Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Clovie on November 02, 2019, 09:18:08 AM
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Hi ladies
I've been happily taking Utrogestan for years now but I received a letter from my GP (who was not the GP who put me on Utrogestan as we moved from down south to Scotland 5 years ago) saying they were reviewing ladies on HRT and wanted me to make an appointment saying 'Utrogestan is no longer recommended in Scotland ' and that she is aware that finding products suited to me was difficult.
Please, does anyone know anything about this? I've not heard anything about Utrogestan not being recommended anywhere in UK unless I've missed something big?
I simply cannot use the synthetic progs, I've tried a few, and they all make me have raging PMT to the point I really cannot function. I really do not know what I'd do if they took Utrogestan off me... :(
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Hi Clovie,
I'm on Utrogestan and haven't had any updates or heard any recommendations about its withdrawal. I'll def follow-up. Thanks for the heads up.
LF
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This so depressing, I just managed to get a GP to prescribe oestrogel and utrogestan yesterday, . I am supposed to pick it up Monday, if they aren't recommending it, what the(xxx) alternative are they going to use and anyway why?
I am beginning to lose hope with all of this and am now looking at all sorts of deep and dark sinister meanings for it. ( I know probably my meno depressed brain) but really, if it were men having this then they would not have all the power and control of their own treatments taken away. I feel just like a manipulated pawn in a bigger game where I have no idea what the rules are. This absolute loss my own ability to choose and guide my own physical condition is horrible.
Sorry depressive rant over :bang: :bang:
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Are you sure it isn't Norethisterone, as that has been reported as not being recommended,if the letter said Utrogestan it is strange that no one else has been told the same
I thought it had been recommended instead of norethisterone
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I live in Scotland and have utro on my repeats. Nothing from GP to say it's banned. A quick scan of Scottish NHS prescribing doesn't mention anything either. Call your GP on Monday.
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Hia!
Can't even imagine this could be true anywhere, by the way I don't live in Scotland.
Can you add "in Scotland" at the end of your header? As it will attract the others that live there to chime in.
TD
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Just been trawling the net, and apparently in 2009 there was a statement to say utrogestan was not to be recommended for HRT treatment in Scotland.
But, also Tayside Health board ‘s current HRT recommendations, are for Utrogestan only to be prescribed by meno specialists from clinics and are not recommended for GP' s to prescribe as first line treatment. There doesn't seem to be anything more recent than that, or more broadly, cross countrywide. So not really sure what info your GP is going on.
I am hoping my GP doesn't know yours!!!
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Thanks girls.
Please don't worry too much, anyone!
I've looked myself online and can see NO mention of it not being recommended at all! - I fear it is a cost cutting exercise having seen the price of Utrogestan compared to Norethisterone!
And yes it is DEFINITELY Utrogestan and not Norethisterone I'm talking about, sadly.
I will certainly be arguing my case!
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Just been trawling the net, and apparently in 2009 there was a statement to say utrogestan was not to be recommended for HRT treatment in Scotland.
But, also Tayside Health board ‘s current HRT recommendations, are for Utrogestan only to be prescribed by meno specialists from clinics and are not recommended for GP' s to prescribe as first line treatment. There doesn't seem to be anything more recent than that, or more broadly, cross countrywide. So not really sure what info your GP is going on.
I am hoping my GP doesn't know yours!!!
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
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Clovie,
Thank you for the clarification. Sounds like they are reacting from a financial point, which is hardly helpful when it comes down to what is more effective. :thankyou:
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Clovie,
Thank you for the clarification. Sounds like they are reacting from a financial point, which is hardly helpful when it comes down to what is more effective. :thankyou:
I'm certainly thinking finance has SOMEthing to do with it :( And, with the best will in the world, recommendations or not, there ARE no other progs I can try, Utrogestan was given to me as it is bio-identical and the kindest gentlest prog available. I will be beside myself if they take it off me! :(
Please could you give me a link to the Tayside info you mentioned if it's not too much trouble? Thank you. :thankyou:
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Hello Clovie! Long time no "see"?!
There have been recent posts about utro in Scotland and also going back some years too - I think it may well be some of the formularies and defo seems like cost-cutting.
here are some of them (I just did a search for Utrogestan Scotland...)
https://www.menopausematters.co.uk/forum/index.php/topic,43939.msg702916.html#msg702916
https://www.menopausematters.co.uk/forum/index.php/topic,45156.msg726123.html#msg726123
https://www.menopausematters.co.uk/forum/index.php/topic,45018.msg724838.html#msg724838
https://www.menopausematters.co.uk/forum/index.php/topic,44549.msg714417.html#msg714417
https://www.menopausematters.co.uk/forum/index.php/topic,44946.msg722331.html#msg722331
https://www.menopausematters.co.uk/forum/index.php/topic,39957.msg703234.html#msg703234
https://www.menopausematters.co.uk/forum/index.php/topic,24125.msg543031.html#msg543031
You (your doc) should always be able to bypass the formularies' recommendations although I'm not familiar with Scottish practice but you can in England - none of the HRT I have is on our list for my area - but the GP just has to justify it. I mean Utrogestan is the only bio-identical progesterone available so if you don't want to use synthetics for whatever reason - they have to prescribe it for you (surely!) - but presumably have been told to try to recommend alternative cheaper products?
Don't let them!!!
Hurdity x
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Hi Clovie. It's definitely not approved for HRT use in Scotland ( costs presumably) but there are quite a few who get it via the NHS no problem. Mine came from a private consultant ( also works NHS and I attend meno clinic ) but I understand that some GP's refuse to prescribe and others happily do so. It does seem to be a bit of a lottery. You just need to explain to them that you have severe issues with the synthetic progs and hopefully they will continue to prescribe x
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Perhaps someone could write to Dr Currie?
She's based in Dumfries & Galloway and would surely know the ins and outs of Scottish Utro prescribing.
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Hi Clovie. It's definitely not approved for HRT use in Scotland ( costs presumably) but there are quite a few who get it via the NHS no problem. Mine came from a private consultant ( also works NHS and I attend meno clinic ) but I understand that some GP's refuse to prescribe and others happily do so. It does seem to be a bit of a lottery. You just need to explain to them that you have severe issues with the synthetic progs and hopefully they will continue to prescribe x
Hi there :)
Utrogestan was prescribed for me from a NHS meno specialist in Wales so that should be OK I presume?
But what is more relevant I think , is that I've lived up here in Scotland for five years with not a word said up until now.
I do hope I'm not going to have to start all over again seeing another specialist having to explain again that I can't take the synthetic progs :(
Hello Clovie! Long time no "see"?!
There have been recent posts about utro in Scotland and also going back some years too - I think it may well be some of the formularies and defo seems like cost-cutting.
here are some of them (I just did a search for Utrogestan Scotland...)
https://www.menopausematters.co.uk/forum/index.php/topic,43939.msg702916.html#msg702916
https://www.menopausematters.co.uk/forum/index.php/topic,45156.msg726123.html#msg726123
https://www.menopausematters.co.uk/forum/index.php/topic,45018.msg724838.html#msg724838
https://www.menopausematters.co.uk/forum/index.php/topic,44549.msg714417.html#msg714417
https://www.menopausematters.co.uk/forum/index.php/topic,44946.msg722331.html#msg722331
https://www.menopausematters.co.uk/forum/index.php/topic,39957.msg703234.html#msg703234
https://www.menopausematters.co.uk/forum/index.php/topic,24125.msg543031.html#msg543031
You (your doc) should always be able to bypass the formularies' recommendations although I'm not familiar with Scottish practice but you can in England - none of the HRT I have is on our list for my area - but the GP just has to justify it. I mean Utrogestan is the only bio-identical progesterone available so if you don't want to use synthetics for whatever reason - they have to prescribe it for you (surely!) - but presumably have been told to try to recommend alternative cheaper products?
