HRT - being nil by mouth in hospital

[DerekJ]

My partner is on HRT. She wears an oestrogen patch and takes an utrogestan pill for the progestrone. She has had a bad accident and is now in hospital nil by mouth. She cannot take the utrogestan and the doctors have said it can't be administered through the feeding tube. They seem clueless about what to do. She is still wearing the patches. Does anyone know a way round this or if it is ok to be off the utrogestan for a length of time until she can eat and drink again? Thank you.

Op she’s in hospital
just follow whatever the medics say
they obviously aren’t concerned that for a short period no utrogesteron

It will be fine for a short period

Oh dear, hope she'll be ok. Normally if you're immobile ,hrt is discontinued because of any risk of blood clots . Especially estrogen. Sometimes you can continue with patches of progesterone, but if she has injuries, they may not stay in situ, and would she be physically able to use them.I'm a bit confused because you said she has a feeding tube, but is NBM.. that doesn't make sense (ex nurse of over 40 years)

I’m confused as to why this is a priority concern, given the fact your DP is so injured.

Can you explain?

I'm sure if there are blood clot worries they can put stockings on her legs to help prevent them? I wouldn't worry about temporarily missing medication, surely the injuries are more pressing.

Op not an HCP but I think you are right to ask about this. Maybe find out when the next dr round is and raise this then. I would ask two questions. Should she carry on using the patches? What about Utogestan if so?

I dont trust hospital staff to give a crap about HRT, I would just continue with the patch and miss a few days of the progesterone, it wont matter for a few days. Or break open and absorb the progesterone through the gums. Menopause symptoms are real and they matter, physiology also changes with a drop in hormones not to even think about falling off the even emotional keel. Especially in the UK, dont have a blind faith in health professionals about menopause, its not taken seriously. Blood clot risk is minimal compared to the issues from stopping HRT dead. Hope she is better soon x

This might be useful:

https://www.drlouisenewson.co.uk/knowledge/do-i-need-to-stop-hrt-before-surgery

That's a brilliant resource and addresses a lot of myths you hear health professionals spouting.

She could take her Utrogestan vaginally. This would be off label but many women use it via this route. I wouldn’t expect her consultants to have any knowledge about HRT especially if she is under the surgeons or orthopods but perhaps they could refer her to gynaecology while she is in hospital?

You won't know if you are at personal risk of blood clots, unless you have actually had them.You can attempt to evaluate the situation. I was told I didn't need to discontinue my hrt oral before my last surgery, which was major abdominal surgery, I automatically stopped it, beforehand. Yes, compression stockings are an option or flo-tron boots... assuming there are no lower limb injuries. Obviously I have seen the issues up close. A friend had an operation last year, decided to ignore advice, ended up with a blood clot on her lung..

We don't have enough information about this persons injuries,are they physically capable of administration of PV tablets!

If she's nbm but having needs through an NG tube then it's the pharmacist who will know if it can ve crushed, doctors won't know.

Medns, not needs, why is she nbm.

@MissMoneyFairy I’m a hospital pharmacist and Utrogestan can’t go down an NGT as they are soft capsules and can’t be opened. Potentially a nurse could inject them with a syringe and needle and draw out the contents but I think it would be better just to administer vaginally.

To clarify. She has a perforated oesophagus because of a botched gastric procedure, hence the nil by mouth. The feeding tube is through the nose into the stomach but she has to avoid swallowing anything. She is hugely agitated and concerned about the HRT situation because when she came off it briefly a few years ago she experienced awful symptoms and was near suicidal.

Vaginal administration of Utrogestan is the next best alternative to stopping HRT. Plus compression stockings.

She needs you to fight for her on this. Either that or just leave on the patch and lie.

I think this has been covered above, but transdermal HRT (patches and gel) doesn't increase a clotting risk.

Utrogestan can be used vaginally (it is everywhere else except the UK!) and also rectally.

I'd not expect the medical staff to know this unless they had training in HRT.

You can't crush a Utrogestan capsule. It's a soft gel capsule and the micronised progesterone in a finely ground powder, suspended in oil.

Vaginal or rectal insertion is the answer.

@DerekJ It won't do her any harm to stop the Utrogestan. It would be exactly the same as women using it in a cycle where they have 2 weeks without. And some women are long cycle meaning they use it only every few weeks.

She may get some spotting/bleeding which is nothing to worry about, but unlikely.

Apparently the capsules can be taken vaginally. Either way it’s fine for a few days without.

If that's thd case then the doctor and pharmacist can easily sort this out for her.

Obvs the dr and pharmacist COULD sort this out but the point is that its NHS so they are highly unlikely to care.the point is that patients have to face anxiety due to poor care, not a lack of people who could help.

Have you ever used it?
The tablet is a gooey gel inside a rubbery type capsule that dissolves. Powder mixed with oil.
It can't be crushed - if you tried to extract it from the capsule you wouldn't be able to get it all out and the capsule can't be crushed.

Use vaginally or miss a few days which won't be an issue (same as reverting to cyclical and perhaps double to dose depending on how many days are missed..)
Many women never use it orally, ever.