Is anyone on HRT after having Intrahepatic Cholestasis of Pregnancy (ICP)

[Loopzy]

After having had ICP in both pregnancies, I was told I could no longer take the combined pill, as it contained estrogen. I've got an appointment at the drs next week to discuss HRT, but I'm not sure if I'll be able start on it. Is there anyone on HRT who has had ICP?

Thanks

This is a very specialised question. It depends how your liver was at the time.
Active or recent liver disease is usually a no-no or a caution for HRT.
But the newest types of HRT that are not tablet form (gels and patches) bypass the digestive system and you could be offered (perhaps) a Mirena coil or using progesterone vaginally.

I have suspicions your GP won't know or give you a 'No' in which case you'd be better off seeing a consultant gynae with expertise in HRT (and not all have.)

Thanks for your reply. I wondered if it was something that the GP wouldn't know, but hopefully, he can refer me to someone who does!

I had ICP and I'm on HRT - but my LFTs all went back to normal after giving birth and it's never been mentioned as a potential issue for HRT since? It was 15 years ago that I had ICP. I did have an LFT test about 2 years into HRT because I had some unexplained abdominal pain and those tests all came back normal. I guess if you have lasting liver damage from ICP (which I think is very rare) then it would potentially be an issue? I think for most people ICP just goes away as soon as you give birth. I would mention it to your GP and ask them to do liver bloods? I've never heard of the link to oestrogen? But I'm aware of the danger of liver issues and HRT.

ICP pregnancy though... what a nightmare that was 😅

Good luck x

Out of curiosity @Loopzy I had a quick google and this was top of the list.

ICP does not affect your choice of contraception once your liver blood tests and bile acids have returned to normal. If you take an estrogen containing contraceptive such as the combined pill and develop itching you should see your health care professional immediately for review. If you have had ICP, it is still possible for you take HRT in the future.

This information has been developed by the RCOG Patient Information Committee. It is based on the RCOG Green-top Guideline No. 43 Intrahepatic Cholestasis of Pregnancy published in August 2022. The guideline will contain a full list of the sources of evidence we have used. You can find it online at: www.rcog.org.uk/gtg43

Thanks, that's good to know! My LFTs went back to normal too as far as I can remember, so hopefully it won't be an issue. I'll definitely mention it to the GP though.

ICP pregnancy felt like torture...I couldn't believe it when I developed it a second time!

That's interesting, I'll have a read thank you. It is 21 years since I was told that I wouldn't be able to take the pill, so I'm wondering if the guidelines have changed since then.

I had this with my son (now 24) and never did the GP mention it regarding the pill or now HRT.

Live function returned to normal after giving birth and it was never mentioned again.

I am on HRT patches and have the merena coil. I have bloods done now and then from GP and never any issue with liver function. I hope that helps OP

@Loopzy Maybe what you were told was incorrect even way back then?

The Pill is different anyway to HRT.
The estrogen in the Pill is a synthetic one and in a much larger amount than HRT.
The estrogen in HRT is called body-identical, so it's the same as our own.
And as a PP says it can be given as gels or patches which bypass the liver.

Might be worth reading and printing off the RCOG leaflet in full, if your GP isn't up to speed.

Thanks for your reply. That's good to know, I was worried that I wouldn't be able to go on HRT because of it.

Yes, it is possible that I was given incorrect information. I will print off the leaflet and do some reasearch before my appointment. Thank you.

From https://www.icpsupport.org/index.html

They suggested that the use of the pill can cause ICP in pregnancy. They just dont know how long before or if it is long term.
They are still finding out and just scratching the surface.

I Have Gilberts Syndrome as with all family and have gallstones my live function tests have always been bad witht he enzymes so when I got ICP was easy to find out why it happened.