Don't let them!!!
Hurdity x
Hi Hurdity!! :)
Yes, long time no 'see'!!! :) Hope you're doing OK! :)
Thanks for your reply!
I certainly will be fighting my corner for keeping the Utrogestan, it is working a treat, and I'm scared she will take me off HRT altogether if I say there are no other progs to try. (Tried and have been very ill on the synthetic ones)
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Perhaps someone could write to Dr Currie?
She's based in Dumfries & Galloway and would surely know the ins and outs of Scottish Utro prescribing.
Good idea! I'll see how I get on when I see my Gp first! :)
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Are you sure it isn't Norethisterone, as that has been reported as not being recommended,if the letter said Utrogestan it is strange that no one else has been told the same
I thought it had been recommended instead of norethisterone
jaycee the general consensus now amongst the menopause specialists is that the body-identical progestogen ( ie progesterone) is preferable biologically and in relation to some side effects and some health risks. However norethisterone is not licensed for separate use as part of HRT (for some bizarre reason as it is very effective in protcting the womb lining!) but only as part of combi products.
It is interesting that the Chelsea and Westminster show only this (norethisterone) and not Provera as the synthetic progestogen of choice for separate oestrogen and progestogen HRT (I read a link sonmewhere...) - but they are a specialist clinic.
Incidentally there are no guidelines that say norethisterone containing HRT should not be recommended - they would be taken off the market if it was not safe to use.
Hurdity x
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Thanks Clovie - all good :) and good luck with your doc!
Hurdity x
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The problem is in my view that most of the patch HRT has norethisterone in them, and many women have had bad side effects from it,
As you will know,i have had bad hair loss from Evoral Conti, so has my daughter, and i have read of others with the same problem and some with heavy bleeding, that didn't happen to me thank goodness,
I wish Evoral Conti had suited me, as it gave me a real boost of energy, but i also had diarrhea for several days on it and stomach cramps
Isn't Norethisterone what women are given to stop periods or something as a single pill.? maybe that is what is not being advised to use it as, but just as bad in patches i think
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I certainly have awful awful side effects with synthetic progs :(
I cannot function, my life is a misery whilst on them. I feel extremely depressed and anxious, cannot sleep and am tearful and paranoid. My husband was actually very very worried about me.
If they take this off me I will go to the highrest authority.
Im afraid they will say to come off HRT altogether.
What are my options?
Can I go to a private clinic and have Utrogestan prescribed? But why should I? :( It is working fine! No spotting, makes me feel OKAY, not brilliant but much better than the synthetic options.
Sorry for being so dramatic :( But I have to get my head round having a big operation in 6 weeks time (I'll need to stop HRT temporarily in 2 weeks anyway) and this is so unfair to land me with this stress at this time when the doctor KNOWS how anxious I am! :( :( :(
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Clovie, are you - or do you know anyone else - visiting Spain in the foreseeable future? You could ask them to buy you a year's supply. Alternatively, do you know anyone in Spain who could buy it and post it to you?
In Spain Utrogestan is cheap and readily available, same goes for norethisterone if anyone is interested.
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Clovie, are you - or do you know anyone else - visiting Spain in the foreseeable future? You could ask them to buy you a year's supply. Alternatively, do you know anyone in Spain who could buy it and post it to you?
In Spain Utrogestan is cheap and readily available, same goes for norethisterone if anyone is interested.
Oooh really? That is SO useful to know thanks! :)
Well, I'd have no problem getting it from abroad - however how would that work with my GP I wonder?
Wonder how I'd get the estrogel?
I'm sure she wouldn't prescribe the gel on it's own?
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Clovie - just take whatever she suggests, stash it and continue with your Utro as normal. You never know, you might use it one day and if you can't get what's considered the most natural form of prog from your nhs doc then why should you suffer? I'm convinced it's all cost related but not entirely convinced it won't be available in Scotland. As I said before, it hasn't been mentioned to me and it's on my repeats. I also live in Scotland.
Let us know what your doc says please.
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Clovie - just take whatever she suggests, stash it and continue with your Utro as normal. You never know, you might use it one day and if you can't get what's considered the most natural form of prog from your nhs doc then why should you suffer? I'm convinced it's all cost related but not entirely convinced it won't be available in Scotland. As I said before, it hasn't been mentioned to me and it's on my repeats. I also live in Scotland.
Let us know what your doc says please.
Thank you KiltedCupid, and I will let you know how it goes. :)
I fully intend to ask her to produce links to the actual recommendation and for what exact reason (other than the fact that on NICE website Utrogestan = c£21 and Norethisterone = £2.57).
I'm beyond annoyed at this I really am.
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Clovie, I agree, take the prescription from your doctor to get the gel and either leave out the synthetic progesterone part of the prescription if that is possible or just take it and sit on it. Am I right in thinking prescriptions are free in Scotland?
Do what you have to but don't suffer, you have been put in this position through no fault of your own and it is your right and your privilege to take responsibility for obtaining Utrogestan if you choose to.
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Utrogestin £21.00 ? It costs less than £10.00 on a private prescription?
Dr Currie prescribes utrogestan ( or did a couple of months ago when I asked her )
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Just looked it up 21p per pill
Private online pharmacy 😊
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Utrogestin £21.00 ? It costs less than £10.00 on a private prescription?
Dr Currie prescribes utrogestan ( or did a couple of months ago when I asked her )
Thanks Mary, so does Dr Currie do private appointments?
If so I'd love to have a private appointment! :)
I've not researched it at all in any great detail, these are the pages I've got my first (rudimentary I admit) research from these links (Apologies if I'm posting links I ought not to!)
200mg Utrogestan = https://bnf.nice.org.uk/medicinal-forms/progesterone.html
Norethisterone tablets = https://bnf.nice.org.uk/medicinal-forms/norethisterone.html
Even at first glance there appears to be some kind of financial implication :(
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I was looking at 100mg price wise at 21p.
I was at a menopause event and she was a speaker and I asked her and yes she prescribes on the NHS I don't “think†she does private practice
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I was looking at 100mg price wise at 21p.
I was at a menopause event and she was a speaker and I asked her and yes she prescribes on the NHS I don't “think†she does private practice
Ahhh shame :(
Wonder if she'd advise on Scotland's recommendations or otherwise for Utrogestan? :-\
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Just back from a GP appt.
Bottom line is it is being STOPPED completely by NHS Lothian for every woman.
On the grounds that it is not safe and does not protect against endometrial cancer.
So it's for our own good. Apparently.
However, it seems that other Scottish HAs and English, Welsh etc don't feel the same way and are allowing women to continue ;risking their health' by having it. (Despite the fact it does not protect against endometrial cancer .) They are having the same drug.
Appt was an awful experience, felt rushed and the GP constantly did not listen to me, speaking over the top of me. I do have health anxiety but my husband, who was with me does not and he agreed it was not a pleasant experience.
She also told me that our risk of breast cancer goes up up and up (in an alarmist way, I have to say) if on combined HRT for more than 10 years there would be an extra 40 cases in 1000 women. She gave me a print out of this recent study. 'Collaborative Group on Hormonal Factors in Breast Cancer' published August 2019.
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I'm really sorry to hear this Clovie. :( Do you think it's a cost saving exercise because of the free prescriptions and the amount they have to pay for the Utrogestan. Or is there a genuine concern for female health?
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I'm really sorry to hear this Clovie. :( Do you think it's a cost saving excersise because of the free prescriptions and the amount they have to pay for the Utrogestan. Or is there a genuine concern for female health?
