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[violetbat]

I am on everol 100 on a sequi regimen. I have been taking 6 nori day tablets for over a year now as my progesterone ( intolerant to utrogestan). I was told this was enough. At my review over the phone yesterday the gp had consulted with her colleagues and said I had been very under protected and should have been on 5mg tablets. This is their mess up.So they have asked for a scan to see how things are.
Of course the expert gp in the practice is on holiday and now I am panicking.
My withdrawal bleeds have always been very light.
I have put in a medication request for the 5mg dose.

[Dotty]

Hi have a look at page 7 of this document:

https://thebms.org.uk/wp-content/uploads/2023/04/14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf

The reason that 5mg is given is because there isn’t a lower dose available. It says that 1-2mg would be enough.

[bombsh3ll]

There are oral combined hormone therapy tablets which contain 1mg of norethisterone.

This is paired with 2mg of oral estradiol, which I would consider clinically comparable to a 100mcg patch in terms of plasma estradiol and equivalent bone protection.

You haven't been over treated, and given you have no abnormal bleeding I would expect your scan to be normal, although it is a good idea to check (I personally support annual well woman pelvic scans anyway).

5mg of norethisterone is brutal, and if it were me and I had a normal lining on ultrasound, I would cut these in half.

[violetbat]

Hi have a look at page 7 of this document:

https://thebms.org.uk/wp-content/uploads/2023/04/14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf


The reason that 5mg is given is because there isn’t a lower dose available. It says that 1-2mg would be enough.

Thanks
No where does it recommend the amount of t of norithisterone for a 100 patch.
Thank you for reassuring me.
It’s good to have this j fo to refer to when they come back to me next week.
I am more than happy to cut a 5mg in half.

[Dotty]

Hi 6 Noriday tablets that you’ve been taking will equal 2mg.
https://thebms.org.uk/wp-content/uploads/2024/12/01-BMS-GUIDELINE-Management-of-unscheduled-bleeding-HRT-NOVEMBER2024-A.pdf

P16 gives more advice in this document but it also states that 5mg is the only available dose.

[sheila99]

When I was on norethisterone 5mg tablets I cut them in half because of side effects. GP was OK with it.

[flo69]

The difference is probably the lack of clinical studies and the pharma companies being content to make up the facts, when permitted to, I really doubt you are in any danger because the dangers are for women taking unopposed oestrogen for many years.

Evorel conti delivers 170mcg norethisterone per 24hours into the bloodstream of women who wear a patch equivalent to 50.

Most doctors seem to double both hormones together, so that would be 340mcg a day you'd need with 100 strength Evorel.

Noriday claims to be "rapidly and completely absorbed" and the oral bioavailability is 64% according to Drugbank.com.

So you've been taking 6x350mcg a day, thats 2.1mg a day absorbed. At 64% bioavailability that's 1344mcg in your bloodstream each day.

Around four times what you'd be getting from Evorel conti patches, so don't panic.

It's not been that long and it's not been unopposed, I think they like to tell women off, so they tell you off for their mistake.

[violetbat]

Thanks so much for the reassurance. I have asked to have the norithisterone 5mg prescribed and I can cut that in half. So much easier than taking 6 pills a day!

[Mary G]

I really wouldn't worry at all.  In my experience, norethisterone is lethal and virtually strips the womb lining, even at low doses.

I had a very bad experience with it and (not relevant to you I know) I had 5 migraine auras in one day.  I was supposed to take 5mg per day for 7 days but I didn't take anything like that amount and one month I took just one 5mg dose and gave up because the migraine auras started up but I still had a full, heavy bleed a few days later.  My next TVS scan revealed the usual 3mm womb lining.

I think norethisterone is way over prescribed as are other forms of progesterone used in HRT regimes.  Most women don't need such high doses of progesterone but I think someone, somewhere decided to work out the minimum progesterone dose that women need and then doubled it as a catch all because the NHS don't routinely offer women uterine scans.  It's not doing anyone any favours, it causes too many side effects, it causes unnecessary distress and worry and it makes a lot of HRT regimes completely unviable and many women end up giving up on HRT altogether. 

My womb lining was just 1mm at my last scan which is too low but I've now increased my oestrogen dose.  I'm already using a lower dose of progesterone so god knows what it would have been if I was on a standard NHS dose.  My point is this, progesterone can be too high as well as too lower so if in doubt, don't try and guess how much progesterone you need, have a uterine scan and find out for sure.