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[loulou@9]

I've just had my HRT review and was advised afterwards ( the Junior doctor obviously received advice) that there are new guidelines to increase Progesterone to 200 mg for women on high dose Oestrogen. Is this correct? I'm on 100 mg Estrogen patch daily and 100 mg Progesterone daily plus Tostran 1 pump a week. There was no discussion or review of risk or side effects so I'm unsure if it's ok or not. I'm 65 and on HRT for 7 years with no issues.

[bombsh3ll]

These are the new guidelines however they are flawed in my opinion because they are based on the dose of estrogen applied, rather than amount absorbed, and follow a one size fits all approach rather than individualised treatment.

I can understand the principle of this as some women are developing hyperplasia on progesterone - it is less effective for endometrial protection than the older progestins used, and the NHS simply hasn't the resources to offer endometrial monitoring.

So for unmonitored women on a decent dose of estrogen it is reasonable to ask them to take 200mg.

Your options are - try the 200mg. You may not notice any difference. There is also no evidence of any increased health risk with higher progesterone doses however none has been looked for. The main complaint is side effects.

Continue as you are and accept that this may mean less good endometrial protection (although you would have to let your GP think you were taking 200mg).

Continue as you are and pay for a private ultrasound every year or two to check your lining. Personally this is the option I would choose.

[Dotty]

https://thebms.org.uk/wp-content/uploads/2024/12/01-BMS-GUIDELINE-Management-of-unscheduled-bleeding-HRT-NOVEMBER2024-A.pdf

Hi Clovie I think the new guidelines came in  April 2024.  However Dr Louise Newson and other specialists have been researching whether this is necessary and have produced a paper on this...not sure if it's published yet. Louise Newson argues for an individualised approach.

Just before this guidance the guidance was to increase the progesterone if bleeding as happening, but no need to do so if there was no bleeding.

[Clovie]

https://thebms.org.uk/wp-content/uploads/2024/12/01-BMS-GUIDELINE-Management-of-unscheduled-bleeding-HRT-NOVEMBER2024-A.pdf

Hi Clovie I think the new guidelines came in  April 2024.  However Dr Louise Newson and other specialists have been researching whether this is necessary and have produced a paper on this...not sure if it's published yet. Louise Newson argues for an individualised approach.

Just before this guidance the guidance was to increase the progesterone if bleeding as happening, but no need to do so if there was no bleeding.

Thank you Dotty, I removed my message because I stopped being so flippin' lazy and looked it up for myself!! 

But THANK YOU so much for your reply, and for the the extra info you give, again, very interesting


*to avoid any confusion on the flow of the thread, I just said this was interesting, and asked when did those guidelines come in.

[Mary G]

Personally, I would ignore it and have regular scans which is something the NHS should be routinely offering to all women because it's not just about checking womb lining, it's about catching ovarian cancer early and checking the bladder etc.

Their reason for changing the guidelines is purely financial constraints.  The NHS can't afford to support women on HRT unless they are prepared to accept bog standard HRT at bog standard doses and they don't have any problems.

[loulou@9]

Thank you all! It seems the consensus is stay on 100 mg and get private scans? Can anyone recommend a good place/ provider for a scan and how much are they please?  I think it's typical of the NHS when looking at women's health to just draw a new line in the sand and let us work it out for ourselves and/ or suffer the consequences in the meantime. I hope Louise Newson n comes up with somet useful research ( though I suspect an "individualised approach" might be commercially led in the end.

[bombsh3ll]

I use ultrasound direct, I think a pelvic scan is about £130 -£150, I get a CA125 blood test as well.

[loulou@9]

Thank you so much