I strongly suspect financial cull due to the fact that Utrogestan is wildly more expensive than synthetic prog (according to NICE pricing) >:(
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I'm really sorry to hear this Clovie. :( Do you think it's a cost saving excersise because of the free prescriptions and the amount they have to pay for the Utrogestan. Or is there a genuine concern for female health?
I strongly suspect financial cull due to the fact that Utrogestan is wildly more expensive than synthetic prog (according to NICE pricing) >:(
That's pretty crap then...
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Clovie - please don't worry too much, you can buy utro online and I know you shouldn't have to but if that's the prog you feel best on, then so be it. And as Mary G has said, if you or someone you know is going to Spain, you can stock up there. I vaguely remember a post from a few years ago from a lady in Lothian who mentioned then that her meno clinic were being sniffy about it. Obviously she was right but it's taken some time to filter through. I'm also in Lothian and am just about to trial a new regime using utro as my fem7 patches won't last much longer and if it works I'll buy it online.
What did your GP offer as an alternative? Did you suggest you'd get scans? Did she discuss oral vs vaginal route? It might be a good idea to try a different GP just in general, as that one sounded very abrupt. The other option is to go the private route and buy your utro outside Scotland.
You do have options Clovie, please don't worry. There's ways to sort this.
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Clovie - please don't worry too much, you can buy utro online and I know you shouldn't have to but if that's the prog you feel best on, then so be it. And as Mary G has said, if you or someone you know is going to Spain, you can stock up there. I vaguely remember a post from a few years ago from a lady in Lothian who mentioned then that her meno clinic were being sniffy about it. Obviously she was right but it's taken some time to filter through. I'm also in Lothian and am just about to trial a new regime using utro as my fem7 patches won't last much longer and if it works I'll buy it online.
What did your GP offer as an alternative? Did you suggest you'd get scans? Did she discuss oral vs vaginal route? It might be a good idea to try a different GP just in general, as that one sounded very abrupt. The other option is to go the private route and buy your utro outside Scotland.
You do have options Clovie, please don't worry. There's ways to sort this.
Hi Cupid
She said she was a locum so could make no decisions but she said she would not herself recommend Utrogestan to any of her patients as she has to 'do no harm'
I explained I had NO alternative as I've used various synthetic progs so I was stuck. She said she'd write away and explain my case and see what happens. She was holding out no hope though in reality. She mentioned something about being prescribed private prescriptions from the surgery for utro POSSIBLY. She mentioned Mirena and I declined as it is pure synthetic prog and Id have no immediate control of how to stop it if got bad on it (My prog symptoms are bleakness, tears, anger, paranoia, guilt insonia. I cannot function basically)
She said, if I WAS to be allowed would I be prepared to take it orally? (as if orally was better than vaginally which I understand to be the opposite0, and she also mentioned would I take it continuously. I said no. No because it is prog that is responsible for increases in breast cancer so Id like to keep my exposure low. She went on about protectlng against uterine cancer, which I know all about, and said Utro did not protect against it. Yet she offered me NO scan.
I'm cross because she said they had to stop utro because it is not licensed for use in HRT and someone could basically sue them if someone got breast cancer, yet my hubby asked how long had it not been licenced for HRT use and she said 2009 (?)
Can I really buy Utro online? Can you buy it from UK legally etc, you know. I really would buy it online, I need it.
You're in Lothian too? And you're getting it? I wonder if its just our surgery. I'm confused. Head in a spin with all this. Trying to get focussed on having a major op in 5 weeks. I really do not need this...
Thanks so much for your reply. xx :)
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I've sent you a pm Clovie.
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"She said, if I WAS to be allowed would I be prepared to take it orally? (as if orally was better than vaginally which I understand to be the opposite0, and she also mentioned would I take it continuously. I said no. No because it is prog that is responsible for increases in breast cancer so Id like to keep my exposure low. She went on about protectlng against uterine cancer, which I know all about, and said Utro did not protect against it. Yet she offered me NO scan."
I think I would if told a white lie there and said 'yes' to the continued prog. Asked for a scan of the womb to see all is well and then take it from there. Would she have prescribed if taken orally every day?
I must say I've not heard of any issues on taking Utrogestan vaginally instead of orally. Maybe she's knows something we don't..
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Clovie. I really do sympathise, I've never heard so much BS. From what I have read and from what my gynaecologist has said, it is synthetic progesterone that can cause breast cancer not body identical progesterone.
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"She said, if I WAS to be allowed would I be prepared to take it orally? (as if orally was better than vaginally which I understand to be the opposite0, and she also mentioned would I take it continuously. I said no. No because it is prog that is responsible for increases in breast cancer so Id like to keep my exposure low. She went on about protectlng against uterine cancer, which I know all about, and said Utro did not protect against it. Yet she offered me NO scan."
I think I would if told a white lie there and said 'yes' to the continued prog. Asked for a scan of the womb to see all is well and then take it from there. Would she have prescribed if taken orally every day?
I must say I've not heard of any issues on taking Utrogestan vaginally instead of orally. Maybe she's knows something we don't..
Hi Tracey
Yes in hindsight maybe I should have - But then again no, she still wasn't prescribing it. Not allowed to anyway as it is being stopped full stop, but said even if she could she wouldn't as wasn't safe.
(I think she was talking about writing to the sexual health clinic and explaining my case when she asked me would I take it orally and/or continuously. My head is in a spin, the appt was so rushed, and I got so stressed and upset) :(
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Clovie. I really do sympathise, I've never heard so much BS. From what I have read and from what my gynaecologist has said, it is synthetic progesterone that can cause breast cancer not body identical progesterone.
My thoughts entirely.
It's down to money. I just know it. :-\ :(
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Clovie. I really do sympathise, I've never heard so much BS. From what I have read and from what my gynaecologist has said, it is synthetic progesterone that can cause breast cancer not body identical progesterone.
Agree Mary G - if the best meno clinics and gynaes in the UK are still prescribing it, they can't all be wrong. It's the safest prog, Clovie, your locum is clearly knee jerking from some memo sent out by NHS Scotland.
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Big hugsss Clovie I'm sure it will get sorted soon. Do you want to carry on taking it?
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Clovie - your locum does not know what she is talking about. Of course it's licensed for HRT!!!
She might be referring to the withdrawal of the 200 mg capsules which used to be available for HRT as well as fertility - but now only available for fertility - so only the 100 mg version is available for HRT. That does not mean it is dangerous. When used as part of cyclical HRT you just use 2 x 100 mg instead of 1 x 100 mg. Also if she is referring to that it was much more recently than 2009 that the 200 mg was withdrawn. I think she's got it the wrong way round. In fact utrogestan was first available for fertility purposes and then later licensed for HRT maybe around 2010 or so?. There is a heap of research about it.
I don't even know where to begin!
She is trying to fob you off with information. None of the breast cancer stats were carried out using micronised progesterone, but synthetic progestogens. She is also feeding you with misinformation and sounds like my GP ( not the nice gynae one) whom I don't see any more who also believes all the stats and doesn't know enough about it - whereas my nice gynae GP was also very scathing about the recent Lancet study (which was much discussed on here) giving an increased risk of breast cancer from HRT but ising a whole lot of compiled stats. There's a massive thread devoted to this and links to responses by all the learned menopause societies.
Also even though Lothian is not recommending it - I am sure that if it is licensed in UK then docs can bypass the forumlary or trust recommendations provided they justify it - and certainly in England they do not need to write? I'm sure I said earlier EVERYTHING I get for my HRT on NHS ( apart from estriol cream and vagifem) is not on the list for my area. Maybe it's different in Scotland?
Re doing your own thing and buying it online etc going to Spain. I know lots of women advocate doing this on here - and especially to get their HRT if there is a shortage - but for a licensed product not in short supply you should not need to do this. I totally understand why you would want to go down this route if you can afford it in order to keep well - but it's an issue that needs ironing out too so that other women know what to do.
