Monjaro and HRT?

[ArtesianWater]

I'm about to start Monjaro and targeting a much-needed four stone loss. I am buying it via a private online pharmacy and the screening did not ask me about HRT. I'm on oestrogen gel and oral progesterone for peri symptoms; previously I had patches and they didn't work as well as this combination.

Does anyone know if the Monjaro can interfere with HRT? Should I be seeing my GP before starting or is there a way to combine the two? I'm sure this must be relevant for many women who want to use WLI.

I had unexpected post menopausal bleeding the third week I took mounjarno. I was also on oestrogen gel and oral progesterone. My GP advised that mounjarno slows down the absorption of progesterone and advised me to double my dose. I stopped my HRT until I had further investigations which revealed I had polyps which could have caused the unexpected bleeding. I have decided not to use HRT whilst taking mounjarno. I would suggest you talk to your GP before starting mounjarno if you want to combine the two as they may advise you to change the dose of your HRT.

Hello @ArtesianWater

I would advise you check with your GP. I take combined HRT tablets and have found them to be less effective, due to them being absorbed in your stomach and Mounjaro slowing digestion therefore slowing HRT absorbtion.

This can be particularly dangerous for progesterone absorbtion as if progestogen from oral HRT isn't properly absorbed, your womb lining may not be adequately protected.

I'm switching to patches at the end of my current packets of tablets as I'm defo feeling peri symptoms, I'd forgotten how crap they are!

NHS England has some information here https://www.england.nhs.uk/ourwork/prevention/obesity/medicines-for-obesity/weight-management-injections/

"If you’re using tirzepatide (Mounjaro®) and taking hormone replacement therapy (HRT), you should consider using patches or gels which are absorbed through the skin. This is because your body may not absorb the HRT whilst using tirzepatide (Mounjaro®). For more information about taking tirzepatide (Mounjaro®) and HRT, speak to your doctor."

Hope this helps x

Yes it can affect the absorption of oral progesterone. There have been a few post here on MN about it, if you do a search,
you can also find info on The Menopause society website, or your provider might have info, I’m with Oushk and they have info on it.
Personally I now take my oral progesterone vaginally which works for me, but I’m in maintenance and just take 2.5 MJ and not going up the doses.
You need to discuss with your HRT provider.

On a side note, there is lots of research showing the GLPs work very well alongside HRT so I would suggest you get good advice to make sure your progesterone works, but would not advise coming off HRT.
if you want good professional info, on GLP and HRT I’d suggest following Dr Susan Brian on Instagram (susanbrianmd)

I’ve moved from oral progesterone to the combined oestrogen and progesterone patch due to Mounjaro slowing the absorption of the oral progesterone. My GP wouldn’t prescribe me more oral progesterone without a move to the combined patch

Sorry should be saying WLI (instead of GLP).

I recently had a check up & review with my HRT specialist. We discussed the fact that Mounjaro could slow down the absorption of oral progesterone. As I am already on the upper dose, taking it every day, and have not had any changes with intermittent bleeding etc, she was very happy that there was nothing to be concerned about. So I am continuing with the Estrogel and oral progesterone regime.

Same as @MagnoliaTreePetals
I Have been taking mounjaro since january, and have stayed on 5mg since february.
My GP is happy for me to take the oral progesterone, but I need to speak with them before I go up a dose of mounjaro. I don't intend to go up, as in maintenance now.

That’s odd, I have never not had to fill in a medication section when ordering MJ. I have been on it almost a year now and used a variety of pharmacies. Are you sure it’s absolutely legitimate?

I've had to fill out a medication section with every pharmacy I've used, and have also used a variety of pharmacies.

In relation to oral HRT - if it's oral progesterone then you could use vaginally instead (check with GP first) as this removes the need to increase the dose. If you don't do this, then I was told by my GP that my oral dose should have been doubled each time I went up a dose for 4 weeks. Unfortunately, the previous GP I had seen to actually query this didn't bother doing it, and just kind of ignored the query. The GP I saw a couple of weeks ago (wasn't HRT related but we got chatting about it) wasn't too impressed that the previous GP had ignored it.

