Utrogestan supply restrictions: what you need to know
The supply of HRT medication Utrogestan is being restricted by the UK government due to shortages.
Pharmacies will only dispense two months’ worth of Utrogestan 100mg capsules per prescription.
Here’s what you need to know.
What is Utrogestan?
Utrogestan is a type of progestogen known as micronised progesterone. It is derived from plants, including yam, a root vegetable. It is identical in structure to the hormone progesterone produced in your body. Because of this, it is often referred to as ‘body identical’, which is different to unregulated, compounded bioidentical hormones.
Women who take HRT and still have their womb (uterus) are required to take a type of progestogen in addition to estrogen. This is because taking estrogen can lead to a build up in the lining of your womb over time. Taking a progestogen such as Utrogestan prevents this occurring and reduces associated risks.
Why is Utrogestan supply being restricted?
A Serious Shortage Protocol (SSP) was issued across the UK for Utrogestan 100mg capsules on 19 May amid rising demand for HRT.
SSPs are a standard procedure used to manage temporary and potential medicine supply issues, and this will allow pharmacists to dispense a maximum of two months’ supply per prescription to help ensure continued access for women.
Minister for the Women’s Health Strategy, Maria Caulfield MP, said the move would mean more women will be able to access Utrogestan, and stressed the vast majority of HRT products are in good supply.
How long is this likely to last?
The SSP provisionally ends on 18 August, and the Department of Health and Social Care (DHSC) said Utrogestan is expected to be in intermittent supply until late 2023.
DHSC added deliveries are frequently being made by the manufacturer, Besins, but they have struggled to meet rising demand. Besins is taking steps to increase supply, but in the meantime the SSP will support access to available stock.
I have a prescription for Utrogestan. What should I do?
The SSP covers both NHS and private prescriptions.
GP, Menopause Specialist and balance founder Dr Louise Newson says of the Utrogestan SSP:
‘It is of course frustrating for women who take Utrogestan to hear this news; hopefully this is a short-term solution and I hope it is resolved as soon as possible.
‘However, it’s important to remember that we have lots of different types and brands of HRT, so we can often find a very similar product to the one that is temporarily in short supply.
‘Healthcare professionals will work to find a suitable alternative for you should the need arise.’
Are there any alternatives to Utrogestan?
It’s crucial that you take a progesterone as part of your HRT regime if you still have a womb. Here are some alternatives to Utrogestan, and you speak to your healthcare professional for individualised advice based on your health history and current HRT prescription, personal preference and local supply.
A good alternative to Utrogestan is to have the Mirena coil fitted. This is a small plastic device that is inserted into your uterus and it stays there for five years, releasing a low and steady dose of progestogen straight into the lining of your womb. It can be used alongside estrogen patches, gel and sprays or tablets, and also acts as an excellent contraceptive.
Cylclogest is a vaginal pessary containing body-identical progesterone.
It is often used off-license to provide the progesterone component of HRT in women who experience side-effects with oral progesterone. It contains the same progesterone as Utrogestan and can be given in the short-term as an alternative to Utrogestan.
The Bijuve oral capsule is the first HRT treatment to contain body identical estrogen and progesterone. Designed to be taken daily, it contains 1mg of estradiol and 100mg of body identical progesterone. The progesterone it contains is the same type and dose as Utrogestan. Studies have shown there is no clot or stroke risk with Bijuve (unlike older types of tablet HRT).
Bijuve has been licensed for use in the UK since 2021, however it is only available in a handful of areas on the NHS.
If moving to Bijuve your healthcare professional may need to reduce the dosage of estrogen you may already be taking, as Bijuve already contains estrogen (for example, 1mg estrogen is roughly the equivalent of 50mcg of Evorel patches or two pumps of estrogen gel).
There are also products that contain estrogen and synthetic progestogens, including patches and tablets. However, there is a small risk of clot and heart disease with the synthetic progestogens. This risk is still low though.
Dosage varies by brand and you can find out more here.
Combination patches containing varying amounts of estrogen and synthetic progestogens include Evorel Conti, FemSeven ContI, Evorel Sequi and FemSeven Sequi.
Again, your healthcare professional may need to reduce the dosage of estrogen you may already be taking if you move to combination HRT tablets or patches.