I do think writing to Dr Currie ( who as far as I know is wholly an NHS gynaecologist, not private - and good for her!!) might be an idea. It would cost £30 but you would get the definitive answer and whether Lothian's position is valid, and how to overcome it - eg what to quote if needed.
I did write to Emma about this the last time it came up and asked her to pass it on to Dr C and possibly to post on the relevant thread - and Emma did so but at the same time said that Dr C was extremely busy. However if you pay for a consultation - you will get an answer!!
Obviously clovie you need to do what's right for you and I remember our discussions a few years ago ( can't remember when it was now?) but it just keeps on coming up!!!
So sorry you have been made to feel upset over such an important issue and good luck with whatever you decide...
:bighug:
Hurdity xx
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Hi Clovie - I just checked and utro is available online from oxford online - £29.99 and they have them in stock.
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Hi Clovie,
I'm afraid Utrogestan for HRT is not readily available within NHS Scotland for economic reasons. This is the 2009 decision mentioned by your GP. Utrogestan was still being marketed by its original manufacturer, Ferring.
https://www.scottishmedicines.org.uk/medicines-advice/micronised-progesterone-utrogestan-fullsubmission-54209/
NSH Wales has recently approved it for HRT, if combined preparations are not suitable/tolerated:
http://www.wales.nhs.uk/sites3/Documents/814/HRT%5FABUHBpathway%26Formulary%5BPrimaryCare%26O%2BG%5DFINAL.pdf
If the cheaper generic micronised progesterone becomes available (like in France and other countries), I suppose the Scottish Medicines Consortium could change this decision.
Meanwhile, you could ask for a referral to a menopause clinic, they might be able to prescribe it off-licence for menopause (off-label) [edited for clarification].
I'm going to suggest to Emma (admin) that a note explaining this could be added to Utrogestan on the Treatments board section... it's odd that a Scotland based website doesn't mention this problem regarding prescribing Utrogestan in Scotland.
BeaR.
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Hi Clovie, I've been a bit busy, but the 2009 recommendations came from the SMC, If you google HRT guidance Scotland , and look for micronised progesterone you will find it.
It says , and I'm quoting “ micronised progesterone was as effective as another progestogen in protecting the endometrium from hyper plastic changes associated with oestrogen treatment.
They add “ However, the manufacturers did not present a sufficiently robust economic analysis to gain acceptance by the SMCâ€
So it does sound as though that was a financial reason initially.
The second piece I found came from Tayside Formulary, Scotland NHS uk.
It says under, “ Non- Formularly items, that micronised progesterone is coloured amber, meaning that utrogestan “ maybe prescribed 2nd line under direction of Tayside menopause clinic as per local protocol.â€
That's all I've got, hope that helps, also my GP has prescribed both oestrogel and utrogestan for me, so it Isn't a Scottish policy!
I mean it doesn't seem to be a national, country wide practice
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Hi Clovie,
I'm afraid Utrogestan for HRT is not readily available within NHS Scotland for economic reasons. This is the 2009 decision mentioned by your GP. Utrogestan was still being marketed by its original manufacturer, Ferring.
https://www.scottishmedicines.org.uk/medicines-advice/micronised-progesterone-utrogestan-fullsubmission-54209/
NSH Wales has recently approved it for HRT, if combined preparations are not suitable/tolerated:
http://www.wales.nhs.uk/sites3/Documents/814/HRT%5FABUHBpathway%26Formulary%5BPrimaryCare%26O%2BG%5DFINAL.pdf
Meanwhile, you could ask for a referral to a menopause clinic, they might be able to prescribe it off-licence.
BeaR.
bear - this is incorrect The whole point about all of this discussion is that Utrogestan IS licensed in UK and therefore should be available. There is no question of off-licence prescribing and we have seen ( and in the links I posted about other threads) that it is prescribed sometimes - thanks Choc Ice! Clovie should not have to be referred to a menopause clinic - although i am sure this might be helpful if a lengthy wait, nor go privately.
I do feel l am like a broken record here! What we need is clarification as to whether the Scottish system is like the English - whereby there are local recommendations etc (in realtion to some LICENSED medicines, but the doctor can override these on the computer system provided they can justify it.
The key point here is the small print at the end of the the document you linked to bear.
"This advice does not override the individual responsibility of health professionals to make decisions in the exercise of their clinical judgement in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. "
As far as I would be concerned - that says it all!
There is no other body-identical progesterone available - full stop!!!
Hope this helps clovie?
Hurdity x
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Hi Clovie,
I'm afraid Utrogestan for HRT is not readily available within NHS Scotland for economic reasons. This is the 2009 decision mentioned by your GP. Utrogestan was still being marketed by its original manufacturer, Ferring.
https://www.scottishmedicines.org.uk/medicines-advice/micronised-progesterone-utrogestan-fullsubmission-54209/
NSH Wales has recently approved it for HRT, if combined preparations are not suitable/tolerated:
http://www.wales.nhs.uk/sites3/Documents/814/HRT%5FABUHBpathway%26Formulary%5BPrimaryCare%26O%2BG%5DFINAL.pdf
If the cheaper generic micronised progesterone becomes available (like in France and other countries), I suppose the Scottish Medicines Consortium could change this decision.
Meanwhile, you could ask for a referral to a menopause clinic, they might be able to prescribe it off-licence.
I'm going to suggest to Emma (admin) that a note explaining this could be added to Utrogestan on the Treatments board section... it's odd that a Scotland based website doesn't mention this problem regarding prescribing Utrogestan in Scotland.
BeaR.
That's really interesting Bear, thank you. :) It just seems a terrible shame that there can't be a uniformed approach over the whole of the UK. I do think that free prescriptions are impacting negatively on prescribing certain medications in Scotland. Crikey Utrogestan isn't that expensive.
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Tracey E - you're right, NHS Scotland is an entirely different body and apparently the best performing of all the NHS bodies within the UK, unfortunately for some, they can and do make decisions on drugs and how they are prescribed independently of other NHS boards and licensing. However, that doesn't help Clovie's plight. And in that respect, I shall write to Dr Currie and ask her to post clarification on Utro in Scotland in order that we all know where we stand.
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Hi Clovie and anyone else using Utro and living in Scotland.
I wrote to both Emma and Dr Currie this morning asking for clarification on Utro prescribing in SNHS. Emma has kindly posted a link in the Oestrogel/utrogestan thread but to save you a journey, it's the same link as BeaR has posted above.
Hopefully Dr Currie will also clarify.
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bear - this is incorrect The whole point about all of this discussion is that Utrogestan IS licensed in UK and therefore should be available. There is no question of off-licence prescribing and we have seen ( and in the links I posted about other threads) that it is prescribed sometimes - thanks Choc Ice! Clovie should not have to be referred to a menopause clinic - although i am sure this might be helpful if a lengthy wait, nor go privately.
I do feel l am like a broken record here! What we need is clarification as to whether the Scottish system is like the English - whereby there are local recommendations etc (in realtion to some LICENSED medicines, but the doctor can override these on the computer system provided they can justify it.
The key point here is the small print at the end of the the document you linked to bear.
"This advice does not override the individual responsibility of health professionals to make decisions in the exercise of their clinical judgement in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. "
As far as I would be concerned - that says it all!
There is no other body-identical progesterone available - full stop!!!
Hope this helps clovie?
Hurdity x
Hi there,
As I understand it, Utrogestan is ‘off licence' in NHS Scotland for treating menopause, the same way as Utrogestan 100mg is ‘off licence' for vaginal route in NHS England, hence the term ‘off-licence' as in 'off-licence use' or 'off-label' (I will edit my previous post for clarification).
https://www.nhs.uk/conditions/medicines-information/
I'm sorry, but no matter what the BMS recommends or patients do on their own account, these are the current NHS Scotland recommendations.
