Progestogens for use with oestrogen only therapy (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

LEVONORGESTREL INTRAUTERINE SYSTEM (LGN-IUS)

Therapy notes

Formulation and dosage details

Formulation:

Mirena (releasing levonorgestrel 20 micrograms/24 hours) intra-uterine system (IUS)

Dosage:

Used for the prevention of endometrial hyperplasia during oestrogen replacement therapy.

In line with guidelines from the Faculty of Sexual Health and Reproductive Medicine the Mirena® IUS should be changed no later than 5 years after insertion [off-label the licence states 4 years] irrespective of age at insertion; refer to FSRH Clinical Guideline: Contraception for Women Aged over 40 Years (August 2017, amended September 2019) - Faculty of Sexual and Reproductive Healthcare.

ORAL MICRONIZED PROGESTERONE

Therapy notes

The oral utrogestan capsule may be used vaginally off-label if patient continues to experience side effects. It is effective for endometrial protection through the first pass vagina effect. The dose will be the same as for the oral preparation. However, the effect on sleep and anxiety is only when taken orally (ie will lose this benefit when taken vaginally). Information is available from the British Menopause Society. 

Formulation and dosage details

Formulation:

Capsules 100mg oral (eg Utrogestan®)

Dosage:

Low to standard oestrogen dose (eg 25 to 50 microgram patch, 1 to 2mg oral or 1 to 2 pumps of Oestrogel) 

  • Sequential regimen:
    2 x 100mg AT NIGHT on days 15 to 26 of each 28-day cycle. Oral (or vaginal - off-label).
  • Continuous regimen (off-label indication as per British Menopausal Society guidance to avoid withdrawal bleed):
    1 x 100mg AT NIGHT, oral (or vaginal - off-label)

Moderately high oestrogen dose (75 microgram patch, 3mg oral or 3 pumps Oestrogel)

  • Sequential regimen:
    2 x 100mg AT NIGHT on days 15 to 26 of each 28-day cycle. Oral (or vaginal - off-label).
  • Continuous regimen (off-label indication as per British Menopausal Society guidance to avoid withdrawal bleed):
    1 x 100mg AT NIGHT, oral (or vaginal -off-label).

High oestrogen dose (100 microgram patch, 4mg oral or 4 pumps Oestrogel):

  • Sequential regimen:
    3 x 100mg AT NIGHT on days 15 to 26 of each 28-day cycle. Oral (or vaginal - off-label).
  • Continuous regimen (off-label indication as per British Menopausal Society guidance to avoid withdrawal bleed):
    2 x 100mg AT NIGHT, oral (or vaginal - off-label).

Women taking moderate or high dose oestrogen should be informed that the adequacy of endometrial protection provided by micronised progesterone is uncertain. The use of 200mg as a continuous preparation, and 300mg as a sequential preparation, should be offered if using high dose oestrogen or if unscheduled bleeding occurs with low to moderate high dose oestrogen.

Capsules should be taken at night on an empty stomach (eg 2 hours after eating).

Editorial Information

Last reviewed: 27/05/2024

Next review date: 31/05/2027

Version: V2

Document Id: F334