Switching from oral progesterone to patches because of Mounjaro - anyone else?

[namechange0998776554799000]

I've been on HRT for about a year - estradiol gel sachets and progesterone capsules (200mg on days 1-14). I'm 45 and menopause was kicked off by chemo, my only major symptom was hot flushes which were unbearable. My periods stopped for a long time but have now come back very irregularly - I'd say I have a full period every few months, and light withdrawal bleeds sometimes in between. I've had an ultrasound recently, everything fine.

I started on one sachet of the estradiol then after a while the hot flushes started to come back so I increased to one and a half, then again to 2. I've been quite happy on this regimen - I hate the flat feeling I get while on the progesterone, but on the other hand it makes me sleep really well. So if there was no reason to, I wouldn't be changing anything.

Last week I started on Mounjaro and since I've been warned it can affect absorption of oral progesterone I had a GP appointment today to discuss switching to patches.

She's told me that patches only go up to the equivalent of 1 sachet of estradiol, so I'll essentially be halving my dose of oestrogen. She said maybe I could just use two patches, but admitted this is off licence and didn't seem confident. I've asked to be referred to the menopause clinic, who were excellent when I was first prescribed, but the wait time will be a few months. My plan in the meantime is to switch to the patches and just see how I go.

Has anyone had a similar experience? Any advice?

I'm not going to consider the coil, after a lot of cancer treatment and many complications I am 100% not putting any more objects into my body unless absolutely necessary.

Look on the BMS website at equivalent doses.
https://thebms.org.uk/wp-content/uploads/2024/02/15-BMS-TfC-HRT-preparations-and-equivalent-alternatives-JAN2024-B.pdf
A 1mg sachet is equivalent to a 50mg patch. You can get 100mg patches (they’re not off-licence).

@PlanetSaturnthe only 100mg patches I see on there are listed for women who've had a hysterectomy/don't need progesterone, maybe that's why the GP didn't mention them? (Although she specifically said they don't exist so sounds more likely she was just unaware!).

@namechange0998776554799000 Are you taking generic progesterone pills or Utrogestan? I switched to taking my Utrogestan vaginally instead of orally. This is off-label in the UK but quite common. Oral Utrogestan makes me feel a bit ropey anyway whereas no side effects at all when I take it vaginally, and that also means the Mounjaro doesn’t affect it either. (So I take Oestrogel and Utrogestan).

I'm taking utrogestan and yes I'd seen it mentioned on here about taking it vaginally. I'm thinking that will be my back up plan if I don't get on with the patches

Actually, having said that, while my original prescription was utrogestan I now see that my latest batch were generic ones

Hi OP. I am on 100mcg patches prescribed by my GP.

I started at 50, went to 75 after two months then 100 two months further on.

They definitely exist. I am peri meno and use Mirena for progesterone. I also have testosterone.

Hmm ok. Maybe I'll start with the 50 patches and if symptoms come back I'll make an appointment with a different GP, or hope the menopause clinic referral has come through

Another idea is to take the capsules vaginally.

Op is talking about combined patches which only come in 1 strength 50. Another option is to take 300mg for the 2 weeks a month instead of 200 whilst on mounjaro.

https://thebms.org.uk/wp-content/uploads/2025/05/23-BMS-TfC-Use-of-incretin-based-therapies-APRIL2025-E.pdf

https://www.pcwhs.co.uk/_userfiles/pages/files/resources/glp1_contraception_hrt_article.pdf

you might find these links helpful if you haven’t seen already . One BMS suggestion is to increase utrogestan dose for the 4 weeks of initiating Mounjaro and at each dose increase. If you don’t go up the Mounjaro doses quickly (many stay on 2.5mg for months) that is just one month of increased utrogestan to try out.

i have been on Mounjaro for over a year on the same dose, I started HRT after Mounjaro and been fine on standard dose of oral utrogestan. I did try vaginal utrogestan for a month but didn’t like it, found it messy, and had some bleeding

Thanks @NoTouch, I'm reluctant to increase the oral progesterone because it already gives me side effects. Im hoping the patch will be better so I'm going to try it out but if I don't get on with the lower dose of oestrogen I'll see what the menopause clinic say

Could you explain this please ?