If the NHS was a single body it would be called NHS UK. Therefore, I'd suggest a more cautious approach. Besides, all prescriptions are free in Scotland, which justifies their decision to not recommend Utrogestan based on costs.
Tayside non formulary section lists Utrogestan as ‘not recommended by SMC', but ‘may be prescribed 2nd line under direction of Tayside Menopause clinic as per local protocol', hence my suggestion to ask for a Menopause Clinic referral. That doesn't mean all Menopause clinics in Scotland have the same formulary indication, though.
BeaR.
PS. You don't mind calling me 'bear', so why 'LICENSED'? I thought you didn't like caps ;)
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BeaR - in a nutshell, that's the case. SNHS is different and, it would appear, varies from board to board even within SNHS itself. I worked on a campaign many years ago to launch the new NHS Scotland livery and had to contact all the boards independently as they run almost as separate businesses. We even had meetings with the then Scottish Health Minister as it was crucial that each board and indeed the entire SNHS and it's role was communicated clearly to the public.
What a job that was!
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It does seem to be a bit of a lottery up here ( Scotland), when I went to collect my prescription, my pharmacist ( who is really good and helpful) said that it was available " after having been given the "OK"' so I guess it isnt a given that we get it. I should have asked what that meant, ( my bad, sorry), I was just soo relieved to get something after the comedy of my patches being unavailable.
I think it means we have to be a bit more proactive and vocal in our needs, or we will end up being given just what is the cheapest and easiest rather than what is the best.
As an aside, I used to be a Medical Rep, and when our branded products went off patent ( after 7 years) they became "generic" which is Supposed to be exactly the same, and much cheaper ( which is why health boards like them) . The active chemical formula is the same, but the fillers and the components used to bind the rest together are not. This explains why frequently many people generics do not suit, because the generic houses use different chalks, binders to complete the product. So sometimes it is not always the wisest option to go for the unbranded one. Unfortunately you are not going to know until you try. Awful, the luck of the draw!
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Choc Ice - that's really interesting and probably explains why ladies on US sites hate their generic alternatives and can almost always tell the difference. I don't think I've ever had a generic hrt product in the UK, apart from a certain gel, but I'd rather not start another gel-gate. I really hope they don't become commonplace here.
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Hi there,
As I understand it, Utrogestan is ‘off licence' in NHS Scotland for treating menopause, the same way as Utrogestan 100mg is ‘off licence' for vaginal route in NHS England, hence the term ‘off-licence' as in 'off-licence use' or 'off-label' (I will edit my previous post for clarification).
https://www.nhs.uk/conditions/medicines-information/
I'm sorry, but no matter what the BMS recommends or patients do on their own account, these are the current NHS Scotland recommendations.
If the NHS was a single body it would be called NHS UK. Therefore, I'd suggest a more cautious approach. Besides, all prescriptions are free in Scotland, which justifies their decision to not recommend Utrogestan based on costs.
Tayside non formulary section lists Utrogestan as ‘not recommended by SMC', but ‘may be prescribed 2nd line under direction of Tayside Menopause clinic as per local protocol', hence my suggestion to ask for a Menopause Clinic referral. That doesn't mean all Menopause clinics in Scotland have the same formulary indication, though.
BeaR.
PS. You don't mind calling me 'bear', so why 'LICENSED'? I thought you didn't like caps ;)
AS far as I know this is still not right - it's not off-label or off-licence. Off-label is prescribing something for a different purpose than which it was manufactured and trialled eg Clonidine (a blood-pressure medication) for hot flushes, and beta-blockers (heart medication) for anxiety (although the latter may now be on-label).
Yes I know they are the scottish recommendations but once again - the small print indicates that these are only recommendations and can be overriden and does not alter the status of utrogestan as a licensed medication in UK - as far as I understand it.
I know Scotland is different but it's still part of the UK (for the moment!). Just as in England, Scottish local formularies have different local recommendations.
Once again, what we need is clarification as to whether the small print (in the guidelines) together with the status of utrogestan as a licensed medication in UK, is sufficient for docs to override the Scottish 2009 recommendations if the patient chooses for example to have body-identical progesterone - for whatever reason. If this can't be done except through referral to a menopause clinic then at least members will know - but at the moment it just isn't clear because of the patchy NHS provision throughout the country. Well not to me anyway!
Hurdity x
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Hi again,
Maybe that's how you understand it. Dr. Newson agrees with my use of 'off-licence' (page 5).
https://pcwhf.co.uk/wp-content/uploads/2019/01/PCWHF-Easy-HRT-prescribing-guide-31_01.pdf
It's not just about local formularies and local recommendations, it's about costs and it's the SMC recommendation.
How can that not be clear to you? NHS Scotland doesn't agree to buy Utrogestan for menopause (although they do buy it for ART) when there are other options available. I'm sure the BMS is trying to change that, but it takes a lot of work and negotiations between authorities, medical specialists and manufacturers. I'm sure this will change soon, because Utrogestan generic version is already available (same manufacturer, Besins, and others) and the price is bound to drop. Well done NHS Scotland, a lot of money has been saved!
BeaR.
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Not that it adds much to the discussion but regarding costs and free prescriptions - in NI prescriptions are free but we can get gel, utrogestan and testosterone on the NHS. My GP practice didn't bat an eyelid when they were prescribed. Obviously it is on the formulary list and no one is bothered about cost. Possibly not a responsible attitude but it cuts out the prescribing battle many women face. My own GP uses oestrogel and was very familiar with Utrogestan, probably uses it too ;)
Only comments have been from a pharmacist who said "you do know testosterone isn't licensed for women" to which I set her straight about how and why it was used and to which she replied "oh you learn something new everyday"! :) Other than that nothing mentioned by our lot about licences. Suppose I'm really lucky. Just shows how prescribing attitudes vary around the UK.
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Ladybt28 - there's big changes being proposed for Scotland over the next few years. Independence is looming and to that effect, Scotgov want to put their best foot forward in terms of being seen to favour certain demographics. Whether we like it or not, fertile women are a priority, as they should be, and my guess is that the health budget for them will increase and some more expensive drugs eg utro, will take a hit for those in the population who can use something less expensive. I completely understand this thinking and applaud efforts to keep certain demographics favoured eg, elderly, infertile, mental health, it's a fairer society. We all have budgets and need to carve up the funds in the fairest way possible whilst providing the necessities.
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Hi again,
Maybe that's how you understand it. Dr. Newson agrees with my use of 'off-licence' (page 5).
https://pcwhf.co.uk/wp-content/uploads/2019/01/PCWHF-Easy-HRT-prescribing-guide-31_01.pdf
It's not just about local formularies and local recommendations, it's about costs and it's the SMC recommendation.
How can that not be clear to you? NHS Scotland doesn't agree to buy Utrogestan for menopause (although they do buy it for ART) when there are other options available. I'm sure the BMS is trying to change that, but it takes a lot of work and negotiations between authorities, medical specialists and manufacturers. I'm sure this will change soon, because Utrogestan generic version is already available (same manufacturer, Besins, and others) and the price is bound to drop. Well done NHS Scotland, a lot of money has been saved!
BeaR.
Er.... yes Louise Newson is talking about off-licence vaginal use of utrogestan in general (in UK) - no-one is disputing that as the correct term. Its prescription in Scotland or not is nothing to do with off-license or off-label - as you know, but due to recommendations as you have said.
