Without Utrogestan, progesterone containing HRT is going through a supply crisis. Utrogestan was short in supply in 2022, however recent shortage (January/February) is more predominant with UK pharmacies not being able to obtain any Utrogestan. What is the latest on the Utrogestan shortage? Are there any Utrogestan alternative HRT products?
Table of Contents
What is Utrogestan?
Utrogestan is a brand of hormone replacement therapy (HRT) medication which contain progesterone. Each Utrogestan capsule contains 100 mg of micronised progesterone.
What is hormone replacement therapy?
Hormone replacement therapy (HRT) is a medical treatment that involves supplementing the levels of estrogen and/or progesterone in the body to relieve the symptoms of menopause or other hormonal imbalances. Menopause is a natural process in which the ovaries stop producing eggs and menstrual periods stop, and it typically occurs in women around the age of 50. The hormonal changes that occur during menopause can lead to a range of uncomfortable symptoms, including hot flashes, night sweats, mood changes, vaginal dryness, and decreased sex drive. HRT can help relieve these symptoms and improve quality of life.
What types of HRT medicines is available?
There are different types of HRT available, including:
Estrogen-only therapy: This type of HRT is recommended for women who have had a hysterectomy (surgical removal of the uterus) and do not need progesterone to protect against uterine cancer.
Combined estrogen and progesterone therapy: This type of HRT is recommended for women who still have their uterus, as the addition of progesterone (Utrogestan) helps protect against uterine cancer.
Low-dose vaginal estrogen therapy: This type of HRT involves using creams, gels, tablets, or rings that deliver low doses of estrogen directly to the vagina to relieve vaginal dryness and discomfort (Vagifen and Vagifem alternatives).
HRT can be administered in various forms, such as pills, patches, gels, creams, or vaginal preparations, and the type, dosage, and duration of treatment should be customized to each individual based on their symptoms, medical history, and risk factors.
What is Utrogestan used for?
Utrogestan capsules are used as hormone replacement therapy in postmenopausal women with an intact uterus alongside estrogen treatment.
Why Utrogestan capsules are needed to treat menopausal symptoms?
Utrogestan (progesterone) and estriol are often used together in hormone replacement therapy (HRT) for postmenopausal women. Estriol is a type of estrogen that can help relieve symptoms of menopause, such as hot flashes and vaginal dryness, by replacing the declining levels of estrogen in the body.
However, the use of estrogen alone can increase the risk of developing endometrial cancer, which is why progesterone is added to HRT regimens. Progesterone helps to counteract the effect of estrogen on the lining of the uterus, preventing the overgrowth of cells that can lead to endometrial cancer.
Therefore, by using progesterone and estriol together, the protective effect of progesterone helps to balance the hormonal effects of estriol, reducing the risk of endometrial cancer while still providing the benefits of estrogen replacement therapy.
Utrogestan shortage – the latest news
At the end of January and throughout February Utrogestan became unavailable with most pharmacies not being able to order Utrogestan from the wholesalers. Besins Healthcare released product supply status towards the end of January which states the following about Utrogestan availability (Besins Healthcare, 2023):
Following a short interruption to supply, we have received new supplies into the country which are available to wholesalers. We are continuing to bring in supplies to try and meet the high demand we are experiencing. As these supplies work their way into the supply chain, pharmacies may experience temporary interruptions at their local wholesaler. We sincerely regret any inconvenience this may cause.
We are experiencing an interruption in supply. New supplies are expected at the end of February 2023. In the meantime, we are working to reduce this timeframe and hope to keep any disruption to a minimum.
Utrogestan is back in stock
On 22.03.23 pharmacies started to receive Utrogestan. Utrogestan became available in the main wholesalers. Some wholesalers put restrictions in place on how many Utrogestan boxes can be ordered.
Utrogestan alternative HRT
1. Other synthetic versions of progesterone
These are synthetic versions of progesterone that are commonly used in hormone replacement therapy (HRT) and birth control pills. Examples of progestins include medroxyprogesterone acetate Provera) and norethindrone acetate.
Medroxyprogesterone (MPA) can protect the lining of the uterus (womb). In women who take estrogen replacement therapy (ERT), the use of MPA in combination with estrogen can help reduce the risk of endometrial hyperplasia (overgrowth of the uterine lining) and endometrial cancer. This is because MPA acts as a progestin, which means it helps to balance the effects of estrogen on the uterine lining.
Adding MPA to ERT can prevent the growth of the endometrial lining by causing the lining to shed in a regular and controlled manner.
2. Bijuve as Utrogestan alternative
Each Bijuve soft contains 1 mg estradiol (as estradiol hemihydrate) and 100 mg progesterone. Bijuve is used as continuous combined hormone replacement therapy (HRT) for estrogen deficiency symptoms in postmenopausal women with an intact uterus and with at least 12 months since the last menses.
3. Mirena coil
Mirena coil, also known as the hormonal intrauterine device (IUD), is a type of birth control that is inserted into the uterus to prevent pregnancy. It is a T-shaped plastic frame that contains a progestin hormone called levonorgestrel, which is slowly released into the uterus for up to five years.
In addition to preventing pregnancy, the Mirena coil is also used to treat heavy menstrual bleeding and reduce pain associated with endometriosis. It can also be used as a form of hormone replacement therapy (HRT) for women who are experiencing menopausal symptoms.
Combination HRT preparations
4. Evorel Sequi patches as Utrogestan alternative
Evorel Sequi is an HRT which comes in a form of transdermal patches that is applied to the skin.
Evoral Sequi treatment involves the use of two patches:
- Evorel 50 which contains 3.2 mg of estradiol hemihydrate equivalent to 3.1 mg of estradiol
- Evorel Conti which contains 3.2 mg of estradiol hemihydrate equivalent to 3.1 mg estradiol and 11.2 mg of norethisterone acetate equivalent to 9.82 mg of norethisterone.
Estradiol is used to replace the declining levels of estrogen in the body that occur during menopause. Norethisterone is added to protect the lining of the uterus from the harmful effects of estrogen, which can increase the risk of endometrial cancer.
5. Elleste Duet and Elleste Conti tablets
Elleste Duet contains two types of hormones, estradiol (an estrogen) and norethisterone acetate (a progestogen).
6. Femoston tablets
Femoston tablets (1mg/10mg and 2mg/10mg) contain estradiol hemihydrate and dydrogesterone. Dydrogesterone is a synthetic progestogen, which means that it has similar effects to the natural hormone progesterone.
Can you transfer a prescription from one to another pharmacy?
With Electronic Prescription Service (EPS) it is possible to transfer a prescription from one to another pharmacy, providing that supply of any medication on that prescription did not happen. Partly dispensed prescriptions cannot be returned and dispensed by another pharmacy.
Conclusion
Patients who look for Utrogestan alternatives need to contact their GP and discuss treatment options. Synthetic versions of progesterone (medroxyprogesterone and norethindrone) are good alternative options to Utrogestan, however, both are not licensed as an add-on to HRT treatment.
A different form of HRT including combination medicines (patches ad tablets) offers licensed treatment when estradiol needs to be taken with progesterone.
References:
Besins Healthcare (2023). PRODUCT SUPPLY STATUS 24 January 2023. Available at: https://www.besinshealthcare.co.uk/wp-content/uploads/2023/01/BHUK_2023_025-Product-Supply-Update-No.7-Jan-23-v1.pdf Accessed on 20/02/2023
