Women have been urged to seek out alternative HRT drugs as pharmacists warn of shortages

Women who are unable to get their usual hormone replacement therapy (HRT) due to shortage shouldn’t worry about switching to products that aren’t in short supply, top menopause doctors advised.

Demand for a HRT drug, Utrogestan 100 mg, has doubled in the past 12 months and increased fivefold since March 2021, according to manufacturer Besins.

The surge has led to stock shortages in some areas, and the government last month enacted a severe shortage protocol that restricts pharmacists from prescribing capsules for no more than two months.

The British Menopause Society (BMS), which represents leading treatment specialists, has now published guidance, suggesting alternative medicines for women to take.

Women shouldn’t worry if they can’t get hold of Utrogestan, as there are some similar drugs that primary care physicians can prescribe that do the same thing, said Dr. Paula Briggs, BMS president and sexual and reproductive health consultant.

HRT typically involves two female sex hormones, estrogen and progesterone, taken together. In some forms of HRT, both hormones are combined in a single pill or patch, however it is more common to take them separately.

Estrogen-based HRT taken alone increases the risk of thickening of the lining of the uterus known as endometrial hyperplasia and even cancer of the uterus. Progesterone reduces this risk to considerably.

Utrogestan contains micronized progesterone, which is identical to the natural progesterone produced by the body. Other similar drugs contain synthetic versions, known as progestogens, and the BMS recommends taking them if Utrogestan supply is a problem.

The main thing is that women keep taking something to protect the uterus, Dr. Briggs says. There is a small increased risk of blood clots and breast cancer with progestins, but it’s almost negligible, especially if it’s short-term.

The Utrogestan shortage is likely to clear up by the end of the year, so we recommend taking one of several alternatives in the meantime.

The BMS advises: Alternative progestogen options include norethisterone 5 mg per day and medroxyprogesterone acetate (MPA) 5 mg per day, for those using estrogen replacement therapy.

There’s also the option of switching to oral HRT, including Bijuve and one of the Femoston range, both of which contain the two hormones combined, she adds. An intrauterine system known as a coil containing the progestin levonorgestrel is another choice.

Some private doctors on social media have instructed women to ask for Cyclogest, a drug used in fertility treatment, which also contains micronized progesterone.

But the new BMS guidance states: Cyclogest is not licensed for [use in HRT] and there is no evidence to support its use in preference to synthetic progestogens, particularly as it will not be available from most NHS general practitioners.

Cyclogest is delivered via a pessary inserted into the vagina. Dr Briggs said: It often causes a lot of losses, which is not pleasant. It’s also never been studied for use in HRT, so we don’t know how well it protects the uterus.

Progesterone can cause side effects in some women, including mood swings, breast tenderness, bloating and digestive problems.

While micronized progesterone is the closest thing to natural progesterone, Dr. Briggs says there’s no evidence that women feel any different when taking synthetic progesterone, particularly on a short-term basis.

If you’re running out of Utrogestan, you can go straight to a progestin and it shouldn’t make any difference, she adds.

In April, the BMS issued an alert in response to an investigation by the MoS which revealed that general practitioner Dr.

It said estrogen shouldn’t be prescribed regularly in higher than higher doses [licensed] limit to ensure patient safety.

Dr. Briggs says: If women take very high doses of estrogen, they need to take double the normal amount of progesterone to protect the uterus. At higher doses, the drug is more likely to cause side effects.

Any woman on HRT on estrogen at the maximum authorized dose or higher should talk to her doctor about exactly why she was being given so much and discuss any potential risks.