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[Hurdity]

Ladybt28 - I don't know, but I suspect that the reason utro has been stopped for hrt use is because it's original use is intended to save lives, ie. support pregnancies and saving lives would be part of the criteria used to reach a decision. I'd imagine utro is not the only pharmaceutical to be targeted in this cost cutting exercise but it can be replaced, without risk to life.

Um -  Much as I am totally in agreement with simple measures like this (progesterone) to help women whose pregnancies cannot be maintained without it (and who wouldn't be?), it is not life-saving medication in the same way that many other medications are - even without considering ladybt's view she articulated very well and which I hinted at re mental health - a group you said the Scottish govt are prioritising. Fortunately there are numerous alternative progesterone preparations available to support the pregnancy for the minority of women who badly need it, and the quantities (doses) used for this purpose far exceed those for HRT - probably about 3x the dosage per woman. However there are no licensed alternatives to utrogestan for hRT purposes.

Hurdity x

[Hurdity]

Hi again Ladybt28,

Utrogestan has already been given a green light on NSH Grampian, so no, it's not being denied, it's just a matter of priorities and resources, but it is available for menopausal women.

https://foi.nhsgrampian.org/globalassets/foidocument/foi-public-documents1---all-documents/fgd201909.pdf

I don't want to sound confrontational, so I won't post on this thread any more, I think it's easier to generalise and suppose than to investigate and understand exactly what are the real facts.

Clovie has mentioned that she has been prescribed Utrogestan by a specialist and only been denied it by her GP, so all I have said makes total sense.

Hi Choc Ice 

Thanks for this!
Hardly a recent thing is it? I've been with my GP for FIVE years now and just now mentioning it. Hence I think it's a cost cutting exercise perhaps!

My Utrogestan was actually prescribed by a meno specialist at a clinic so I'm hoping I can keep it.
Either way I'll be arguing my case for keeping it!   

Edited - please could you give me a link to the Tayside info? Thank you in advance

BeaR.

The thread has developed since clovie's original post and what ladybt (and I) are taking issue with is kilted Cupid's speculation as to the reasons for the Scotland NHS decision (whatever that is!) not to recommended Utrogestan for menopause purposes (or withdraw it?), and her subsequent judgement and comments on that supposed reason, as well as the tone of some of these comments!

As it is – we have not seen (on this forum) any very recent communication or statements from NHS Scotland indicating either that Utrogestan is dangerous/unsafe nor that it should not be prescribed even as second line of treatment. In fact the recent letter I linked to in relation to the HRT shortages implies that Utrogestan can now be considered if alternatives are in short supply – and this is, in any case, in my view,  allowed for in the post-script of the 2009 statement not recommending Utrogestan (on cost grounds) while acknowledging that it has equal efficacy compared with other progestogens ie perfectly safe. Recent letter: https://www.sehd.scot.nhs.uk/pca/PCA2019%28P%2918.pdf

I imagine that the addition of utrogestan to the updated Grampian list you linked to bear (17th Sept)  might have been made as a result of the letter from NHS Scotland (26 Aug). https://www.sehd.scot.nhs.uk/pca/PCA2019%28P%2918.pdf

I would urge anyone encountering a problem to draw the attention of their surgery/local practice to this letter - in case it does any good!. Anyway, once again, even if it is not on the local formulary list we still haven't had an answer whether a doctor (ie local GP) can override the local recommendations as they can in England, which the wording of the 2009 ruling implies they can, as well as the experiences of many on here - that they are happily obtaining utrogestan from their GP.

Also bear - clovie has been getting it for FIVE YEARS from her GP and we have had no good reason for the recent suggestions apart from incorrect stats - which sound like the opinion of that particular doctor, as there is no scientific basis for it.

Also - it should be available as FIRST line of treatment - to women who would like it, without having to wait for an appointment at a menopause clinic ( unless these are more numerous and with shorter waiting lists than England?). if it's just a question of a letter - than that would be no problem - but you have to have the support from the GP so better that they have the power to say yay or nay, provided one can argue one's case, and the local formulary guidance can be overriden.

I know I keep saying the same things but it is a matter of principle as well as process - and the latter is still not clear.

Clovie - did you guess your post would create such a lively discussion?! 

Hurdity x

[Tracey E]

Just to change the conversation completely my friend went through IVF twice. Both times she took Utrogestan and she's has now been diagnosed with breast cancer and has had to have her breast removed. No previous family history of the disease and she wasn't on the pill previously either. Quite scarey she's convinced it's the Utrogestan that's caused it.

[Hurdity]

In terms of alternative progesterone, I'm going to ask my gp for Lutigest or Crinone gel if she can't give me utro and I'll post her reply so other members can be updated. I've only just started a new utro regime as my preferred hrt is no longer available, I'm not happy about that but once again, what can I do? I just have to pick my way through as best I can.

