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HRT Preparations: Progestogens


PROGESTOGENS - Progestogens are given with estrogen to protect the womb lining from becoming thickened from stimulation by estrogen. Progestogens are generally not required after a hysterectomy (removal of the womb). (See Menopause and HRT after hysterectomy)

In the Perimenopause, progestogens are given for part of each 4 week cycle of estrogen, leading to a 4 weekly bleed in most users. This is known as “Sequential” HRT.

Please note: Patients should consult a health professional to decide on the appropriate treatment option to be prescribed.

As well as being given as part of a ready made combined therapy, the following progestogens can be given with estrogen only regimes:

PROVERA -
also available as Climanor (5mg tabs)

MPA 10 mgs daily for 14 days per 28 days £3.27 for 28 5mg tablets
UTROGESTAN micronised progesterone 2 x 100mg daily at bedtime for 12 days per 28 days (days 15-26 inclusive) £4.28 for 15 200mg capsules

Careful explanation is required as to the timing of administration of the separate progestogen, in order to synchronise it with the existing cycle.

In the Postmenopause, progestogen is given every day along with the estrogen. This is known as "Continuous Combined" or "Period-free" HRT.

PROVERA

Medroxyprogesterone

2.5 or 5 mgs daily

 

UTROGESTAN

Micronised progesterone

100mg at bedtime from day 1 to 25 of each 28 day cycle

£4.10 for 30 100mg capsules

With continuous combined HRT, some bleeding in the first few months of treatment is quite common, but should have settled by six months. Any bleeding persisting beyond 6 months of continuous combined therapy, or bleeding occurring at a later date, should be investigated.


MIRENA
Mirena is a levonorgestrel (type of progestogen) releasing system which sits inside the womb, gradually releasing the progestogen into the womb. It is licensed in the UK and Ireland as a contraceptive agent, for treatment of heavy periods and, from August 2004, also for the progestogen component of HRT. It can be used in both the perimenopause and postmenopause and it is particularly useful for:

  1. Persistent progestogenic side effects from systemic HRT despite changes in type and route of progestogen.
  2. When contraception is required along with HRT in the perimenopause.
  3. When withdrawal bleeds on sequential HRT are heavy, after investigation if indicated. (see WHEN TO BE REFERRED )

With Mirena in place, systemic estrogen alone can be taken as the Mirena provides adequate protection of the womb lining and the estrogen dose and route can be tailored to meet the individual's needs.

Progestogenic absorption throughout the body is minimal so reducing progestogenic side effects. The effect of Mirena on the womb lining can significantly reduce bleeding and when used as part of an HRT regimen, in time, 30 to 60% of women have no bleeding at all. Although Mirena used for contraception is licensed for 5 years, the license for use for the progestogen part of HRT is currently 4 years.
Price: £88.00

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Page last updated: 16 February 2015

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