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

I think because it's body identical it is considered to be. It's not absorbed transdermally though so the only option with patches is a synthetic version. I'm planning to switch back to utrogestan eventually as I was getting on well with it

The guidance isn't new, they recommend extra precautions if used for contraception for the first four weeks of the wli and again with any dose increase to be advised for extra precautions again for a further 4 weeks.

@Onetwothreefour1234 it is the guidance for HRT that is new.

Thank you, I had misunderstood

https://www.facebook.com/OxfordMenopause/videos/1456671608826751/?fs=e&s=TIeQ9V&fs=e

This is really interesting. I’m on combined HRT patches - Evorel conti - and on week 4 MJ 2.5mg. I was very surprised to have a period after not having one for over a year. I hope it stops soon. I’m not having any other menopausal symptoms. So if I read right more progesterone could be needed. I do have progesterone tablets left from when I was on gel/tablets. Wonder how many have been affected and why this hasn’t come out before.

@Butterfly44 if you are on conti you get you progesterone through your patch, not orally so you are not impacted in the way the new guidelines are discussing.

But potentially either Mounjaro, losing weight or other non related changes in your hormones might mean your HRT balance needs adjusted.

Any post menopause bleeding needs discussed with your Dr and investigated to check everything is ok.

Ok, now I’ve read it properly, they suggesting oral not transdermal progesterone could be affected. As I’m on patches it might just be a coincidence I've suddenly got a period. Would be worth them doing a study as many on WLI are also on HRT.

@Butterfly44 I think you can report any side effects through the medication yellow card scheme and that allows them to build a picture outside of trials or might instigate more trials.

Please do contact your HRT GP as any bleeding means there has been changes in your endometrial lining that are important to get properly checked out.

I have just started a heavy bleed again (W6D3) after fist bleed/period (W4) which stopped last week. I am post meno on HRT. I have been to GP 2 weeks ago and she ref me to 2 week scan (no date yet). What are others going? Doubling oral prog dose?

I’ve only been on HRT since January and on same Mounjaro dose for 10 months.

I’ve had some bleeding but she wasn’t too concerned as said normal for first 6 months after starting HRT. Told me to let her know if I was considering changing Mounjaro dose and as I wanted to stay with body identical progesterone she would probably suggest trying upping utrogestan from 100mg to 200mg for the 4 weeks. She wasn’t keen on vaginally (don’t think many GPs are as informed on that method), but was going to speak to the relevant department for advice if I did want to up my Mounjaro dose, so no change for me for now unless bleeding continues beyond the usually HRT settling in 6 months.

just complicates if I want to up my Mounjaro dose at any point I probably need to wait 4 weeks for a Dr appointment 🤦🏻‍♀️

The meno clinic below explains recent advice from British Menopause Society which recommends either fitting a coil or doubling the dose of oral prog for 4 weeks if MJ users experience post meno bleeding. I am waiting to hear about a scan (should have been within 2 weeks) so might call my GP to ask if I can double dose of prog whilst I wait as the bleeding is very heavy and I feel bloated and uncomfortable.

https://www.dralicescott.co.uk/2025/05/01/mounjaro-wegovy-affecting-hrt/

Utrogestan can be taken vaginally (also rectally), bypassing the gut. Presumably absorption wouldn't be affected when administered that way?

I started both HRT including oral progesterone and estrogen gel and MJ the same week.
The only thing I would say is I am a slow loser.

I had my appointment with the doctor, to share the BMS's advice about doubling my dose of progestrogen. I have plenty of it in stock (somehow) and thought I just needed the 'go ahead'. He refused to discuss it as the MJ is privately prescribed.

My second period whilst on MJ is now two days overdue.

I have booked in with the receptionist for my annual HRT check-up. Again.

I feel disheartened and judged. It's like I'm a fat, middle-aged woman who is constantly told I'm overweight and need to lose weight (as if I haven't noticed and I haven't tried) but NOT LIKE THAT.

He's a Prat @Mounraine.
Go see another doctor in the practice if possible.
Or see the practice nurse. Mine does hrt reviews & was perfectly happy for me to take 2 utrogestan tablets. Failing that ask to switch to a transfermal patch comtaing both oestrogen & progesterone.I'm having issues with excess bleeding at the moment and asked to be referred for a scan. My practice nurse was very happy to do so.