I have posted further on the Lutigest thread about this kilted Cupid - as I have found more information which I thought might be helpful. It's not long 

Tracey E sorry to hear about your friend and I hope she is in remission. It is never possible to establish quite what the cause is of that dreadful disease, breast cancer. All we can do, if we want to take additional hormones for whatever reason, is to minimise our risk from other factors, ie re weight, alchohol, diet and general fitness. Genetic factors one can't do anything about except preventative surgery. However I don't want to dwell on BC as it's going away from the subject of this thread but I hope she managed to achieve a pregnancy. 

Hurdity x

[Tracey E]

Yes she did Hurdity two lovely children..

[KiltedCupid]

Great news! I've just returned from my GP (in NHS Lothian) and Utro can be prescribed for ladies who can't tolerate any other type of prog. You'd have to have a really difficult GP to not prescribe it for you if it's your preferred prog and you get on with it.

So, ladies of Scotland, fear not, you can get your Utro if that's your choice.

[Hurdity]

Dandelion - I've put your post onto this thread as it's about the availability of Utrogestan which is what your question is about. Most of the post refers to Scotland but England is referred to ( and it gets a bit heated  ) but I think the main points are there. In other words whatever the formulary says, as far as I know you can be prescribed Utrogestan by your doctor and do not need a specialist - as long as they can justify it in their notes on your record - which they can in your case. None of the HRT products I use im England (except for vaginal oestrogen) are on our local list and that probably is the case for many women on here. I wasn't even aware of formularies  or CCG Guidance until it was brought up on here and then I had a look! Please do not fret!!

Hurdity x

I found Emma's link on twitter - thank you! It explains why a lot of us who want Estradot have 'been able to get' Estraderm (as if it's a luxury!)

Estraderm is awful. The 75mcg is a massive patch 5cm x 5cm and no wonder Estradot is preferred.  I bet all this Estraderm was ordered at the same rate as Estradot but sitting on the shelves, unprescribed as Estradot was prescribed more and more. 

Now that the NHS has put anyone off even selling HRT to the UK what we've got now is what was left on the shelf.

It's bad enough that in many areas Utrogestan is on the RED list of the CCG Formularies defining it as specialist prescription only. Then nationally they go and move all the HRT into the fixed price cupboard making it pointless supplying it.

I can't tell you how mad I am. It doesn't help that my husband gently stroked by thigh when I got into bed and the stupid Estraderm rolled right off my leg. I couldn't be bothered to get out of bed to put another one on and ended up going 12+hours without it and I've had a very frustrating powerless and tearful afternoon whilst negotiating the sale of a house (I'm an estate agent) and writing oodles of letters to all sorts of people. Thank goodness this is my own business!

Hi I'm writing about the bit of your post that I have bolded.
I am addicted to valium and take 200mg utrogestan daily as it is cross tolerant to valium.
For this reason I cannot take a cheaper progestin as it will mess up my GABA receptors with disasterous results.
I read that red list drugs are hospital only prescriptions and it takes ages to get a hospital appointment in my area.
I am worried about running out of utrogestan, the menopause expert Elizabeth Vliet says it is like a strong benzo, so altering my dose or removing it will either have disasterous effects or it will kill me.
I cannot order online because no one takes conti progesterone 200mg daily, so the online doctor will not approve it.
I don't know if it is on the red list in my area. I tried to check online to see if it is on the red list in my area but I can't check. I think it needs a clinician to check.
The independent pharmacy don't sell utrogestan.
What am I to do?
I can only order so much at a time, and worried that when I come to order it next on 3 Dec I will find that it is on the red list.
What is the way forward?
I'm too young to die or suffer disasterous consequences by changing from micronised prog.

[Dandelion]

Dandelion - I've put your post onto this thread as it's about the availability of Utrogestan which is what your question is about. Most of the post refers to Scotland but England is referred to ( and it gets a bit heated  ) but I think the main points are there. In other words whatever the formulary says, as far as I know you can be prescribed Utrogestan by your doctor and do not need a specialist - as long as they can justify it in their notes on your record - which they can in your case. None of the HRT products I use im England (except for vaginal oestrogen) are on our local list and that probably is the case for many women on here. I wasn't even aware of formularies  or CCG Guidance until it was brought up on here and then I had a look! Please do not fret!!

Hurdity x

I found Emma's link on twitter - thank you! It explains why a lot of us who want Estradot have 'been able to get' Estraderm (as if it's a luxury!)

Estraderm is awful. The 75mcg is a massive patch 5cm x 5cm and no wonder Estradot is preferred.  I bet all this Estraderm was ordered at the same rate as Estradot but sitting on the shelves, unprescribed as Estradot was prescribed more and more. 

Now that the NHS has put anyone off even selling HRT to the UK what we've got now is what was left on the shelf.

