WLIs and HRT / oral progestogen - recent guidance from BMS concerning

[WeAllHaveWings]

Just seen this in facebook which is a bit concerning.

I have asked my provider for feedback. Interested in any feedback from other providers.

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://thebms.org.uk/wp-content/uploads/2025/04/23-BMS-TfC-Use-of-incretin-based-therapies-APRIL2025-C.pdf

The guidance saying non-oral progesterone might be needed when starting and on dose increases

Also interested if anyone on HRT and prescribed WLI from the NHS have had any guidance on their oral progestogen?

Following. I'm on oral progesterone and mounjaro and have always declared the HRT on ordering the meds but had no advice on this

I was a bit worried about it restarting my periods or kicking off endometriosis - I've had very few symptoms for ten years now and I think my periods have stopped. Just on break from contraception and seeing if they have before thinking about HRT. Four months and no periods, and so far seven jabs in no obvious adverse effect from mounjaro.

Hopefully by this summer I'll neither be overweight nor obese and my overall risks of endometrial conditions will have dropped considerably.

https://fb.watch/z0YcDpmeqO/

Looks like the new guidance was only released yesterday.

https://fb.watch/z0YGa3YUd9/

Not sure where that link came from, here (I hope) is the correct one!

I've booked an appointment with my gp to see if it is sensible to switch to patches for the time being.

I’ve had a couple of emails back and forth today with a Dr through my provider, last one was at 7:30pm!

He is happy for me to stay on my oral progesterone for now as I am on and have been on the same lower dose of Mounjaro for over 9 months (I am buying 5mg pens), and only on HRT for 3 months, but said if they were to increase my Mounjaro strength it would be a good idea to look at non oral methods first, perhaps taking the utrogestan vaginally to ensure absorption isn’t affected.

He mentioned he had spoken to some patients on 12.5mg/15mg who had noticed reduced efficacy of their progesterone with occasional bleeds so it was important to monitor and act on any symptoms (he didn’t say what was recommended to them, I would guess it would be to speak to their GP as they would with any unusual bleeds).

I think it is worth a conversation with your own provider or GP with your own Mounjaro history, not only but more so if on higher doses and/or been through more changing doses/schedules, had a lot of side effects and if you have had any symptoms of your oral progesterone not working as well.

Thanks for this! I’ve only been on mj for a month and hrt for three months. On 2.5 so was wondering what to do in the immediate. I’ll speak to my gp in my next catch up but carry on for now

Another useful link shared on menopause board

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

Thank you for those links. Will take them to my appointment

Thanks all. I have a history of post meno break through bleeding and thickening of the womb lining. Have twice been on the 2 week cancer pathway leading to hysteroscopy/biopsy - cellular results clear but womb lining is thickened.

Been on MJ 4 weeks - noticed insomnia - which makes sense now as likely prog not being absorbed - but I have had heavy bleeding for a week now. Will call the GP tomorrow to look at alternative options prog.

This is so interesting. I was at GP on Thursday and she’s actually just called me back so I thought I’d pop here and search. I’ve had 3 lots of post meno bleeding over the past 5 weeks. She has referred me through the cancer pathway for review but called me today as the hrt/WLI info has been released. She advised me I can take 2 oral progesterone tablets until I’m seen or wait until I’m seen by gyn and discuss with them. I’ve been on Mounjaro for a year with no issues until now but I’m now at a healthy BMI. I did have same issue 4 1/2 years ago but was given the all clear after referral (wasn’t on any WLI at that point).

I am also wondering if the non absorption of prog is the reason why my weight loss has stalled - as I am currently having a huge period which I've not had for nearly a decade. My breakthru bleeding in the past was very minimal - this is very uncomfortable and heavy.

Thank you so much for sharing this.

Looks like the advice is for me to double my dosage. I’ll print it out and take it to my HRT review which is in a couple of weeks.

Urgh. Started period today - 2 years post menopause and only 2nd bleed since started HRT in January so might just be the HRT settling down.

Phoned GP today and have a telephone appointment with the woman's health Dr next Wednesday to discuss my HRT 3 month review and the bleeding so will raise then and see what they think.

I've seen my gp today about this. She wasn't aware of the new guidance but has agreed that it's potentially safer now for me to be on patches and so has swapped me to them.

I didnt know you could have prog patches - I was worried that I would have to have a coil fitted. I saw my GP yesterday and dont think she was aware of new guidance but has put me back on the 2 week emergency cancer pathway - so I will have an abdominal scan next week and then maybe another hysterosopy and biopsy. I know she has to put me thru this pathway as I have had breakhrough bleeding before and have hyperplasia (thickened womb lining) and this will be my 3rd time going through this route (both clear last time) - I am 100% confident that this is the MJ absorption issue and nothing more sinister. Also the bleeding has now stopped and it followed the pattern of my usual full week period (from 8 years ago....) - rather in the past it was random spotting.

I'm so glad this has been posted because I've had this issue with period like bleeding every 7-10 days on 15 mg Mounjaro for the last few weeks. I have a appointment next week but will start taking two progesterone tablets from tonight

@taylorsdoingapart@Terrapinn

Personally, being on lower Mounjaro doses, I am going to initially try to stick to micronised/body identical progesterone if the Dr allows me when I speak to them next week rather than switching to synthetic progesterone (patches/IUD). Micronised/body identical progesterone has some benefits over synthetic that are worth reading up on so you are aware of potential new side effects (lots of women get on fine with synthetic), I am particularly worried about my already very thin hair getting thinner with the androgenic effects from synthetic progesterone as my mum suffered terribly from this too so it might be genetic.

I am hoping if they think I need to do something they will agree to increase my utrogestan dose or agree to me taking it vaginally (very commonly done, but off license so some GPs won’t agree).

I've just read the document - am I picking this up correctly - I am on MJ 7mg at the moment, I take 2 utrogestan for 12 days a month. This research is saying I should increase the utrogestan (I really don't want to get a coil or use patches) but I couldn't work out by how much.
Is my GP likely to know, since this is so new?

Just to put two pence worth in. I was on gel and utrogestan until 2 years ago. I didn't want to change, but after having covid, it felt like my HRT at the time was no longer working. Covid has done this to me twice.
I was moved onto patches, reluctantly, however almost immediately felt like I had more energy and motivation. I believe it was the difference between utrogestan and norethisterone (the synthetic progesterone in the patch)

That's confusing me now as I thought that utrogestan was the best kind of prog!

I think the calming effect utrogestan has that works well for helping with sleep can work too well for some people and may cause tiredness during the day. Not sure if synthetic progesterone actually gives more energy but removing the utrogestan might if that impacted you, HRT has so many options with different positives and negatives that seem to need to be tailored to the individual

My gp didn't know but suggested three tablets instead of two as an option instead of patches. The guidance is clear that they don't know how much you need to increase progesterone by though