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.

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Hi @WeAllHaveWings

My answers probably aren’t very helpful but will do my best.

1. I don’t differentiate between where my Utrogestan is made. Quite frankly after the shortages where I couldn’t get any for months, I’m just happy there’s some available.

1. I’m not aware of any applicators. I just use my finger and push as far as I can. I do it just before getting into bed.

1. I don’t use Ovestin cream. All I use is Oestrogel and Utrogestan as these are the least risky for someone with a family history of breast cancer (which I do have). Looking into trying testosterone but need to wait for my next menopause clinic appt for their decision now they have my blood test results.

thanks @HundredMilesAnHour

I use patches for my main estrogen (instead of your gel), then ovestin cream which is tiny dose of local estrogen for vaginal atrophy (dryness, itching, urinary tract etc), but because it is cream based if using both internally the ovestin can coat the vaginal walls and affect absorption. I'll need to work that one out before trying.

I wonder if it would even get absorbed vaginally with heavy bleeding?

I am on continuous progesterone so rarely bleed (a little but only because I am still in first 6 months of HRT) @Terrapinn , heavy bleeding would probably need to discuss with a Dr that supports using vaginally (not my GP!)

@HundredMilesAnHour can I ask you another question?

When you switched from oral to vaginal Utrogestan, how long did it take for you to feel "not crap"? Just wondering if I give it a go vaginally how long I should give it to see if it is the problem.

@WeAllHaveWings I felt much better within a couple of days max. I was so relieved as taking Utrogestan orally just made me feel rubbish.

For a while when there was a Utrogestan shortage, I took synthetic progesterone orally and I felt fine on that but obviously that was no good given my breast cancer family history. But Utrogestan made me feel ill and it was obviously that as once I swapped to vaginal, I felt normal again.

Hope it works for you too!

Thanks @HundredMilesAnHour may give it a go starting tonight!

Just re-ordering my next pen and this message popped up from the pharmacy:

"Weight loss injections can make oral progesterone like Utrogestan® or Gepretix® less effective. To keep them effective and reduce the risk of womb cancer we recommend an adjustment. What this means for you: From now on, instead of swallowing your Utrogestan® or Gepretix®, insert it into your vagina. The dose stays the same. This is not a licensed use, but it is commonly recommended in clinical practice. How to do this: Insert the Utrogestan® or Gepretix® capsules high into the vagina using a clean finger, ideally while lying down or squatting. Do this once daily at bedtime. You will need to wash your hands before and after use. Other options that you can discuss with your GP include dose changes, the Mirena® coil, or a combined HRT patch."

Thanks for sharing this

I've been changed to generic progesterone capsules does that work too does anyone know, they can't seem to do Utrogestan anymore.

@Terrapinn thanks for sharing. Which provider is that from?

It is great they are proactively engaging with the new advice, and while I don't disagree with their advice and it is what I will probably look into doing if I need to increase my Mounjaro dose, it is interesting that they are instructing patients to administer medication prescribed and supported by their GPs in an off license way without asking them to speak to their GP.

Most GPs would say no to vaginally (many are not aware of using this way) and offer a different solution, mine has said they will double my progesterone for 4 weeks if I want to increase Mounjaro (as per the PCWHS guidelines). They also don't seem to have mentioned any of the alternative options. It feels a little like the pharmacy is over stepping the boundaries and not giving all the information needed.

It also leaves the patient in an awkward position if they experience any side effects or symptoms using vaginally (irritation, thrush, unusual bleeding etc) and having to fess up to their GP.

@WeAllHaveWings that was from Pharmacy2U

the capsules are so small I feel they would just roll out again 😃

@Orangesandlemons77 I think the genetic is pretty much the same contents just not branded and cheaper for the NHS, it certainly looks the same in the packet (although I haven’t opened them yet).
@Eggtoastie I’ve never had them fall out but I do find I get a little bit of discharge, as they seem turn to a liquid as they dissolve.

I inserted my Utrogestan vaginally last night for the first time. I used my Ovestin applicator which it nicely fits in the end of so I could insert high up. I can't imagine what it would be like chasing the little round capsule around and trying to push it far up with a finger!

I did waddle gently to the en-suite after with thighs tight together to wash applicator incase it fell out again 😂

Utrogestan and apparantly Gepretix (from the Pharmacy2U alert above) can be used vaginally because the capsule coatings are suitable for this. Any other brands should be checked to ensure they will dissolve and absorb properly - I think I read in the MN menopause board several are not suitable for vaginal use.

I still haven't worked out what to do on days I use vaginal estrogen cream too.

I might ask the GPs what to do about this, there is one who has an interest in menopause.

Mine just says "progesterone" now

My gp has sent out a warning about this and requested I make a medication review. Would love to know what they'll advise - I'm hoping not giving up either MJ or HRT!
I can increase my dose but how much by? I don't think anyone knows do they?

Hi thanks for your post. I am waiting for an appointment about this. I have doubled my dose of progesterone ( utrogeston ) to 4 tablets for the 2 weeks on in until i speak to my dr. I had the vaginal ones before to try but they were very messy and smelly. Im hoping i can switch to a patch?

What I really don't like is that I can't tell if my womb lining is thickening, aka if the progesterone is working.
Or is monthly bleeding a sufficient sign?

I had my hysteroscopy yesterday & was asked whether I wanted a mirena coil & whether I wanted to continue to be on hrt. The doctor then said something about a possible hrt holiday.

Yes im wondering this too as i really don’t have a clue.

An HRT holiday makes it sound like fun!!

I don't think it will be fun for me. I'm really not looking forward to the associated night sweats & anxiety. Even before I increased my utrogestan dose to two daily I had a return of the night sweats. I think I'd rather agree to a mirena.

Can i reassure & say the hysteroscopy itself was fine. I had very little pain with a gel local & 2 ibuprofen pills taken an hour before.

The PCWHS link has suggested increases of oral progesterone doses in it. There is also the option to switch to an non-oral alternative - patches, IUD or vaginally. Giving up either MJ or HRT would be the very last option.

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