It's bad enough that in many areas Utrogestan is on the RED list of the CCG Formularies defining it as specialist prescription only. Then nationally they go and move all the HRT into the fixed price cupboard making it pointless supplying it.

I can't tell you how mad I am. It doesn't help that my husband gently stroked by thigh when I got into bed and the stupid Estraderm rolled right off my leg. I couldn't be bothered to get out of bed to put another one on and ended up going 12+hours without it and I've had a very frustrating powerless and tearful afternoon whilst negotiating the sale of a house (I'm an estate agent) and writing oodles of letters to all sorts of people. Thank goodness this is my own business!

Hi I'm writing about the bit of your post that I have bolded.
I am addicted to valium and take 200mg utrogestan daily as it is cross tolerant to valium.
For this reason I cannot take a cheaper progestin as it will mess up my GABA receptors with disasterous results.
I read that red list drugs are hospital only prescriptions and it takes ages to get a hospital appointment in my area.
I am worried about running out of utrogestan, the menopause expert Elizabeth Vliet says it is like a strong benzo, so altering my dose or removing it will either have disasterous effects or it will kill me.
I cannot order online because no one takes conti progesterone 200mg daily, so the online doctor will not approve it.
I don't know if it is on the red list in my area. I tried to check online to see if it is on the red list in my area but I can't check. I think it needs a clinician to check.
The independent pharmacy don't sell utrogestan.
What am I to do?
I can only order so much at a time, and worried that when I come to order it next on 3 Dec I will find that it is on the red list.
What is the way forward?
I'm too young to die or suffer disasterous consequences by changing from micronised prog.

Hi Hurdity-thanks for your post.
I also replied on the supply thread but wanted to come on here.
I order online and any GP in our massive surgery either signs or refuses to sign the prescription request.
I hear you about justifying it in my notes.
There is nothing on my notes to say that I need 200mg a day due to the cross tolerance with valium and the diasterous effects it would have if it were witihdrawn, and the GP's don't understand that I absolutely need it or I will go into severe life threatening withdrawal because of the cross tolerance with progesterone and valilum.
There is also nothing on my notes to say I cannot change to a synthetic progestin.
It's mainly the bleeding on my notes.
Does this mean there is still a chance that when I put my request in, it will be refused.
Sorry to ask its just that I am really panicking as I live alone and taking away utro will make me go into a severe crisis with my health.

[bear]

Hi again Dandelion,

Who has prescribed you Valium? If you can get a letter from a clued GP or mental health team that Valium and Utrogestan both affect neurotransmitters (GABA and others) you might be able to get your daily 200mg prescription. Unlike many of the HRT preparations that are in short supply, Utrogestan is widely used by millions of women worldwide, so lots of places where Besins can allocate supplies.

BeaR.

[Dandelion]

Hi again Dandelion,

Who has prescribed you Valium? If you can get a letter from a clued GP or mental health team that Valium and Utrogestan both affect neurotransmitters (GABA and others) you might be able to get your daily 200mg prescription. Unlike many of the HRT preparations that are in short supply, Utrogestan is widely used by millions of women worldwide, so lots of places where Besins can allocate supplies.

BeaR.

Hi
My psychiatrist prescribes the valium, he has no clue about it's interaction with utrogestan.
The thing that made me scared was that there was a couple of posts on the hrt supply forum, one saying it is on the red list, hospital scripts only, and another lady in october ordered and was told it was shut down and she had to wait till january to see a consultant, she has not posted since, her posting name is oldsheep.

[Hurdity]

Hi Dandelion

As you probably know different formularies and CCGs in different areas have their own list of preferred products. When it comes to HRT though I am pretty sure you really can have ANY licensed product whether or not it is on the list. Like I said - neither Estradot nor Utrogestan are on my formulary list of preferred brands at all - not in any colour - green amber or red.... ! I am not clear what the problem is - your doc should be prescribing you what you need regardless of the status on the formulary list? This is a completely different issue to the drugs shortages - it is based on cost and a guide for medical professionals to use when prescribing. If you are happily getting utrogestan from your GP now then s/he is overriding any sort of recommendations (Utro isnt usual first line or even second I don't think? No experience of other areas of UK - just on what members say on here).

The drugs shortages issue is different. This is a manufacturing and supply/supply chain problem. So - no shortages of utrogestan (manufactured within EU).

You need to make sure your notes give what your preference is and why.

Please do not worry so much! Try not to think about what might be round the corner - because if it's not you will have worried for nothing! Make sure you put in your renewals at the right time and just keep taking your prescribed dose. Are you getting your prescribed utro from your GP at the moment?

