tell him to check the nice / meno society guidelines op.

And complain to the practice manager about your doctor!

25/28 days of utrogestan is fine.

Thanks Panty. It seems I might be less likely to withdrawal bleed with 25/28….here’s hoping!