Utrogestan® 100 mg capsules are currently in short supply and subject to a serious shortages protocol (SSP). This is due to a discrepancy in supply and demand, as a result of increasing awareness about menopause management and specific hormone replacement therapy regimes, recommending Utrogestan® as the progestogenic arm of HRT. Although the manufacturer, Besins, are working on a solution to increase supply, this could take some time.
Utrogestan®, micronised progesterone, is identical to the naturally occurring hormone, progesterone, produced by the ovaries following ovulation. There may be less associated risk of venous thromboembolism and breast cancer in women using micronised progesterone for endometrial protection, when compared with other available synthetic progestogens, including norethisterone and medroxyprogesterone acetate, but the difference in risk is very small, particularly for short term substitution1.
An intrauterine system with 52 mg of the progestogen levonorgestrel in its core (LNG-IUD), is a very good method of providing endometrial protection, with potential added benefits, including contraceptive cover and control of heavy menstrual bleeding, both of which may be indicated for perimenopausal women.
Alternative options for endometrial protection, in women using estrogen replacement therapy, include use of norethisterone, for women with a BMI less than 30 and medroxygesterone acetate (MPA). The exact dose of either drug will depend on the dose of estrogen prescribed and recommendations can be found in the BMS Tools for Clinicians on progestogens and endometrial protection2.
An alternative option is to switch women to Evorel Sequi/Conti or FemSeven Conti or to change eligible, otherwise healthy women, to oral HRT. This will allow access to micronised progesterone in Bijuve® and dydrogesterone in the Femoston® product range, which comes in different doses and both sequential and continuous combined preparations.
Cyclogest® 200 mg, Utrogestan vaginal pessaries 200 mg or Lutigest 100 mg vaginal pessaries are not licensed for endometrial protection and may not be available from the majority of NHS GPs.
1 Canonico M et al BMJ. 2008 May; 336(7655): 1227-31
2 Hamoda, H. Progestogens and endometrial protection. British Menopause Society, Tools for Clinicians. October 2021