It's possibly my mistake. There was no question about HRT under the long list of other conditions / medications but there could have been an 'anything else' box that I failed to tick (I never think of HRT as a 'medication'). It was only when I started reading more in preparation for starting the jabs that I found the guidance on HRT. It sounds like I should check with my GP before starting and do something to tweak the oral progesterone, but that otherwise it will be fine.

Just a reminder that both your HRT and mounjaro should be declared on your travel insurance as well (well, obesity rather than mounjaro itself). A few horror stories around of what could happen if you don't!

Most of the info are in these links released in April.

https://thebms.org.uk/wp-content/uploads/2025/05/23-BMS-TfC-Use-of-incretin-based-therapies-APRIL2025-E.pdf

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

You will need to speak to your GP about switching to non-oral progesterone or increasing your oral progesterone dose when starting Mounjaro or at each Mounjaro dose increase.

Options for non-oral include patch, IUD - both will not be body identical/micronised progesterone or possibly taking micronised progesterone vaginally - but many GPs aren't keen on that.

I’ve listed my HRT with both pharmacies I’ve used (started in June 2024) Superdrug and Oushk, I though they all asked if you took regular medication?

@WeAllHaveWings these are very helpful, thank you. From reading I think I only need to increase my oral progesterone tablets by the listed amount in the paper. I might trial this while waiting for a GP appointment, which tends to take weeks with my practice.

I might have worded my comment. Badly here because that’s what I’m saying - you have to fill out the meds you are on

I'm at the point of looking at starting HRT and the nurse recommended I have the progesterone via the mirena coil rather than orally because of the absorption thing, I think she said I'd have to have a higher dose because of the mounjaro or something.

I'm not aware of it interacting with oestrogen gel.

The paper linked by @WeAllHaveWings provides good advice. I don't want a coil fitted but increasing oral progesterone would be an easy change.

👍
Glad you've clarified things

As an aside, the coil seems like a good option for me as my periods are ridiculously heavy.

I was nervous about insertion but literally didn't feel a thing

I believe the advice was to increase the dose of oral progesterone within 4 weeks of starting or increasing the dose of Mounjaro. Please someone correct me if that is wrong and advice has been updated.

I've not increased from 2.5mg Mounjaro, so I have just kept my progesterone dose the same. No changes in bleeding etc.

I’m with MedExpress and via them my GP rang me and advised me to switch from the gel and oral progesterone to the patches and obviously I took that advice.

I definitely have, from Asda pharmacy and chemist 4 u.

Yes that’s what I was saying I just worded it really clumsily. Every pharmacy I have ever used has a box to add meds you are on, hence I was asking if OP ordered from a legit place. Turns out she just didn’t fill it out properly.

I spoke to the menopause clinic that I am under as I was concerned about this. I’ve just this week started on 2.5mg of Mounjaro. I’m currently on Oestrogel, Utrogestan (progesterone) and testosterone for HRT.

The doctor I spoke to was aware of the recent BMA guidelines, but she said they are just a precaution and there is no actual evidence for this. After extensive research her company has done both in the UK and after speaking to their US colleagues, they have decided that their advice to HRT clients on WLIs is to continue 1 oral tablet of Utrogestan (progesterone) if that was their current dose. If there is any spotting or breakthrough bleeding then her advice was to double the dose to 2 tablets per evening for 4 weeks and after that move back to 1 tablet.

I’m glad I spoke to her as I was a bit concerned but I’m going to stay on 1 tablet as per her advice and take it from there.

Thanks @VioletandMauve. I've scheduled a telephone appointment with my GP to discuss it but have a couple of weeks to wait for that. I've decided to hold off on starting the jabs until then although it's a bit annoying. Good to know the response that you had.