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[jaycee]

As I have posted on another thread,i did read,but can't remember where that there was some concern about norethisterone's side effects and it sounded as if it was going to be not used much in future,and not recommended
I wish I could find it,it was somewhere among the reports about the shortages

[Perinowpost]

Good, I hated noresthisterone, I found it much too harsh and not fit for purpose X

[Jenna]

As I have posted on another thread,i did read,but can't remember where that there was some concern about norethisterone's side effects and it sounded as if it was going to be not used much in future,and not recommended
I wish I could find it,it was somewhere among the reports about the shortages

Is this the post by shropshirelass you are thinking of, jaycee?


'Re: Link to Guardian article this morning re increased breast cancer risk on HRT
« Reply #229 on: September 05, 2019, 10:31:40 AM »

"With an average use of 10 years of MHT in current users at diagnosis, and 7 years in past users, much of the exposure to MHT preceded the first publication of the Women's Health Initiative study, after which prescribing practices changed substantially. Consequently, virtually all of the included information pertains to MHT formulations and doses known to have adverse breast effects that are no longer recommended. Specifically, the use of the progestogens medroxyprogesterone acetate and norethisterone (norethindrone) is now discouraged because of their known adverse effects, but these account for nearly all of the data for combined estrogen-progestogen therapy included in the paper.

I had no idea norethisterone is no longer recommended and now discouraged. (!)"


Anyone who is using evorel sequi or evorel conti will be using norethisterone. This treatment was recommended to me at a menopause clinic. I want to know what adverse effects are being referred to and whether I should consider other options when any become available.
« Last Edit: September 05, 2019, 12:14:15 PM by shrosphirelass'


From https://www.menopausematters.co.uk/forum/index.php/topic,45086.225.html

[KiltedCupid]

Good detective work ladies!

I find it an absolutely brutal prog. I'm sure it has its uses but as a product for combined hrt, it's really harsh. I wonder if that's why their manufacturing plant has been bought out by theramex?

[jaycee]

Jenna,yes thank you that is the one, very clever of you to find it,i have searched several times, but couldn't remember where i saw it

[bear]

Hi girls,

Regarding norethisterone, I think those results are for ORAL preparations, but I will check the study and report back.

Regarding the recent Theramex acquisiton of Janssen's Evorel portfolio... It's not a simple operation. Janssen's press release states that Theramex currently anticipates 're-launching the product range in their packaging by Q1 2020'. https://www.janssen.com/uk/hormone-replacement-therapy-hrt-shortages-uk They also say 'that the agreement with Theramex is not the cause or the reason for the current shortage of the Evorel range.'Well, now that they have mentioned it...

Regarding FemSeven... the patent (estradiol and levonorgestrel transdermal patches) has expired. I think Theramex was trying to prolong the patent by modifying the adhesive matrix. This is a well known strategy to delay entry of generics to the market https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688687/ Let's hope they will succeed in the next few months or a new generic product will be available.

BeaR.

[Choc Ice]

Oh dear, well the HRT shortage has finally reached me (Scottish Highlands). I went to get my prescription for Evorel Sequi, and was told by by the pharmacist that they were informed by their supplier that it wasn't available until June 2020. No instructions from the GP re alternatives, so I guess that is up to me to sort out! Our practice is not good at out the box thinking.
Are oestrogel cream and progesterone cream close substitutes because the sequi combo works really really well for me. I'm soo worried about slipping backwards. Any thoughts would be helpful. TIA

[Katejo]

Oh dear, well the HRT shortage has finally reached me (Scottish Highlands). I went to get my prescription for Evorel Sequi, and was told by by the pharmacist that they were informed by their supplier that it wasn't available until June 2020. No instructions from the GP re alternatives, so I guess that is up to me to sort out! Our practice is not good at out the box thinking.
Are oestrogel cream and progesterone cream close substitutes because the sequi combo works really really well for me. I'm soo worried about slipping backwards. Any thoughts would be helpful. TIA

They are still available here. You don't pay these prices if you can send them an NHS prescription   https://www.theindependentpharmacy.co.uk/menopause-hrt/evorel-sequi

[Choc Ice]

Katejo, thank you soo much for the link , I've just filled out their forms and the order is in “process “, hopefully it will be successful.
However I've just had a phone call from the GP and at present they are recommending a tablet! But I am having  a proper teleconference with a GP on Friday, so hopefully that won't be their only suggestions! What on earth are these people thinking of?