Hurdity x

[Dandelion]

Hi Dandelion

As you probably know different formularies and CCGs in different areas have their own list of preferred products. When it comes to HRT though I am pretty sure you really can have ANY licensed product whether or not it is on the list. Like I said - neither Estradot nor Utrogestan are on my formulary list of preferred brands at all - not in any colour - green amber or red.... ! I am not clear what the problem is - your doc should be prescribing you what you need regardless of the status on the formulary list? This is a completely different issue to the drugs shortages - it is based on cost and a guide for medical professionals to use when prescribing. If you are happily getting utrogestan from your GP now then s/he is overriding any sort of recommendations (Utro isnt usual first line or even second I don't think? No experience of other areas of UK - just on what members say on here).

The drugs shortages issue is different. This is a manufacturing and supply/supply chain problem. So - no shortages of utrogestan (manufactured within EU).

You need to make sure your notes give what your preference is and why.

Please do not worry so much! Try not to think about what might be round the corner - because if it's not you will have worried for nothing! Make sure you put in your renewals at the right time and just keep taking your prescribed dose. Are you getting your prescribed utro from your GP at the moment?

Hurdity x

hi Hurdity, thanks for your post, I just  noticed this.
I forgot to tick the notify me of replies box.
I didn't make myself very clear.
It's not that I am worried about utrogestan shortages in the context of HRT shortages regarding suppliers,in general, it's the fact that one poster on here said it is on the Red List.
By formulary list or preferred brands, am I understanding you right by that meaning Red List
A poster on the supplies thread said that utrogestan in their area is on the hospital prescription list only, which is what sparked my worry.

How can I make sure my notes give what my preference is and why? What would I say to my GP as they don't understand the issue regarding cross tolerance with valium and my need to stay on utrogestan.

Thanks for your help

[Hurdity]

Hi there Dandelion - different formularies have their own way of recommending different meds. You could if you wanted look up the one for your area if you know which one it is. Might take some googling -mine did! However like I said - this can be overriden - you should be  able to stand your ground. There is no other progesterone on the market for HRT and therefore iyou shiudl be able to insist on body-identical products - rules or no rules. Like I said the doc will put in their notes. If you are happily getting your utrogestan prescpription on repeat from your doc - which I think you are - you've been on it for some time - then I wouldn't worry, as there are no shortages. Re the info from your ?Psychologist - there should be information sharing re medical issues. I don't know how it works re mental health and medical records but either you should ask your doc to include this on your notes or discuss this your psychiatriast - if they do not know about the cross-tolerance and aks him/her to write to your GP. Otherwise it should anyway be up to you - so if the psychiatrist won't do so then you will need to talk to your GP. Like I said if you are getting it OK then there is no problem surely? Stop worrying about potential red lists in other areas!!!! I mean that with the best of intentions Dandelion! If there is any scientific info or a paper on this ( the cross-tolerance) then if necessary print this out when you go to your GP or psychiatrist - so that they can see you;re not making it up! Sorry this really is not an area I know anything about... All the best.

Hurdity x

[Dandelion]

Hi there Dandelion - different formularies have their own way of recommending different meds. You could if you wanted look up the one for your area if you know which one it is. Might take some googling -mine did! However like I said - this can be overriden - you should be  able to stand your ground. There is no other progesterone on the market for HRT and therefore iyou shiudl be able to insist on body-identical products - rules or no rules. Like I said the doc will put in their notes. If you are happily getting your utrogestan prescpription on repeat from your doc - which I think you are - you've been on it for some time - then I wouldn't worry, as there are no shortages. Re the info from your ?Psychologist - there should be information sharing re medical issues. I don't know how it works re mental health and medical records but either you should ask your doc to include this on your notes or discuss this your psychiatriast - if they do not know about the cross-tolerance and aks him/her to write to your GP. Otherwise it should anyway be up to you - so if the psychiatrist won't do so then you will need to talk to your GP. Like I said if you are getting it OK then there is no problem surely? Stop worrying about potential red lists in other areas!!!! I mean that with the best of intentions Dandelion! If there is any scientific info or a paper on this ( the cross-tolerance) then if necessary print this out when you go to your GP or psychiatrist - so that they can see you;re not making it up! Sorry this really is not an area I know anything about... All the best.

Hurdity x

Hi Hurdity thanks for your post
Unfortunately, the website for our area is being updated and has been in this status for months, so I cannot tell if progesterone is on the red list in my area.
My mental health team have no clue about the cross tolerance issue.
I did google scientific info on cross tolerance and progeseterone, but there is none, the only evidence I have is other valium dependent women going into severe withdrawal when their progesterone is altered or changed.
I rang my GP surgery to see if it is on the red list, the reception said they will send a task to the prescripton clerks to ask their pharmacist and it will be on my notes tomorrow.
Have I dropped myself in it by asking this?

[Butterfly22]

Ok don't tell me off but what Norethisterone.? A progesterone? I thought there was only two Provera and ustrogen xx