I had a quick initial loss week 1 & 2 - then zero for 3 loooooong weeks followed by the unexpected heavy period for a week (already on HRT) - assume the plateau was PMS water rentention. Then it dropped off when period stopped and has continued (even though period is back again in under a week) - so totally erratic.

Thank you @Cantonet . I’m feeling pretty deflated with the whole thing. Starting to wonder if I should give up on Mounjaro and weightloss.

I've had a scan & now have to go for a hysteroscopy apparently. Due to a thickening of the uterine lining.
This can be caused by too much oestrogen or oestrogen only hrt. Anyone else had this issue?
I'm now taking 2 progesterone tablets a day rather than 1.

Yes I’ve had 2 since starting on HRT, both before taking MJ, both results were fine.
Ask for pain relief, I’ve had with and without pain relief and it’s not nice without.
I have been referred and checked since starting MJ due to heavy bleeding, but thankfully didn’t need a hysterectopy, I increased my progesterone for 2 weeks.
Since the recent change in guidelines about oral progesterone and MJ I now either take 1 tablet vaginally, which is a bit messy, or take 2 orally, I discussed this with my specialist as taking vaginally is an off license practise.

Hopefully they will find nothing concerning and it has simply been the reduced progesterone absorption during Mounjaro dose increases that has caused a thickening and the increase (or even a further increase) in progesterone will clear it up soon.

I know it is easy to say, but try not to worry too much, it really sounds like there is a clear and plausible reason for why bleeding has started. Hope the hysteroscopy goes smoothly💗

Yes I have had 2 hysteroscopies and biopsys (pre MJ) due to post meno 'spotting' following a scan showing thickened womb lining. I found the procedure uncomfortable but not painful - but it is very invasive and taking painkillers before is a good idea and have a restful day/evening after.

I am still waiting for a scan from bleeding due to starting MJ (was supposed to have come through in 2 weeks) - will chase GP tomorrow.

I’ve been on HRT for a couple of years and also taking MJ for the past 10 months. I’ve been stable on 10mg for months and finally just reached a BMI of 25. This updated guidance is complete news to me so thank you to @WeAllHaveWings as I haven’t been told anything by my MJ provider although I did tell them I was on HRT when I started.

I use Oestrogel and Utrogestan but seems that is a rare occasion when I may have got lucky as I started taking the Utrogestan vaginally before I started on MJ. I originally took it orally but 1)it makes me feel like crap and 2)I have a condition that can make swallowing difficult and the damn Utrogestan was always stuck in my throat. So I just switched to vaginal instead after doing my own research. I did tell my menopause clinic specialist at my last appt and she either didn’t care and/or wasn’t really paying attention as she didn’t have an issue with it.

My GP have contacted me and scheduled a phone appointment with the surgery pharmacist. It’s not for a couple of weeks though, so not urgent. I am on 1 oral progesterone a day since having the mirena coil removed last year.
I’m post meno and have been on MJ since February. I’ve not had any bleeding in that time.

I expect to be at goal weight within a month or so, so I will be reducing my MJ soon.

@HundredMilesAnHour Can I ask you a couple of questions about taking utrogestan vaginally?

I am feeling crap. Just wiped out, plus some other symptoms, but there are a few possibilities going on which I am checking with GP, but the Mounjaro which they don't prescribe so not as interested in complicates things - perhaps B12 deficiency from long term omeprazole use, perhaps utrogestan started, perhaps mounjaro, perhaps significant weight loss. Waiting for blood test results, but a couple of thought I have is trying B12 injections and utrogestan vaginally (GP not keen on this) to see if it helps.

When you take the utrogestan vaginally

1. Does it matter which utrogestan (there are two pack designs - one made in France the other from Spain) are they both ok vaginally? I know other progesterone isn't.
2. How to you insert it far enough, is there an applicator you can buy?
3. Do you also use Ovestin cream for local estrogen - how to do you manage progesterone vaginally and estrogen cream as I read they can't both be done at the same time as ovestin can impact progesterone absorption