And yes - the 2009 decision by the SMC is absolutely clear to me. To repeat - nevertheless it can be, is, and has been prescribed in Scotland on NHS from the posts we have seen on this and the other threads I linked to, not always by menopause specialists.
And again to repeat, the small print, as I would interpret it "This advice does not override the individual responsibility of health professionals to make decisions in the exercise of their clinical judgement in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. "" suggests that any such recommendations can potentially be overriden.
We just need to know if, even in the face of individual formularies upholding the refusal, whether doctors can override this even without referral to a menopause clinic - as they can in England, provided a case is made by the patient.
Also we need to know whether due to the shortages the recommendations can be varied - eg here is a letter sent by Scottish government about hRT shortages in which Utrogestan is listed as available. The letter implies that individual discretion might be used: https://www.sehd.scot.nhs.uk/pca/PCA2019%28P%2918.pdf. For example this wording: "The table also provides an update of all HRT preparations that remain available. Clinicians may be required to switch patients to alternative HRT products that contain the same active ingredients for a temporary period". Well temporary is better than nothing and is certainly different from blanket refusal!
Clovie - I hope this is helpful? You can see the issue is complex and very much not straightforward!
Hurdity x
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Hi Clovie,
I have just sent you a PM.
BeaR.
PS. I rest my case ;)
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Hi Clovie,
I have just sent you a PM.
BeaR.
PS. I rest my case ;)
Bear what case? Referring to a pm (ie your ps) on an open forum is not really helpful as none of us know what you mean - as it's then all very cryptic! If you have any further information that sheds light on this issue - ie under what circumstances that docs can override these 2009 recommendations or those in the local formulary - this would be very helpful if you vould post as I don't feel it has been resolved yet. I know it's Clovie's thread but I think there are others who would benefit - if you don't mind, Clovie?
Hurdity x
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Hi there,
If Clovie wants to post the information, it's entirely up to her. I've done what I could trying to help her. Good luck, Clovie!
BeaR.
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Ladybt28 - there's big changes being proposed for Scotland over the next few years. Independence is looming and to that effect, Scotgov want to put their best foot forward in terms of being seen to favour certain demographics. Whether we like it or not, fertile women are a priority, as they should be, and my guess is that the health budget for them will increase and some more expensive drugs eg utro, will take a hit for those in the population who can use something less expensive. I completely understand this thinking and applaud efforts to keep certain demographics favoured eg, elderly, infertile, mental health, it's a fairer society. We all have budgets and need to carve up the funds in the fairest way possible whilst providing the necessities.
INteresting - I would view post-menopausal women who may live for 40 years for their life post-menopause - as a priority especially as getting it right for them could save the NHS thousands later in life re cardio-vascular problems, osteroporosis etc. Also it is well known that the mental health of women can take a dive as they enter peri-menopause and may well persist in the absence of the right treatment which includes having the right hRT that suits them. I think the whole point about this is that some women CAN'T easily use something less expensive, due to side effects etc (including anxiety and depression?) and there is still the question mark over the potential role of progestogens (especially the less expensive synthetic ones) and breast cancer. So it's not an easy one (maybe more difficult in a country that provides free prescriptions to all - which I think is amazing!). Even if it were available (Utrogestan) probably most women will still be given and be happy on most of the common cheaper brands of HRT, it's just that we don't tend to hear about them (no idea about the stats on this!).
Hurdity x
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Ladybt28 - there's big changes being proposed for Scotland over the next few years. Independence is looming and to that effect, Scotgov want to put their best foot forward in terms of being seen to favour certain demographics. Whether we like it or not, fertile women are a priority, as they should be, and my guess is that the health budget for them will increase and some more expensive drugs eg utro, will take a hit for those in the population who can use something less expensive. I completely understand this thinking and applaud efforts to keep certain demographics favoured eg, elderly, infertile, mental health, it's a fairer society. We all have budgets and need to carve up the funds in the fairest way possible whilst providing the necessities.
INteresting - I would view post-menopausal women who may live for 40 years for their life post-menopause - as a priority especially as getting it right for them could save the NHS thousands later in life re cardio-vascular problems, osteroporosis etc. Also it is well known that the mental health of women can take a dive as they enter peri-menopause and may well persist in the absence of the right treatment which includes having the right hRT that suits them. I think the whole point about this is that some women CAN'T easily use something less expensive, due to side effects etc (including anxiety and depression?) and there is still the question mark over the potential role of progestogens (especially the less expensive synthetic ones) and breast cancer. So it's not an easy one (maybe more difficult in a country that provides free prescriptions to all - which I think is amazing!). Even if it were available (Utrogestan) probably most women will still be given and be happy on most of the common cheaper brands of HRT, it's just that we don't tend to hear about them (no idea about the stats on this!).
Hurdity x
Menopausal women are not producing future generations, I'd imagine that's why governments prioritise fertile women. And yes, our NHS apparently outperforms the rest of the UK. I'm happy with their decisions.
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Menopausal women are not producing future generations, I'd imagine that's why governments prioritise fertile women. And yes, our NHS apparently outperforms the rest of the UK. I'm happy with their decisions.
I was referring to your mention of the other groups particularly, and also I'm not sure what you mean that governments prioritise fertile women - in what respect? You've lost me there. Not clear why lack of approval of utrogestan for HRT on cost grounds has to do with fertile women :-\ but maybe my poor elderly brain isn't working properly!
Re your being happy with NHS decisions in Scotland - that's great for you, but many women are not, in terms of the utrogestan issue in particular which is the subject of this thread, especially those (the many) who cannot afford the private treatment in England that some have taken advantage of in order to get the HRT they want (need...) that is denied them.
Hurdity x
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Menopausal women are not producing future generations, I'd imagine that's why governments prioritise fertile women. And yes, our NHS apparently outperforms the rest of the UK. I'm happy with their decisions.
Re your being happy with NHS decisions in Scotland - that's great for you, but many women are not, in terms of the utrogestan issue in particular which is the subject of this thread, especially those (the many) who cannot afford the private treatment in England that some have taken advantage of in order to get the HRT they want (need...) that is denied them.
Hurdity x
Name the many women who aren't happy.
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Well it doesn't really relate to me but I'm gonna wade in regardless :-X :-X- just to say that after my experiences on different hrts and finally finding the only thing that works for me is gel and utrogestan - I would be terrified and extremely unhappy if our Executive in NI (haha that's hypothetical cos we don't have a functioning one..but...) suddenly decided that because they gave free prescriptions they were suddenly going to reconfigure the health budget and say Utro was too expensive and that meno women were only allowed cheaper drugs. On top of that if they then, instead of saying it was about money came out with a load of out of date reports and stats that justified their decision by say "they were doing it for our own good so we didn't all get cancer"! I would be terrified and rageing! >:(
There have been a number of women in Scotland Kilted who have written on the forum about problems with prescribing in Scotland along with the women who report problems with prescribing of hrt in general throughout the UK. That sentence is a generalisation, and I wrote it and Hurdity's sentence "many women are not happy..." is also one, but "name the women who are not happy" is a little confrontational if I may say so. The wider issue might be that whilst in a huge, wider, general discussion, there can be for's and against's for "governments prioritising fertile women" this forum relates to issues faced by menopausal women whose lives are destroyed and blighted when medical science has the solutions but refuses to dispense them. And they are indeed destroyed..jobs, marriages, homes, the real damage is hidden and never discussed until maybe very recently.
On the issue of money - I would comment that in this day and age, if "governments" and society in general consider women able to work until we are 65 plus, so they can collect our tax revenue so they can "prioritise fertile women to produce future generations", might I respectfully suggest the wider conversation should be that they give us access to the relevant medications - ALL OF THEM, that might allow us to do so in some comfort and quite frankly it is not much to ask for really especially as our tax revenue will be contributing to the "fertile women's" maternity leave!
