'Ask an Expert: Q&A' is a place for health professionals to ask our team of experts about cases seen in work and/or clinical practice.
Questions can cover a wide range of women’s health topics and will be answered by an expert in the multidisciplinary Jean Hailes health professional team. Read more about this series or learn how to ask a question here.
Answering your questions for this edition of 'Ask an Expert: Q&A' is Dr Elizabeth Farrell AM, Jean Hailes gynaecologist and Medical Director.
In a menopausal woman who is on menopausal hormone therapy (MHT) and has side effects on Prometrium orally, is it acceptable to use the Prometrium capsules vaginally and if so, how frequently do they need to be used?
From Jean Hailes gynaecologist and Medical Director Dr Elizabeth Farrell AM (pictured)
Prometrium is micronised oral progesterone which is available in a 100mg capsule taken at night because of its somnolent properties. The product is registered as an oral preparation for menopause but there is a vaginal preparation available for IVF.
Using oral progesterone in the vagina is therefore "off label" usage and may equate to about double the oral dose. If the woman has side effects orally she may still have side effects with vaginal use.
The dose of Prometrium will depend on the dose of oestrogen used. A dose of oestradiol 50 micrograms patch then the usual daily oral dose of 100mg Prometrium nightly could be trialled every alternating night or three times per week vaginally. It is important to remember that this is "off label" usage.
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I am a Nurse Practitioner/Women's Health Nurse working in primary care and my question is: if someone has had a hysterectomy and is on Estradot 25 micrograms patch twice weekly should they also be on progesterone?
From Jean Hailes gynaecologist and Medical Director Dr Elizabeth Farrell AM
The role of menopausal hormone therapy (MHT) is to treat menopause symptoms (oestrogen) but at the same time to protect the endometrium (progesterone). With hysterectomy, the uterus is removed and therefore the woman has no remaining endometrium. Oestrogen alone is needed.
The only exception is in a woman with severe endometriosis who has had a hysterectomy with or without bilateral salpingo-oophorectomy and has menopausal symptoms. In these women a progestogen or progesterone with the oestrogen is appropriate.
Your patient who is on Estradot 25 micrograms patch and has had a hysterectomy, does not need progesterone.
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