@DollyPop100 the documents linked have all the information from BMS and PCWHS, is there a particular part you don’t understand?

o If an oral progestogen is preferred by the patient, the dose of
progestogen should be increased for four weeks after starting and after
each dose increase of the GLP-1 agonist.
so if I restart my mounjaro but am on 100 progesterone that is saying in 4 weeks time need to take 200 dose ? Unsure what the bit about increasing the progesterone thereafter so if I go up to 5 mj need to increase dose of progesterone again higher than 200 ?
don’t think my gp will agree to the higher dose as it not in bms ?

@DollyPop100 it is mentioned as a potential option in both the BMS and PCWHS links

Just be aware the patches is synthetic progesterone but the oral is bio identical. I use patches for estrogen but oral progesterone (on MJ) but I also have a coil. I have the oral progesterone as I was getting symptoms of low progesterone (not sleeping, headaches) with just the coil. Taking MJ hasn’t made the symptoms come back so I conclude the levels of progesterone in my body must be ok.

I'm on mounjaro and take utrogestran vaginally. Works fine

This is an old thread but I've ended up on double patches following discussion with the menopause clinic. One patch wasn't enough to manage the low oestrogen symptoms (mainly hot flushes), two patches work fine. The progesterone in the patches works better for me - less of a flat/low mood, and no dizziness which I got with the tablets. But I'm now getting a bit of spotting between periods which is annoying.

The menopause clinic told me the next option would be taking the progesterone vaginally, and after that trying going back to oral progesterone but trying a higher dose or a different type.

So much time has passed in the meantime it probably won't be that long before I move into maintenance with the Mounjaro, so I'm not making any changes for now.

Sorry got myself in a pickle really struggled without MJ which is annoying as exercise etc and eat fairly good. Food noise after few weeks of not on it worse than ever been like a demon released ! Gutted as was so hoping tomato taking it been nearly 2 years now. I just feel ‘better’ on it though.
still a stone to go to goal so back to 2.5 .
really going to struggle to get GP help re increase of progesterone in time as go away next week. still got some combined patches left.
Done around 3 weeks on spray and oral progesterone.
Do I
1.just stop the tablets spray and restart the patches I was coping on them to be honest and then no issue with progesterone but no clue when I could start the patches.
2 just carry on taking the spray and oral progesterone a few months surely can’t have that much of an effect on womb what about all these people who have been on it for few years and guidance only just come out ?
3.just continue on spray and oral progesterone until return from hols and try and get spot for when I come back.
could anyone explain re the increase unsure of the wording in guidance so increase up to 200 now if back on mj then back to 100 after 4 weeks and each time I go up a dose with mounjaro increase it back up to 200 for 4 weeks ?
Also does anyone know which is better long term ? patches ?
or spray and oral ?
sorry lots of questions can start new thread if better ? Unsure of MN etiquette

if you do any kind of regular exercise the patches fall off

Rubbish. I exercise every day and swim several times a week and I can barely peel mine off when they are due to be changed. Everol are superb.

I switched to vaginal progesterone.

I used exactly the same brand and if my skin got even slightly sweaty they came off. Your experience is different to mine and everyone’s skin chemistry is different, it’s a fact that sweat breaks down the bond of the adhesive. Furthermore when I worked in a pharmacy and in a doctors surgery patches were well known to not suit individuals with active lifestyles, they nearly always requested to switch to gel. You’ve been lucky that it suits you however I have not experienced this to be the norm.

@CanterThroughChaos fair enough! I must have a really rough dry bottom as they weld themselves on 🤣

@namechange0998776554799000 , I have had a Mirena coil fitted to deliver my Progesterone. I understand this is recommended if you are using both HRT and Mounjaro.