Now - no hair pulling, punching or gauging ladies ;) ;) I like my head, I don't want it ripped off - just lively discussion for the good of the menopausal women everywhere ;D ;D ;)
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Thanks Ladybt for your comprehensive and well-argued reply - it's not just me then! It is such a complex issue and one which affects us all - I don't know what the proportion of menopausal women in the general population is (in UK) but must be pretty high.
Name the many women who aren't happy.
Ladybt: "Hurdity's sentence "many women are not happy..." is also one, but "name the women who are not happy" is a little confrontational if I may say so."
Quite!
Hurdity x
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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.
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but KiltedCupid the issue is that it is the only micronized progesterone of it's kind and for some of us actually, although it might sound dramatic, synthetic substitutes would be "life threatening". What might you suggest it is replaced with because "many women" on this forum would love to know after their trials and tribulations with other forms of progesterone? In my case, I got to within hours of taking my own life sent totally dolally on a course of one continuous synthetic progesterone and although other forms of progesterone were "better" (ie didn't make me actually capable of suicide) you could hardly describe them as "better" just because they didn't actually make me collect tablets or want to jump in front of train every minute of every day, but only once a day every day! What kind of a life is that? Some of the stuff we go through we wouldn't allow to happen to a dog let alone a human and if you had a "disease" with the symptoms of menopause you would get every medication and intervention no questions asked. It makes no sense to me.
I would counter that indeed Utrogestan does save lives but this issue of menopause, quality of life, menopausal suicide has been a totally taboo subject. Menopause is described as "natural" but I have written in other posts I would totally counter that in the last 30 years since the invention of the pill, and feeding our animals hormones, there has been a dramatic change in the incidence of hormones in our water supply, through plastics in the environment and this is having a major impact on things like meno, fertility, and I know it would be totally controversial, but it is just my opinion, the changing shape of the human body and changes in sexuality across the board. Therefore I suggest that meno is now no longer the "normal" it was once considered to be. Plus it was always a problem, remember Victorian women of a certain age could be committed to sanitoriums for the "nerves"! My view is that actually menopausal women have continued to be sidelined but because they wish us to continue working this can now no longer be ignored. 100 years ago you didn't live to 60 and if you did you were not considered "useful to society" after the age of 45 or 50. But now we are useful to society - but the powers that be haven't caught up yet.
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Hi Ladybt28,
I think it's just a matter of being referred to a Menopause Clinic, the same way as some women in England have to be under a specialist to get testosterone. Utrogestan is not being denied to menopausal women in Scotland, it's just not the primary choice. When you have a free healthcare system, number of patients and price of medicines are important when deciding where to allocate limited resources.
BeaR.
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Ladybt28- I completely understand where you're coming from, I believe peri played a large part in the break up of my marriage and some questionable decisions I made after that. I also suffered twice with post natal depression so I'm aware of the power of our hormones and how they can wreak havoc and that finding balance is incredibly difficult not only at this stage of our lives but thoughout our reproductive years. There are some lucky women who seem to dodge all the hormonal turbulence but that's all it is, luck, and possibly genetics. Doesn't seem fair but what can you do?
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.
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but BeaR - check out Clovie's first post on this thread that started all this and the one on page 3 of the thread where she states "it is being stopped in Lothian". Being "denied" is exactly what she has experienced and going forward more Scottish women are likely to experience the same even those who have been on Utrogestan on repeat. Although my understanding on all the links and documents that you, and Hurdity and Kilted have been discussing is not even close to what you understand, the general gist seems to be that the Scottish Government are making a concerted effort to get it withdrawn from being prescribed to menopausal women using spurious out of date stats about cancer or any means they can when in fact the underlying issue is money and a mistaken belief that all women are able to take any progesterone and even better if it is a cheap one without any consequence,
I know this is a very, very general summing up and possibly wide of the mark in semantics but it points to a wider issue around prescribing for menopausal women and a rather worrying one.
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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.
Just been trawling the net, and apparently in 2009 there was a statement to say utrogestan was not to be recommended for HRT treatment in Scotland.
But, also Tayside Health board ‘s current HRT recommendations, are for Utrogestan only to be prescribed by meno specialists from clinics and are not recommended for GP' s to prescribe as first line treatment. There doesn't seem to be anything more recent than that, or more broadly, cross countrywide. So not really sure what info your GP is going on.
I am hoping my GP doesn't know yours!!!
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.
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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
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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?! ;D
Hurdity x
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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.
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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
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Yes she did Hurdity two lovely children..
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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.
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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.
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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.
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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.
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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.
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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
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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
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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
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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?
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Ok don't tell me off but what Norethisterone.? A progesterone? I thought there was only two Provera and ustrogen xx
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Ok don't tell me off but what Norethisterone.? A progesterone? I thought there was only two Provera and ustrogen xx
No one's gonna tell you off, norethisterone is a synthetic progestin.
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Ah thank you, I feel like I should have known this but I've never heard of it x
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Ah thank you, I feel like I should have known this but I've never heard of it x
You weren't to have known.
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Hi, sorry I missed this thread, not logged on for awhile.
I finally achieved estrogen, Utrogestan and testosterone on prescription from my NHS Scotland doctor in the Lothians. I almost danced a victory dance but it was short lived! The Tostran was out of stock (is Testogel more expensive than Tostran hence they prescribe Tostran instead? It's a moot point as I received neither and had been previously told by private gynae that Testogel is now hard to get hence I was prescribed Tostran as alternative).
The next time I went to my highly sympathetic NHS doctor to request a repeat prescription for gel and Utro, he told me that he had been reprimanded for writing the script for Utrogestan and that unfortunately I'd have to go back to my private doc to get that even though he could still prescribe the gel so that means I have to pay consultancy fee for the private doc plus medicine costs..(at a push I don't mind paying for the progesterone but I do the consultancy fee which is £150 per yearly consultation /I am on a low income).
Posts on this thread seems to suggest that if I go back to NHS Lothian doctor and state Utro is the only plant-based micronised progesterone and that I have already been prescribed it (albeit privately) for three years, that according to 'small print' in NHS Scot guidelines he may be able to override the system to write me a prescription despite Utro not being on their list?
I feel my levels of anxiety rising again..just when I thought I had struggled to victory in terms of achieving
prescription on NHS in Scotland.
Thanks for all who have contributed to this thread.
😐Callisto
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Hi Callisto - I don't think we moved any further forward on this one - except the links I gave a couple of pages back (the recent letter about the shortages and the footnote to the original decision) suggested that the recommendations can be overriden as you suggested, and as they can in England. I am sure it is up to the doctor - that they should be able to put a note on your records to prescribe utrogestan - it is the only licensed body-identical progestogen for HRT and therefore should be available. If this is the case then the doc needs to have more of a spine and argue this - even though pressure is being put I imagine on cost grounds? Maybe it is more difficult to override the system in Scotland because prescriptions are free whereas in England there is a charge? However it is a licensed medication and therefore you should be able to have it on repeat through the NHS.
Quite right you should not have to pay for a private consultation nor pay privately for the progesterone - heavens!
One suggestion is to write to Dr Currie - I think she might have been asked for clarification on this previously but no member has reported back since. The other alternative is to write to her as a consultation - but this does cost £30. You would need to be very specific with your question so that you can then tell the doctor how to get around it or what to do on the system - if necessary?
Hurdity x
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Hi Ladies
:-\
I finally got my appointment to see the menopause specialist (as referred arranged by my GP after telling me they could no longer prescribe Utrogestan even though it was the only prog that works for me as I am highly intolerant of the synthetic progs and I've tried a few and to get it I'd need to see a specialist and explain I cannot take synthetic progs) ...)
