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[Roadrunner]

 Hello

I've just come back from my GP. I'm really struggling at the moment, and have been since March. I think I'm not absorbing Femoston 2/10 properly and was hoping to change to gel or estradot patch and a separate progestogen. My GP (who is lovely) cannot prescribe a separate progestogen, just the Mirena.

She doesn't think we have a menopause clinic locally and says even if I went privately she couldn't prescribe a progestogen without agreement from the CCG. I had the Mirena in the past and I didn't get on with it and had to have it removed (hindsight suggests I was peri and didn't know it but I'm still not keen to go there again)

So I've left with a script for Femseven Sequi. I know these don't always stick that well but norethisterone makes me headachy so I thought preferable to Evorel Sequi. I'm gong to give these a go and see if i can get my head above water again and get a stable dose of hormones. Currently feeling like I could cry, I'm so fed up.

I've looked at the private option but the info seems a little out of date. My nearest clinic would be Bristol and I know Annie Evans has retired.

Any other suggestions ladies?

RR xx

[Taz2]

Hi RR - did your GP say why she can't prescribe a separate progesterone? Mine prescribes utrogestan without any fuss. She did have to look it up in her big book though!

Taz x 

[CLKD]

Send an e-mail to Dr Currie on here?

Speak with a local Pharmacist, they have private rooms these days.  Take a list of your concerns and ask if he/she can give advice and if there are any Surgeries that support Menopause better than others.  Do you have a Practice Nurse who might be more willing to discuss in detail?

[Roadrunner]

Thanks Ladies

It seems that utrogestran is "specialist use only for the treatment of infertility". My GP is lovely and I think felt frustrated. The annoying thing is that even if I went to see a private specialist (which I'm seriously considering) my GP can't do any ongoing prescribing. I'm stuck.

RR xx

[CLKD]

Your GP probably 'wont' rather than 'can't'.   

Maybe find out where your local infertility clinic is and ask if that statement by your GP is true?  Also do a search here for 'utrogestran'  ?

[dahliagirl]

http://www.portsmouthccg.nhs.uk/Downloads/Meds%20management/Area%20Prescribing%20Committee/Area%20Prescribing%20Committee%20October%202016%20Notes.pdf

At this CCG, they say that utogestan 100mg are licensed for hrt but that uterogestan 200mg are not licensed for hrt and should be used only for fertility and started by a specialist.

As far as understand people use 100mg for continuous and 200mg for sequi.

Is this the problem?

[Cassie]

Thats nonsense loads of ladies use Utrogestan. How frustrating for you.

[CLKD]

Tnx dahliagirl .........

[dahliagirl]

http://www.mhra.gov.uk/spc-pil/'subsName=PROGESTERONE&pageID=SecondLevel

There are
utrogestan 100mg capsules
utrogestan 200mg capsules
utrogestan Vaginal 200mg

The last one is the fertility product.  The other two are for menopause etc.

Do you think someone somewhere has their products in a muddle?

I think it may be worth taking up CKLD's suggestion of asking a friendly pharmacist as they might know which way is up (we could do with one posting  )

[dahliagirl]

Blimey - just looked at the formulary for my own CCG - has Prepak-C Elleste-Duet and Cyclo-Progynova as first line , then 2 patches as second line.  No mention of the Femeston that I am on 

I hope no one ever reads that 

[CLKD]

How you doing on it though?

[dahliagirl]

Femeston is fine    I do need vit D and vagifem as well though    And exercise  and good food but I eat too much of it 

 My list looks somewhat old fashioned, as if they haven't looked at it for 20 years 

[Katia]

I struggled to get mine to prescribe it.  He'd never prescribed it.  I'd been to see a private consultant and I pointed out to him that it's in the nice guidelines.  It's not working out for me and I'm now struggling to get him to prescribe a synthetic as the consultant keeps saying to stay on it a bit longer.

[Roadrunner]

Hello everyone

Thanks for your support. I must admit I came home, felt really sorry for myself, and had a little cry. OK two little cries. It's really hard isn't it when you're feeling tired and emotional?

I think my GP would be willing to approach the CCG and request special funding, but it will take months to get approval so I would need something in the interim. Also, what if utrogestran doesn't suit me? Like you Katia? All that fuss and effort ... I suppose it might offer up opportunities for the next patient?

I don't think there is confusion between 100mg and 200mg - in my area it looks like only 100mg is available. Here's what the formulary in my local area lists for progestogens:

6.4.1.2 Progestogens
Medroxyprogesterone acetate
Tablets 5mg, 10mg
Endometriosis, dysfunctional uterine bleeding
Medroxyprogesterone acetate
Tablets 5mg, 10mg
Treatment of infertility
Norethisterone
Tablets  5mg
5mg preparation is not licensed for HRT.

Progesterone
Pessaries 200mg, 400mg (Cyclogest)
Vaginal gel 90mg per application (Crinone)
Injection 50mg in 1ml, 100mg in 2ml (Gestone)
Capsules 100mg (Utrogestran)
All specialist use only for the treatment of infertility


Dydrogesterone
Tablets
All specialist use only for the treatment of infertility
Ulipristal acetate
Esmya® tablets 5mg
For the pre-operative treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age. Duration of treatment is limited to three months.
Ulipristal acetate
Esmya® tablets 5mg
For the intermittent treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age.
See Shared Care Guidelines.
NB intermittent treatment includes 3 months cycles of treatment and 3 months of no treatment.   
Levonorgestrel
Mirena®
Intra-uterine system releasing 20 micrograms of levonorgestrel per 24 hours
Mirena is effective for 5 years.
Prescribe by Brand Name.
MHRA Drug Safety Update 21st January 2016: Levonorgestrel-releasing intrauterine systems should always be prescribed by brand name because products have different indications, durations of use, and introducers.
Licensed for use in HRT

RR xx

[dahliagirl]

 

You'd better get the hairdryer out to get those patches stuck down.

It is very demoralising.  I had wanted to get patches or something transdermal, because they are supposed to be better for your liver and if you have a history of gallstones (my mother died of them, and my sister has had her g bladder out) but I haven't managed to prove the tablets don't work so have ended up counting my blessings as I can actually manage fine on Femeston 2/10.