Change to the Progestogen dose for Endometrial Protection in HRT

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
Oral Oestradiol4mg* 

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 your usual GP or our pharmacy team within Beacon Medical Group to discuss the change. 

Microionised Progestogen (e.g. Utrogestan)Medroxyprogesterone    (e.g. Provera)NorethisteroneMirena
Every day2 weeks on 2 weeks offEvery day2 weeks on 2 weeks offEvery day2 weeks on 2 weeks offContinuous
200mg300mg10mg20mg5mg5mg5 years use

Dr Louise Horrocks
Clinical Lead for Women’s Health at Beacon Medical Group

* Off license use – not recommended by BMS – individual discussion with prescribing clinician needed. Please arrange review if you would like to talk further.