Change to the Progestogen dose for Endometrial Protection in HRT

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In April 2024, The British Menopause Society released a new joint guideline which has made suggested changes to the dose of progesterone for women on oestrogen for HRT. 

This comprehensive new Guideline was produced by the British Menopause Society (BMS) in partnership with the British Society of Gynaecological Endoscopy, British Gynaecological Cancer Society, Faculty of Sexual & Reproductive Healthcare, Getting It Right First Time (GIRFT) and the Royal College of Obstetricians & Gynaecologists, in response to the significant increase in women presenting with unscheduled bleeding on HRT.

The progestogen dose change only applies to women on the high dose oestrogen regimens

Route of administrationDose per day
Oestrogel4 pumps
Patch100mcg

If you are taking any of the preparations above, at the high dose regimens, the progestogen dose needs to be balanced to reduce the risk of endometrial cancer and unscheduled bleeding. 

We are looking to change women to the higher doses outlined below and so you may see a change in your prescription. If this change has not been made, please contact the practice to discuss the change. 

Type of ProgesteroneType of dosage regimenRecommended dosage per day
Microionised Progesterone (e.g. Utrogestan)Every day200mg
2 weeks on 2 weeks off300mg
Medroxyprogesterone (e.g. Provera)Every day10mg
2 weeks on 2 weeks off20mg
NorethisteroneEvery day5mg
2 weeks on 2 weeks off5mg
MirenaNo change – continuous5 years use