Women who can’t get their usual hormone replacement therapy (HRT) because of shortages shouldn’t worry about switching to products that aren’t in short supply, top menopausal doctors have advised.
According to manufacturer Besins, demand for one HRT drug, Utrogestan 100mg, has doubled in the past 12 months and has increased fivefold since March 2021.
The surge has caused supplies to run out in some areas, and last month the government issued a severe shortage protocol restricting pharmacists to prescribing no more than two months’ worth of capsules.
The British Menopause Society (BMS), representing leading treatment specialists, has now issued guidelines proposing alternative medicines for women to use.
“Women needn’t worry if they can’t get Utrogestan as there are quite a few similar drugs that GPs can prescribe that do the same thing,” said Dr Paula Briggs, chair of the BMS and a consultant on sexual and reproductive health.
Stocks of popular HRT pills like Utrogestan, pictured, are running out, leading the government to implement a Serious Shortage Protocol that restricts pharmacists from prescribing no more than two months’ worth of capsules
HRT usually consists of two female sex hormones, estrogen and progesterone, taken together. Some forms of HRT combine both hormones in a single pill or patch, but it is more common to take each separately
HRT usually consists of two female sex hormones, estrogen and progesterone, taken together. Some forms of HRT combine both hormones in a single pill or patch, but it is more common to take them separately.
Estrogen-only HRT increases the risk of thickening of the lining of the womb ? known as endometrial hyperplasia ? and even cancer of the womb. Progesterone significantly reduces this risk.
Utrogestan contains micronized progesterone, which is identical to naturally occurring progesterone produced by the body. Other similar drugs contain synthetic versions known as progestins, and the BMS advises taking these if utrogestan supply is a problem.
“The most important thing is that women continue to take something to protect the uterus,” says Dr. Briggs. ‘There is a very small increased risk of blood clots and breast cancer with progestins, but it is almost negligible, especially if it is short-lived.
“The shortage of Utrogestan will probably be solved by the end of this year, so in the meantime we advise taking one of the many alternatives.”
The BMS advises: ‘Alternative progestin options are norethisterone 5 mg per day and medroxyprogesterone acetate (MPA) 5 mg per day, for those on estrogen replacement therapy.’
There is also the option of switching to oral HRT, including Bijuve and one of the Femoston range, both of which contain the two hormones combined, it adds. An intrauterine system — known as a coil — containing the progestin levonorgestrel is another choice.
Some social media private doctors have instructed women to ask for Cyclogest, a drug used in fertility treatments that also contains micronized progesterone.
But the new BMS guideline states: ‘Cyclogest is not licensed [use in HRT] and there is no evidence to support its use over the synthetic progestins, especially as it will not be available from most NHS GPs.’
Cyclogest is administered through a pessary that is inserted into the vagina. Dr Briggs said: ‘It often causes a lot of discharge which is not pleasant. It has also never been studied for use in HRT, so we don’t know how well it protects the uterus.’
Progesterone can cause side effects in some women, including mood swings, breast tenderness, bloating, and digestive problems.
While micronized progesterone is “the closest thing to naturally occurring progesterone,” Dr. Briggs says there’s no evidence that women feel any different while taking synthetic progestin, especially in the short term.
“If you’re running low on Utrogestan, you can switch straight to a progestin and it shouldn’t make any difference,” she adds.
In April, the BMS issued a warning in response to a MoS study which found GP Dr Louise Newson, who runs the UK’s largest private menopause clinic, was reportedly ‘prescribing higher-risk’ doses of estrogen HRT than the permitted doses .
It said: ‘Estrogen should not be prescribed regularly in doses higher than the upper one [licensed] limit’ to ‘ensure patient safety’.
Dr. Briggs says, ?If women are taking very high doses of estrogen, they need to take double the amount of progesterone to protect the uterus. At larger doses, the drug is more likely to cause side effects.
“Any woman taking estrogen HRT at the maximum allowable dose or higher should talk to their doctor about exactly why they got so much and discuss any risks.”
Women urged to seek alternative HRT medication as pharmacists warn of shortages