Well, when I got into the appointent room she had no idea why I was there, (What had my GP surgery letter actually said??? I WILL be getting a copy of that) and then when I explained briefly she told me point blank I could NOT have the Utrogestan at all under any circumstance,
This was NHS Lothian.
She was rude and unsympathetic.
I am so upset.
I am going to have to get it elsewhere, like buy it abroad? Do you need a private prescription to buy it from abroad?
Will my GP continue to prescribe the Estrogel without the Utrogestan?
:'( :'( :'( :'(
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Hi Ladies
:-\
I finally got my appointment to see the menopause specialist (as referred arranged by my GP after telling me they could no longer prescribe Utrogestan even though it was the only prog that works for me as I am highly intolerant of the synthetic progs and I've tried a few and to get it I'd need to see a specialist and explain I cannot take synthetic progs) ...)
Well, when I got into the appointent room she had no idea why I was there, (What had my GP surgery letter actually said??? I WILL be getting a copy of that) and then when I explained briefly she told me point blank I could NOT have the Utrogestan at all under any circumstance,
This was NHS Lothian.
She was rude and unsympathetic.
I am so upset.
I am going to have to get it elsewhere, like buy it abroad? Do you need a private prescription to buy it from abroad?
Will my GP continue to prescribe the Estrogel without the Utrogestan?
:'( :'( :'( :'(
I'm so sorry that you cannot get the utrogestan.
There are online sites that you can buy hrt from but they have to be registered with the MHRA and often they need GP approval, not much help, I know, but that is only what I know.
There may be sites that sell other forms of micronised progesterone under a different name abroad, but I don't know how to go about finding such a site.
One consolation is that other scottish women must also be in the same boat, maybe there may be a way of hooking up with other scottish women who can help.
Ah, I've just though of another thing, PALS, I don't know if PALS exists in scotland or you have an equivalent.
PALS helped me get a second opinion from a different specialist regarding a non menopause issue, maybe there is such an organisation, if not PALS who you can go to.
PALS helped me a lot, they got me a GP appointment, GP's had a meeting and a second specialist appointment was arranged.
Wish I could help you more, hope other women come on and can offfer even more suggestions.
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Hi Ladies
:-\
I finally got my appointment to see the menopause specialist (as referred arranged by my GP after telling me they could no longer prescribe Utrogestan even though it was the only prog that works for me as I am highly intolerant of the synthetic progs and I've tried a few and to get it I'd need to see a specialist and explain I cannot take synthetic progs) ...)
Well, when I got into the appointent room she had no idea why I was there, (What had my GP surgery letter actually said??? I WILL be getting a copy of that) and then when I explained briefly she told me point blank I could NOT have the Utrogestan at all under any circumstance,
This was NHS Lothian.
She was rude and unsympathetic.
I am so upset.
I am going to have to get it elsewhere, like buy it abroad? Do you need a private prescription to buy it from abroad?
Will my GP continue to prescribe the Estrogel without the Utrogestan?
:'( :'( :'( :'(
I'm so sorry that you cannot get the utrogestan.
There are online sites that you can buy hrt from but they have to be registered with the MHRA and often they need GP approval, not much help, I know, but that is only what I know.
There may be sites that sell other forms of micronised progesterone under a different name abroad, but I don't know how to go about finding such a site.
One consolation is that other scottish women must also be in the same boat, maybe there may be a way of hooking up with other scottish women who can help.
Ah, I've just though of another thing, PALS, I don't know if PALS exists in scotland or you have an equivalent.
PALS helped me get a second opinion from a different specialist regarding a non menopause issue, maybe there is such an organisation, if not PALS who you can go to.
PALS helped me a lot, they got me a GP appointment, GP's had a meeting and a second specialist appointment was arranged.
Wish I could help you more, hope other women come on and can offfer even more suggestions.
Thank you so much for your kind words and suggestions Dandelion, much appreciated xx
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Thank you so much for your kind words and suggestions Dandelion, much appreciated xx
Hi Clovie, good suggestion from Stellajane, re Scotland.
I just wish I could help more.
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Ugh - that's the worst thing - going to see a specialist and them not having a clue why you've been sent there! It happened to me once, not meno related, but it made me feel I was being a timewaster when it was my GP's decision to refer me! I also got a rude and unsympathetic reaction.
Maybe start a new thread with Scotland in the title to get some local responses?
Thank you so much, appreciate it, and I certainly will do that when I don't feel so emotionally drained because of today's awful experience.
I feel it's so unfair and I feel so powerless....
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Thank you so much for your kind words and suggestions Dandelion, much appreciated xx
Hi Clovie, good suggestion from Stellajane, re Scotland.
I just wish I could help more.
Thank you Dandelion x :tulips2:
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Hi Ladies
I finally got my appointment to see the menopause specialist (as referred arranged by my GP after telling me they could no longer prescribe Utrogestan even though it was the only prog that works for me as I am highly intolerant of the synthetic progs and I've tried a few and to get it I'd need to see a specialist and explain I cannot take synthetic progs) ...)
Well, when I got into the appointent room she had no idea why I was there, (What had my GP surgery letter actually said??? I WILL be getting a copy of that) and then when I explained briefly she told me point blank I could NOT have the Utrogestan at all under any circumstance,
This was NHS Lothian.
She was rude and unsympathetic.
I am so upset.
I am going to have to get it elsewhere, like buy it abroad? Do you need a private prescription to buy it from abroad?
Will my GP continue to prescribe the Estrogel without the Utrogestan?
Hi Clovie - so sorry to hear about your dreadful and upsetting experience with your menopause specialist. How remiss of the GP not to explain why you had been referred. Sounds like the specialist is out of order. Did you take along any the documents that were linked to in this thread?
You will see from the below that (former member) Kilted Cupid was able to be prescribed by her GP in Lothian so there is clearly lack of consistency here.
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.
In addition I quoted from other documents implying that individual discretion could be used despite its lack of recommendation by NHS Scotland (on cost grounds). https://www.scottishmedicines.org.uk/media/2002/micronised_progesterone_utrogestan_final_march_2009_for_website.pdf
Firstly from that document , just to remind you (so you don't have to read the whole sorry thread ::) !) the key point here is the small print at the end of the document when Utrogestan was not recommended.
?This advice does not override the individual responsibility of health professionals to make decisions in the exercise of their clinical judgement in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. ?
In addition, here is a letter sent by Scottish government about HRT shortages in Aug last year in which Utrogestan is listed as available. The letter implies that individual discretion might be used: https://www.sehd.scot.nhs.uk/pca/PCA2019%28P%2918.pdf. For example this wording: "The table also provides an update of all HRT preparations that remain available. Clinicians may be required to switch patients to alternative HRT products that contain the same active ingredients for a temporary period". Utrogestan is clearly listed as an option to consider.
Finally, if you haven't done so already, I would strongly suggest also that you have an e-mail consultation with Dr Currie if you have the funds ( it costs ?30) to get clarification on this issue once and for all. She will know exactly what the position is and whether the specialists are out of order or within their rights to refuse you micronised progesterone. We can help you word that e-mail if you would like us to although your actual experience and what the doctors have said are powerful in themselves. It is what your rights are in your circumstances that are important. I don't see how any doctor or specialist in UK can refuse to prescribe a licensed medication such as this if it is clinically indicated for you due to progesterone intolerance and because there is no other progesterone product available. On principle I would not want to take a synthetic progestogen.
I presume the specialist will reply to your doctor and I wonder what s/he will write? I would ask to see that letter as well.
Don't give up ? I know you don't feel like fighting as you have been slapped in the face but try to be strong and gather together all the information you can as a dossier and prepare to confront them at the highest level that you can ? starting with going back to your GP, and then just keep going...
All the best
Hurdity xx