Your first sentence:
"I am intolerant to the Utrogestan I have been on for two years continuously (have felt absolutely terrible on it) and want to firstly, change the Progestin to one that makes me feel less unwell every day."
I understand this - there is no way I would take Utrogestan, or any progestogen every day due to the side effects.
Some questions:
First - it would be good to know if you are peri- or post-menopausal, if you know, or if you don't, what your periods were doing during the 12 months or so leading up to your starting HRT?
Second what type and dose of oestrogen you are taking?
Third whether the regime you were on for two years controlled your bleeding - and that may well be largely determined by whether you are post-menopausal or not?
To answer some of your specific points:
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Could Norethisterone be used as the Progestin part in HRT and at what doses?
Are there any contraindications or disadvantages using Norethisterone this way?
Would this also be an acceptable regimen to the well known menopause doctors and clinics I'm hoping to consult with next month? "
As you see from the answers - norethisterone is aready used as the progestogen part of HRT - but only in combi preparations, ie as a patch Evorel conti (or sequi), or in tablet form - in various brands you can find in the HRT menus on this site.
You've said you tolerated norethisterone in the past, so depending what type and dose of oestrogen you are taking , and whether you are peri or post-menopausal, one of these may suit you. The problem is the dose is fixed so if you are on a higher oestrogen dose then this is impossible.
Norethisterone is available separately off-label (not exactly though) as part of HRT. The BMS does recommend it - obviously as it is used as part of HRTin combi products. The problem is that the dose available for gynaecological problems, is 5 mg tablets, which is much higher than the 1 mg that is part of medium dose HRT tablets. For those who are progestogen intolerant, this is far too high. However if you tolerated it, then this could be an option.
Because it is not available separately then your doc might not prescribe it - but this would be not very enlightened since it is already used as part of HRT, though not trialled at higher doses. It's clearly going to be effective at higher doses though. just potentially undesirable.
You most definitely should not have to pay for private treatment to get norethisterone should you want to try this as a separate progestogen. Dotty gave you the BMS link and you can just remind them that it is in use as a combi product.
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Also hoping that whoever I talk to will agree to a longer cycle of say 6 weeks or a three monthly cycle.
NICE seems to imply here that three monthly cycle is OK for those who struggle with Progesterone - see here - https://cks.nice.org.uk/topics/menopause/prescribing-information/hormone-replacement-therapy-hrt/#adverse-effects
What would be the doses of Norethisterone needed for a 6 week or three monthly cycle and the amount of days one would need to take for with each cycle?"
As already stated the 3 monthly regime is the proprietary branded product Tridestra. The BMS recommendations do not even mention longer cycles which seem to have fallen out of favour, I think due to evidence of some adverse effects? Some of us are on longer cycles approved by our doctors - mine is through a GP on NHS. No need to go privately though I appreciate some practices do not appear to have sufficient expertise ( shame on them!). You could write an e-mail (£30 per question) to Dr Currie - manager of MM, and then take her reply to your doc. I did this once
The amount of days per cycle of progestogen recommended is 12-14 days per month depending on the progestogen, though for lower doses of oestrogen BMS for example suggest minimum 1 mg norethisterone per day for 10 days per month for low dose [ie lower dose oestrogen] sequential preparations.
A 3 month cycle would not be recommended for higher doses of oestrogen, I doubt, due to risk of endometrial thickening and I'm not sure that any specialist would suggest this nowadays, even private docs, though they might permit 2 monthly cycles with scans?
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...since I saw she had been prescribed a bespoke Progesterone from her clinic in London who sound like they really listen and treat the person as an individual rather than prescribing the same thing for everybody."
Obviously, those who have the funds can afford to pay for the longer appointments where they have time to be listened to, which is very sadly lacking in NHS - of course we should have a menopause clinic in every town!!!
Bespoke progesterone from private clinics - this is not licensed nor regulated and not recommended by the BMS - because the products are not consistent and have not been tested and it is important that the womb is protected. What works for one woman may not work for another. Also very expensive. I can't advise here other than put across the recommended view of the medical profession as stated here and at BMS.
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Is there a way of tagging members here to attract their attention, there doesn't seem to be a way of doing that hence me writing the names of two members here whose posts seemed relevant and knowledgeable (hope you both don't mind!)"
I don't mind but someone had to write to me to alert me that my opinion was being sought. However once you have made 10 "useful" posts, you can send private messages and that way you can write to whoever you want to - I see you can do that now.
I'll answer your later posts on another thread. This one's getting long
Hurdity x