Help needed to negotiate with GP

[Lalavande]

I've been on HRT for a few years now. I was initially using Sandrena gel (2mg) and cyclical Utrogestan but in summer 2024 I had a Mirena coil fitted and stopped the Utrogestan.

The last few months my sleep has got worse than ever which has really impacted my mental health.

In desperation I started taking 100mg of my leftover Utrogestan a night and it's worked miracles. I feel so much better in myself. Its not only helped my sleep, but also the awful feelings of doom I've been having.

I have asked my GP if she can prescribe this. She said she'd need to check with a consultant and has just got back to me to say no. The consultant says it will increase my risk of breast cancer. I'm not overweight and I don't drink alcohol so I do not think the risk can be huge and I'm very willing to take it.

What can I do? I don't think my GP will go against the advice of the consultant. I can't go back to the way I was feeling. It was torturous.

I have a simular problem that my gp won't prescribe me hrt / im 48. Watching this thread /

Sorry to hear that, Amira83. Mine has been good till now although I have had to argue the case for my oestrogen dose to be increased over the years. Has your doctor given any reason? Can you see someone else at the practice?

A friend of mine has been through similar, denied progesterone after a hysterectomy, she’s on oestrogen only. Tried some progesterone she had to help with sleep issue and felt so much better. Gp denied progesterone, but referred her to meno/ gynae specialist at local hospital and if she gets the thumbs up from them she’s then allowed it (on going as you can imagine, long wait).
have you tried buying it in the meantime, from an online pharmacy? More expensive that way I know.

Is it possible to buy online without a prescription? I've actually just checked my stash and I've got 3 months' supply. I wonder if I can get a referral to see a specialist. How long has your friend been waiting? Has she managed to get hold of some utrogestan to tide her over?

@Lalavande I think that is very bad advice from the consultant. They sound as if they know very little about HRT.

The British Menopause Society has guidance on progesterone in HRT.
They say that there is evidence that micronised progesterone is safe for at least 5 years with no added risk of breast cancer. This is online is you google the topic. If you can't find it I'm happy to spend a few minutes looking for you.

On the other hand, the Mirena coil releases a small amount of synthetic progestogen into the system which has to same (low)risk as other synthetic progestins and therefore a higher risk of BC compared to Utrogestan.

The consultant seems as if they don't know this.

You can only get in on prescription.

The other thing to try is upping your estrogen dose. You might bet a better result using Oestrogel (rather than Sandrena) as the pump system allows you to go to 2.5 or 3mgs.

If you can afford it go to The Newson Clinic (virtual or in person), expensive but no referral needed, very knowledgable GP menopause specialists. I highly recommend it.

Thank you @JinglingSpringbells. I can certainly go armed with research. I just don't think my GP will prescribe after what the consultant has said. Do you think I can request a referral to a specialist?

I had to fight to go up to 2mg sandrena. That's more than they usually prescribe. I think that's working OK. Sometimes I use a bit extra and don't tell the dr.

I feel as though it's the systemic progesterone I'm missing. I guess I could have the coil removed and go back to utrogestan but I don't want to do that. It's got rid of my very heavy periods and I've managed to sort out my ferritin levels which were low. I've also had fibroids in the past and I think its keeping those under control.

Thanks @CrackedHeels2. I think I will have to go private as a last resort. It's all very frustrating.

Some gynaecologists specialise in other areas of gynaecology, others are more experienced and trained in menopause.

The Mirena is a higher risk than Utrogestan, but I appreciate why you want to stick with it and that's your own decision.

I can appreciate the the consultant assumes doubling up with 2 types of progestin may add to your risk. That will be their argument.

But as Utrogestan is regarded as 'neutral' that is a debatable point.
Most women now are offered Utrogestan as the default option because of its lower risk.

The other issue is that at the moment, there is no evidence that higher doses of estrogen are a higher risk for breast cancer. Again, this is online but you may need to dig around as it's something that is in medical publications like the BMS and the International Menopause Society 'journals'.

You could consider the option of combined continuous Utrogestan on 200mgs a day (when using a high dose of estrogen) which might control the bleeds so it's 'bleed free'.

I’ve read the research really carefully as has my gp who is female and my age, neither of us are on hrt apart from the mirena and it will be taken out when im 53. A gp needs to stick to the rules given to them by the consultant because that consultant is a medical professional who has weighed up risks and benefits. Patients will be the first to sue if they get cancer - it’s happened locally at a neighbouring practice

Thank you again @JinglingSpringbells. I think 200mg continuous utrogestan might be the answer if the GP agrees. I had to have the coil fitted in hospital so I'm not sure how easy it will be to remove. I will ask.

Yes @tutugogo, I'm sure the GP would never go against the consultant's advice. Adding the utrogestan has been transformational, though. I was really feeling that life wasn't worth living before trying this.

Just be aware that even if you have continuous utrogestan you could still get bleeding.

I ended up having a coil fitted in December 2025 it stopped the bleeding (which was unpredictable and incredibly irritating after years of no periods).

i would want to be really sure and informed before I had a coil removed

I hope you get sorted xx

Thank you @Iizzyb. The thought of the bleeding returning is upsetting. It's been amazing not having periods after years of very heavy ones. I need to think this all through. I thought I'd found the perfect solution but it seems it's not to be unless I can see a specialist or I go private.

Everyone is different.
I get heavy withdrawal bleeds on sequential but I know someone else the same age as me, on the same dose of estrogen and Utrogestan, who hardly bleeds at all.