In April 2024, The British Menopause Society (BMS) released guidance in conjunction with the British Society of Gynaecological Endoscopy, British Gynaecological Cancer Society, Faculty of Sexual & Reproductive Healthcare, Getting It Right First Time, and the Royal College of Obstetricians & Gynaecologists, which has suggested that some women may benefit from a change in the dose of progestogen (the hormone prescribed to protect your womb) prescribed as part of Hormone Replacement Therapy (HRT) for the treatment of menopausal symptoms.

This new guidance was produced in response to the rising number of women presenting with irregular bleeding on HRT and only applies at present to women on high dose oestrogen regimes.

The following are considered high dose oestrogen regimens:

 If you are prescribed any of the preparations above as a high dose regimen, the BMS guidance advises that the progestogen dose ought to be increased to reduce the risk of irregular bleeding and endometrial (womb) cancer.

Unfortunately the evidence is not clear on the impact that changing your progestogen dose will have on your breast cancer risk, however the guidance does stipulate that despite this, the dose should still be increased in those women with high dose oestrogen regimens.  

As such we will be contacting, and adjusting the progestogen dose in all women who this applies to.  We appreciate that this is a lot of information to take in and so if you have any questions or concerns that relate to this, please contact us and we will be happy to discuss this guidance further.

If you are particularly concerned about increasing the progestogen dose, please be aware that alternative options include the following, and again we would be happy to discuss any of these further:

1. Reducing the dose of your oestrogen so that you are no longer on a high dose regimen
2. Continuing on your current dose of oestrogen, accepting that there may be an increased risk of irregular bleeding and womb cancer. It would therefore be imperative that you promptly report any change in your bleeding pattern.
3. Switch your progestogen to a Mirena coil. Here is further information:

https://www.mymenopausecentre.com/gp-resources/mirena-information-sheet/

Please be aware that this option would require a referral to the Gynaecology service.

Dr Rebecca Cruickshank