[Hurdity]

Hi Jaycee,

Norethisterone is not a branded pharmaceutical, it's a progestogen that is part of many branded products, like Evorel and many contraceptives. It has been added to the parallel export BLACKLIST, meaning it cannot be exported to other countries in the EU, in order to remain available to UK patients.

BeaR.

I don't know why there is suddenly this unnecessary fuss about norethisterone bear, which as I said is not normally prescribed separately as part of HRT!!!  It's the oestrogen only and combi products we are most interested in as the progestogens seem to be widely available as far as I know.

As I have posted on another thread,i did read,but can't remember where that there was some concern about norethisterone's side effects and it sounded as if it was going to be not used much in future,and not recommended
I wish I could find it,it was somewhere among the reports about the shortages

The thread that you referred to jaycee and shropshirelass's quote which Jenna found on the thread about the Lancet paper at the end of August....is an extract from the International Menopause Society's response to the study. In fact nowhere in the IMS 2016 recommendations on HRT do they specifically say that norethisterone is not going to be used as far as I can see, so for the time being anyone who is happy with it can relax!

However the much criticised Lancet paper ( which is the subject of detailed comment on the thread jenna found so not really relevant to this thread) found no difference in risks between oestrogen and the 3 main different progestogens - ie MPA ( Provera), levonorgestrel, and norethisterone in increase in breast cancer risk. It has been known for some time that progesterone and the closely related synthetic dydrogesterone are likely to be associated with lower breast cancer risk than all these synthetics. The much criticised WHI study used MPA (Provera) and since then it is known that this progestogen in particular has been associated with increased risk - but that study was flawed anyway!

Let's not get too hung up about it eh? Many women thrive on any of these synthetic progestogens and it is thought that under 60 there is very low overall risk of breast cancer anyway.

Personally I don't like norethisterone, have never tried Provera nor levonorgestrel, nor would I, but I would take dydrogesterone if it were available separately!

Bear there are no generic oestrogen only or combi HRT products apart from estriol cream. I mean it would be good if there were but I can't see that happening any time soon unless there is govt/NHS intervention - I think Jeremy Corbyn promised he would try to initiate this in recent Labour conference.

Much of this is speculation and not sure we can second guess anything really can we? I really think that either we just watch and wait - or contact BMS members and put pressure on them to influence big pharma - if they have any sway at all, or contact the manufcaturers ourselves if we are concerned about any products. I think better to try to effect change or influence the outcome if we can. I am sure that BMS will be doing their absolute utmost to ensure that the widest possible selection of HRT types is available to us - but whether they can influence commercial decisions taken miles away - who knows?!

Hurdity x

[Hurdity]

Oh dear, well the HRT shortage has finally reached me (Scottish Highlands). I went to get my prescription for Evorel Sequi, and was told by by the pharmacist that they were informed by their supplier that it wasn't available until June 2020. No instructions from the GP re alternatives, so I guess that is up to me to sort out! Our practice is not good at out the box thinking.
Are oestrogel cream and progesterone cream close substitutes because the sequi combo works really really well for me. I'm soo worried about slipping backwards. Any thoughts would be helpful. TIA

Hi ChocIce

if you can't get your patches before they are manufactured again, then oestrogel is fine - it is a gel rather than a cream, but progesterone cream is only available privately not on NHS and not recommended as part of hRT. What you would need for bio-identical HRT is utrogestan (along with the gel) which is micronised progesterone in the form of a capsule which can be used orally or vaginally.

Don;t be persuaded to take a tablet against your will - it is your right to keep to transdermal products if this is what you prefer and if your formulary or whatever the Scottish equivalent is - doesn;t normally stock these products - they;re going to have to change pretty quickly if women;s preferred combos aren;t available!!

Good luck

Hurdity x

[KiltedCupid]

Hi Jaycee,

Norethisterone is not a branded pharmaceutical, it's a progestogen that is part of many branded products, like Evorel and many contraceptives. It has been added to the parallel export BLACKLIST, meaning it cannot be exported to other countries in the EU, in order to remain available to UK patients.

