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NEW ALERT
High Dose Oestrogen HRT Regimes Guideline Update
I am writing to you to share some information on recent changes to HRT guidelines. The British
Menopause Society (BMS) have recently updated their recommendations for progesterone
dosage in women using higher doses of oestrogen as part of their HRT. High dose oestrogen is
defined as:

100mcg patch
4 pumps of oestrogel
3mg Sandrena
6 sprays Lenzetto
4mg oral estradiol
As you may recall from when you started HRT, whenever we give oestrogen to women with a
uterus (womb) it is very important that we give them progesterone alongside it. If we were to give
oestrogen without progesterone the lining of the womb (endometrium) can thicken and over
time this can lead to endometrial cancer. The progesterone protects the endometrium from this
risk. Signs that would prompt us to consider investigations for endometrial cancer would be any
bleeding that occurs over 12 months after your periods have stopped or a change in your
bleeding pattern if you periods haven’t stopped (more frequent, heavier, or prolonged bleeding).
As you may also remember the reason that we tend to use Utrogestan (also known as
micronised progesterone) for the progesterone component is that the data suggests this carries
very little or no increased risk in breast cancer.
The new BMS guidelines state:
“There are insufficient data to advise on endometrial cancer risk when micronised
progesterone, at a dose used for low or standard dose Oestrogen, is used in combination with
moderate or high dose Oestrogen. Until evidence relating to safety with moderate and high dose
Oestrogen is available, a pragmatic approach needs to be considered, as the risk to breast
tissue from increasing the progesterone dose is also unknown; the use of 200 mg as a
continuous preparation [this means if you are taking it daily] and 300 mg as a sequential
preparation [this means if you are taking it for 2 weeks out of every 4] should be offered if using
high dose Oestrogen”.
In view of these new guidelines, you have four options going forward:

Consider having a Mirena coil as the progesterone part of your HRT regime – this is a
great option as it provides excellent protection against endometrial cancer on all doses
of HRT and has little or no increased risk of breast cancer. Once the coil has been fitted
it works for 5 years before needing to be changed. It also provides contraception if you
need it. After the first couple of months most women will have no bleeding at all with a
Mirena.
Please contact the practice if you would like to discuss any of this further
Dr Heather Craigie
GP Partner and Menopause Lead

Reduce your oestrogen dose

Increase your progesterone dose as above – accepting that we don’t know if there is an
increased risk of breast cancer associated with this regime

Continue on your current regime – accepting that there may be an increased risk of
endometrial cancer associated with this regime. If you choose this option it is very
important that you report any vaginal bleeding (if your periods have stopped) or change
to your bleeding pattern (if you are still having periods)

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