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[Tulip256]

I have been on HRT about 3 years, evorel 50mg plus 200mg utrogestan 12 days a month. Increasingly the utrogestan has been causing me reflux due  to its relaxing effect on the lower oesophigial sphincter so I have been looking at alternatives.

I was originally thinking of trying the mirana for progesterone but while I am on the waiting list for it my gp put me on evorel sequi as supposedly synthetic progesterone through a patch has less impact on reflux.

I am now wondering whether I should just stay on this long term as it seems to work. However I am a bit worried about the increased breast cancer risk with long term use, I am quite young and on hrt for low bone density so will probably be on itfor 10+ years.

What do others think? I am worried about going through months of bad side effects with the mirana if evorel sequi is working.

[bombsh3ll]

Another suggestion would be to remain on natural hormones with the lowest risk of breast cancer and treat the acid reflux. I take omeprazole which is fantastic.

Taking the progesterone vaginally is another option which can reduce GI side effects.

Or what about taking 100mg micronised progesterone semi continuously or continuously? Sometimes the lower dose can be better tolerated, and bleed pattern isn't the be all and end all.

There is also dydrogesterone which appears as breast safe as micronised progesterone. It is currently only available in oral combination but there are rumours it may become available as a standalone in the UK within the next couple of years.

[Tulip256]

Thank you for your reply. I have already tried vaginal use and reduced dose and still got reflux. I would rather not take a PPI long term.

The dydrogesterone sounds great but I am not sure about having to take it with oral oestrogen (femoston?), doesn't that also pose high risks? Do you know if you can access it privately? It is really annoying that it is not available on the nhs. It doesn't seem very expensive and with a lot fewer side effects.

[bombsh3ll]

You could try and get a private prescription and see if you could get dydrogesterone from an Irish pharmacy.

However if it were me and that was the progestogen I wanted to use, which it one day might be, I would use the oral combination.

I take oral estradiol in the combined pill Zoely and it is great.

There is a lot of fear mongering around both PPI medications and oral estradiol which is completely disproportionate to the actual magnitude of the very small risks.

This often leads to people taking much bigger risks such as untreated or poorly treated chronic reflux or hypoestrogenism, or in your case choosing metabolically less favourable or invasive progestins.

Of course the absolute risk with any progestin is very small however, and it is about finding which best meets your needs overall.

[Tulip256]

I am wondering if I could take the femonston at the lowest possible dose and then top up with the evorel patches to reduce risk. Do you know if GPSs allow this?

I see the dydrogesterone is being added to the hrt pre payment certificate list on 1st Sept but am not sure if that means GPs can prescribe it yet https://cpe.org.uk/our-news/dydrogesterone-10mg-tablets-nalvee-added-to-the-hrt-ppc-medicines-list/

[bombsh3ll]

An NHS GP is unlikely to allow you to mix and match products like this however some private specialists would, provided you had endometrial monitoring if the dose of estrogen exceeded the guideline based dose of progestin.