Progestogen and Patient Advice & Liaison Progesterone regimens in HRT Service (PALS) Progestogens or progesterone should only If you have concerns or wish to give feedback about be taken following the regimen advised by services, your care or treatment, you can contact the your specialist. PALS office on the Ground Floor of the hospital just behind the main reception. Continuous combined HRT regimens: Alternatively, you can send us your comments or • Norethisterone 5mg, every day suggestions on one of our comment cards, available • Utrogestan 100mg every night at the PALS office, or on a feedback form on our website www.chelwest.nhs.uk/pals. Progestogen Sequential combined HRT regimens: We value your opinion and invite you to provide us • Norethisterone 5mg twice daily, for 12- with feedback. and 14 days every month • Utrogestan 200mg (2x100mg capsules) T: 020 3315 6727 at night for 12-14 days every month E: [email protected] Progesterone Further advice and support Regimens in www.the-bms.org (British Menopause Society) HRT www.menopausematters.co.uk www.womens-health-concern.org www.chelwest.nhs.uk/services/womens- health-services Chelsea and Westminster Hospital Information for patients NHS Foundation Trust 369 Fulham Road London SW10 9NH T: 020 3315 8000 W: www.chelwest.nhs.uk January 2016 If you need to re-schedule your appointment, please ring the appointments office on 020 3315 6666. Progestogens and Progesterone When is a continuous progestogen or Deviation from the recommended licensed progesterone used in HRT? regimen may significantly increase the short-term Hormone replacement therapy (HRT) may be risk of irregular bleeding or the long-term risk of If periods have stopped for more than one year, then recommended for women whose periods have stopped developing endometrial cancer. Therefore, a progestogen or progesterone is taken every day and the ovaries are no longer producing estrogen. reducing the dose or number of days that the with estrogen. With this regimen there will be no Women who have not had a hysterectomy will have both progestogen or progesterone is taken should only bleeding. Common prescriptions are: estrogen and a progestogen or progesterone prescribed be taken under specialist guidance. (combined HRT). • Norethisterone 5mg, every day • Utrogestan 100mg capsule, every night Is an ultrasound needed? When is combined hormone therapy An ultrasound may be recommended if there is a recommended? When is a cyclical progestogen or history of new or irregular bleeding. If you progesterone used in HRT? experience new or irregular bleeding, Both estrogen with a progestogen or progesterone are please contact your GP in the first instance prescribed for short-term symptom relief and long-term If periods have not stopped for one year then there is for advice. health protection. a risk of further menstrual bleeds occurring. To avoid the risk of irregular bleeding on HRT a progestogen If you are on a continuous HRT regimen or post- or progesterone is taken for 12-14 days each month menopausal, you should be referred directly to What is the difference between and an artificially induced bleed will follow the local gynaecology rapid access service and a progestogens and progesterone? discontinuation. Common prescriptions are: hysteroscopy may be necessary. Progestogens are synthetic molecules that mimic the • Norethisterone 5mg twice daily, for 12-14 If you are on a cyclical HRT regimen and your action of the ovarian progesterone hormone. There are days every 28 days normal bleeding pattern has changed, then an several different progestogens all with slightly different • Utrogestan 2x100mg capsules at night, for ultrasound may be recommended. properties. 12-14 days every 28 days Progesterone is produced by the ovary. Its role is to Is contraception needed with HRT? maintain a pregnancy, protect the lining of the womb Why is a progestogen or progesterone (endometrium) and control bleeding. important? HRT is not a contraceptive. If you are not postmenopausal, then you may be at risk of In the menstrual cycle, ovarian progesterone protects What is natural or bio-identical pregnancy. The only licensed contraceptive for the endometrium and induces a monthly bleed to use with HRT is the Mirena intrauterine system progesterone? reduce the risk of developing abnormal cancerous containing levonorgestrel. For any other Natural or bio-identical are interchangeable terms that cells. Combined HRT mimics this protective action combined HRT combination, the contraceptive refer to a natural form of progesterone that is identical only if the progestogen or progesterone is taken at options include: to ovarian progesterone (also called body-identical). Bio- the correct dose and for the recommended number of days. • Barrier contraception identical natural progesterone is synthesised from yams. • Copper coil It is only licensed for HRT use as an oral micronised What is progesterone intolerance? • Progesterone only pill progesterone capsule. Other licensed progesterone products may be used with HRT, under the supervision Some women develop side-effects to progestogens or of a specialist. progesterone. This reaction may be limited to a single Sublingual (under the tongue) or transdermal progestogen or progesterone, or from all types. progesterone is not licensed or regulated, therefore is Symptoms are similar to premenstrual syndrome and not recommended for use with licensed HRT. may require a modified combined HRT regimen. .