BeaR.

I don't know why there is suddenly this unnecessary fuss about norethisterone bear, which as I said is not normally prescribed separately as part of HRT!!!  It's the oestrogen only and combi products we are most interested in as the progestogens seem to be widely available as far as I know.

As I have posted on another thread,i did read,but can't remember where that there was some concern about norethisterone's side effects and it sounded as if it was going to be not used much in future,and not recommended
I wish I could find it,it was somewhere among the reports about the shortages

The thread that you referred to jaycee and shropshirelass's quote which Jenna found on the thread about the Lancet paper at the end of August....is an extract from the International Menopause Society's response to the study. In fact nowhere in the IMS 2016 recommendations on HRT do they specifically say that norethisterone is not going to be used as far as I can see, so for the time being anyone who is happy with it can relax!

However the much criticised Lancet paper ( which is the subject of detailed comment on the thread jenna found so not really relevant to this thread) found no difference in risks between oestrogen and the 3 main different progestogens - ie MPA ( Provera), levonorgestrel, and norethisterone in increase in breast cancer risk. It has been known for some time that progesterone and the closely related synthetic dydrogesterone are likely to be associated with lower breast cancer risk than all these synthetics. The much criticised WHI study used MPA (Provera) and since then it is known that this progestogen in particular has been associated with increased risk - but that study was flawed anyway!

Let's not get too hung up about it eh? Many women thrive on any of these synthetic progestogens and it is thought that under 60 there is very low overall risk of breast cancer anyway.

Personally I don't like norethisterone, have never tried Provera nor levonorgestrel, nor would I, but I would take dydrogesterone if it were available separately!

Bear there are no generic oestrogen only or combi HRT products apart from estriol cream. I mean it would be good if there were but I can't see that happening any time soon unless there is govt/NHS intervention - I think Jeremy Corbyn promised he would try to initiate this in recent Labour conference.

Much of this is speculation and not sure we can second guess anything really can we? I really think that either we just watch and wait - or contact BMS members and put pressure on them to influence big pharma - if they have any sway at all, or contact the manufcaturers ourselves if we are concerned about any products. I think better to try to effect change or influence the outcome if we can. I am sure that BMS will be doing their absolute utmost to ensure that the widest possible selection of HRT types is available to us - but whether they can influence commercial decisions taken miles away - who knows?!

Hurdity x

I've had it prescribed, separately, alongside oestrogen only patches.

[Taz2]

I managed to get my Evorel 50 for another month. I've got three months stored up now by lengthening the time I keep a patch on. I appreciate that I can do this more easily as I don't need progesterone due to hysterectomy. This was on the advice of the pharmacist as he said Evorel 50 will become unavailable next month until mid 2020? 

Taz x

[Sparkler]

Well, I went for my 6 month check yesterday and my GP practice were great! She rang the chemist (while I was still in the appt with her) about my evorel 50 and they said they had been able to get some direct from Jansen a few days ago. Wrote me a 6 month prescription and told me to come straight back if it was unavailable.

Chemist rang Jansen while I was in the shop ( I KNOW....great service) and were told my patches will be in the shop in 3 working days. No extra charge to either me or to the chemist for the delivery.

I am flabbergasted as was expecting to need to switch to another form of estrogen.

So, now it's fingers crossed it all actually arrives, but anyone else on evorel, suggest you ask to pharmacy to call Janssen.

Sparkler
X

[Katejo]

Well, I went for my 6 month check yesterday and my GP practice were great! She rang the chemist (while I was still in the appt with her) about my evorel 50 and they said they had been able to get some direct from Jansen a few days ago. Wrote me a 6 month prescription and told me to come straight back if it was unavailable.

Chemist rang Jansen while I was in the shop ( I KNOW....great service) and were told my patches will be in the shop in 3 working days. No extra charge to either me or to the chemist for the delivery.

I am flabbergasted as was expecting to need to switch to another form of estrogen.

So, now it's fingers crossed it all actually arrives, but anyone else on evorel, suggest you ask to pharmacy to call Janssen.

Sparkler
X

I have tried that but Boots refuses to do it. I am also owed some patches from an independent high st pharmacy which insists that it can't get them. I had a go at Boots on their FB page this week but got nowhere.