HRT (progesterone tablets) affected by GLP-1 injections?

[Calyx72]

I have started on Mounjaro yesterday, got my pen from MyLondon Pharmacy. The clinician check went straight through with no delay but I got an email saying I need to discuss with GP as I am on progesterone capsules for my HRT (as well as oestrogen gel). These were changed to continuous about 2 months ago so I am still getting short periods.

I am planning to speak to the GP after this (bank holiday in Glasgow) weekend but I took the first jag yesterday and today I have started a period (or got a bleed at least). Has anyone had this and spoken to the GP? I am worried they will take me off HRT.

(MyLondon Pharmacy email said oral progesterone is affected because the slowing of the gastric emptying can apparently affect progesterone absorption leading to risk of endocrine cancer through unopposed oestrogen intake.)

Hmm, it's important to get enough progesterone but there are other ways to get it. There are patches that contain progesterone, the mirena coil or progesterone taken vaginally. Avoid progesterone creams or gels as these are not effective.

@Calyx72 If you search there are threads on this already.
You can also search places like the menopause society for latest advice.
Oral progesterone is considered a problem due to the delay in passing through the stomach, so it may mean it’s not as effective. The guidance is to increase the amount you take or switch to a non oral method.
Personally I now take it vaginally, which is an off license practise, but approved by my private meno Dr, however I’m now in maintenance and on the lowest dose of MJ, so not going up in strength and do not want to mess around with my HRT.
There is no need to come off HRT there is lots of research that WLI and HRT work very well together.

Mine was changed by my GP to daily rather than weekly. It also effects the contraceptive pill, so you should speak to GP asap.

Thanks all. I tried searching but am on the app on my phone and couldn’t see anything relevant on the results that came up (never managed the search on here!).

Hopefully I can just increase the amount I take as my skin doesn’t tolerate any patches and I am not keen on the coil. Contraception not a problem (unless my husband and I get slim enough to dtd again haha and I was unable to get pregnant when we were dtd back in the day). Really appreciate the replies thanks again!

@Calyx72

https://www.mumsnet.com/talk/weight-loss-injections/5316957-wlis-and-hrt-oral-progestogen-recent-guidance-from-bms-concerning?reply=143616624

This was an older post

That’s super helpful thank you!

You are supposed to up your dose of oral progesterone for 4 weeks every time you go up a dose of mounjaro. That's what my GP said last week. Unfortunately, the previous GP I spoke to about it a couple of months ago wasn't interested at all, pretty much ignored the fact I was on mounjaro, and kept me dose the same.

I'm now on a steady maintenance dose of 5mg. However, I've not had a period since July (peri-menopausal) and so because of this, and the fact the previous GP didn't increase my dose of progesterone whilst I was going up the doses of mounjaro, she has referred me for a pelvic ultrasound. She doesn't think there will be any problems, but just wanted to double check.

Ironically, my appointment last week wasn't even about my HRT, it was about something else. However, this GP is extremely thorough (the only one in the practice who is it seems), and it came up when discussing the issue I'd actually contacted them about. She is also the menopause lead at the surgery (and the head GP). I did request her last time, but was phoned by a different GP, but I will go back to insisting I speak to her in future.

I can't use patches as allergic to adhesive, and don't want a coil.

Gosh glad you got the knowledgeable GP and they are checking you out @macandcheeseforthewine
Fingers crossed for all being well.
I am the same with patches and the coil.
Reading the linked thread I have seen recent guidance for GPs so I will mention it to mine when I get an appointment. I will take 200mg instead of 100mg every night till then though.

My provider told me, as part of the screening process, that as I was taking micronised progesterone I need to take it vaginally rather than orally. I had to check a box to say I would.

I recently had an appointment with a prescribing pharmacist who runs the local NHS menopause service and she said to take extra oral progesterone due to being on GLP1s. It was also a screening question on the online consultation form.

I find this really odd, ethically, that they are recommending you take vaginally rather than recommending you discuss with your GP.

A pharmacist surely cannot change the route of administration that was issued by a Dr without consulting with the prescriber.

Or an online Dr is breaching professional boundaries if they override a GPs prescription instructions with instructions that are off license. Especially if that online Dr is not a menopause specialist.

Where do you go if you start having problems with your HRT - the GP who prescribed orally or your online provider who has changed that prescription?

Yup, my menopause GP told me that when I start taking the injections I need to make sure I let her know so she can up my progesterone as apparently I'll need a higher dose as otherwise it loses effectiveness on the injetions. So I imagine that's what your Gp will do.

I’m contemplating starting mounjaro and am on HRT. Already take my progesterone vaginally so hopefully won’t be an issue. But why is this not thought to be an issue with any other group of medicines? Will someone’s blood pressure tablets statins or antiplatelet agents not be equally affected? 🤔

There have been no studies carried out as to how much the progesterone needs to be increased by to make it effective when using MJ. The suggestion is to double the dose, but there is no data to support this. There are however studies to show how vaginal insertion is an extremely effective and efficient form of delivery.

@Deanefan good question, it may be other meds are affected and it’s not being noted?
I suppose because progesterone is taken to work alongside the oestrogen to prevent the build up of the womb lining it’s something that is already quite well monitored, similar with birth control pills, so maybe that’s why it’s been picked up on.
Also some endocrinologists deal with WLI and menopause so are more aware of issues.