Utrogestan supply issues: what it means and alternatives available

The supply of HRT medication Utrogestan is being restricted by the UK government because of shortages amid increase demand.

Pharmacies will only dispense two months’ worth of Utrogestan 100mg capsules per prescription to help ensure continued access for women.

In this special episode, Newson Health pharmacist prescriber and menopause specialist Faiza Kennedy joins Dr Louise Newson to talk about the restrictions, and where and how to seek advice and help.

They talk about the importance of taking a progesterone as part of your HRT regime if you still have a womb, as well as alternatives to Utrogestan, including progesterone in pessary form, the Mirena coil and combined forms of HRT containing both estrogen and progesterone.

Faiza’s top three tips: 

1. Only order the amount of Utrogestan you need to help everyone get through the shortfall

2. Be organised around ordering your HRT prescriptions. Do it about two weeks before you run out so you have time in case you have any difficulties getting your supply or need to seek an alternative

3. Reach out for help if you are struggling with your supply

Click here for a balance article for more information about the current Utrogestan supply restrictions, plus alternatives.

You can read more about Faiza here.

Transcript

Dr Louise Newson [00:01:09] Hello, I’m Dr Louise Newson and welcome to my podcast. I’m a GP and menopause specialist and I run the Newson Health Menopause and Wellbeing Centre here in Stratford upon Avon. I’m also the founder of the Menopause Charity and the menopause support app called balance. On the podcast, I will be joined each week by an exciting guest to help provide evidence based information and advice about both the perimenopause and the menopause. So today on the podcast, I’ve got someone called Faiza Kennedy, who is one of the few people that I do in my podcast who I actually know and I’ve seen in real life, which is wonderful because so many of my guests are not people that I’ve ever met in real life. But Faiza works very closely, she’s one of our most senior pharmacists, and I’m very grateful for all her work. So with I thought today I would quiz her about what’s it like being a pharmacist in the menopause world and also talk about some of the HRT shortages, which as many of you know, are ongoing and incredibly frustrating. So welcome, Faiza. Thanks for coming today.

Faiza Kennedy [00:02:21] Thank you. Thank you for having me.

Dr Louise Newson [00:02:24] So when we first met, I think you’d emailed me and we were sort of pen pals for a while, and then you came and sat in the clinic.

Faiza Kennedy [00:02:32] Yes. So actually, I heard you being interviewed on the Aural Apothecary podcast, which is one of my favourite podcasts and actually hosted by three of my really good friends, Jamie, Paul and Steve. And I heard you on this podcast and I thought, my goodness, I have to meet this woman and forced Jamie to introduce us and then stalked you by email and you invited me up to the clinic, which is lovely. And then, yes, a year on, I am still here and I love it.

Dr Louise Newson [00:03:02] Which is great. So but you haven’t always done menopause work, have you, as a pharmacist?

Faiza Kennedy [00:03:05] No, I’ve had a quite a varied career, but I suppose my last role was in general practice, which I loved. But if I’m honest, I’ve always liked the kind of the prevention. And then of course, once you see it, you can’t unsee it, can you? So it’s that joy, you know, when you see the difference. My favourite is seeing the follow up patients because you just see that it’s almost like the women come into focus and you know, the ripple effect on their families, on their work life, on everything. It’s just joyful.

Dr Louise Newson [00:03:33] It’s very transformational. I was talking to someone this afternoon, actually, and so whenever I get stressed, or I get over tired or just everything’s a bit overwhelming. I just sit in my clinic and see patients and it’s very powerful. I’ve always been jealous of my husband, who’s a surgeon, because he can really transform people’s life when they’re having an operation, of course. But in general practice, I always felt I wasn’t quite doing enough. And I, I always felt that I couldn’t really make a huge difference. I could make some difference, of course. But doing menopause care really is transformational, isn’t it? There’s very few things in medicine that I see people and say I don’t know how much I’ll make you better, but I know this is probably the worst you’re ever going to feel. And like you say, the first review, you start to see a difference. And then by the second or third or my annual follow up patients, I really love because you’re not just reviewing their HRT or looking at their lifestyle, you’re looking at the way like you say they’re interacting with their family. They’ve often got different jobs. They’ve been promoted or they’ve started work when they haven’t for a while. And you’re really setting them on a path, like you say, of preventative healthcare as well. So it’s not just making them feel better. You know, someone’s really clinically depressed and you give them anti-depressants, of course they’ll feel better, but you’re not going to strengthen their bones and reduce their risk of heart disease, are you?

Faiza Kennedy [00:04:52] Absolutely.

Dr Louise Newson [00:04:53] And I remember you telling me when we first met, I see you were doing some reviews of medication and you would just be taking people off medication, didn’t you?

Faiza Kennedy [00:05:01] Yes. I seem to spend my life trying to take them off medication, but like I said, once you see it, you inspired me, Louise. And once I could see it, and then you give them HRT and actually they can stay off that medication, which is a really powerful thing, I think.

Dr Louise Newson [00:05:15] Yeah, because that’s medications often people are on, sometimes over years there’s layers of medication. So people have often started on, say, antidepressants for their low mood and then their muscle and joint pains, they might get painkillers and then their blood pressure increases without estrogen. So then they’re on a blood pressure lowering treatment and then they’re found on a review to have raised cholesterol. So they then have a statin and then maybe they’re developing osteoporosis, so they’re on a bisphosphonate and before you know it, there’s five or six medications on a prescription.

Faiza Kennedy [00:05:45] Yeah, absolutely. And it’s so sad and disheartening. And I think then they feel so much better on HRT and you think, goodness, you know, that would have been, you know, wish we started there. Just replacing a woman’s own hormones and seeing how they do.

Dr Louise Newson [00:05:59] So one of the things often is that people talk about going to your GP for HRT or going to see your GP if you’re struggling with symptoms, whereas a lot of the time I think, well, the GP’s are overwhelmed anyway with everything else that’s going on. And menopause care actually I often think is better done by people, I’m not being rude about doctors because I am one, but as doctors we are often a bit chaotic. We don’t follow protocols the same way and we’ve got other skills as well. But I’ve always thought, wouldn’t it be better if it was taken away more from GP’s and it was given more to nurses and pharmacists, and you know a lot of pharmacists now, like you, can prescribe. So having a bit of autonomy, being able to see people. And actually prescribe for them in a way that’s safe is actually really good. And I think menopause care is one of the few things that really a lot of nurses and pharmacists, if they prescribe, can do with more autonomy probably than some other areas of medicine. And so we’ve got quite a few nurses and pharmacists, haven’t we, working with us?

Faiza Kennedy [00:07:04] We do. And you’re right. And we also generally tend to have a bit more time, don’t we? And so my little team that I look after, we look after patients in between their appointments with their own clinician as well, so we can help them just, you know, for quick questions or if they’re unsure about things, we can reiterate messages and things. So that is really lovely that the patient just gets an experience where they are looked after in between appointments as well as during their appointments. But yes, I see patients as well two days a week of my own. So and then you develop a relationship with the patients and it’s so lovely because you learn so much from the patients as well, don’t you?

Dr Louise Newson [00:07:40] Yeah, I mean, I’ve always said it’s a great privilege being a doctor and it really is being any healthcare professional, because even though our clinic is private, of course, we see people from all socioeconomic backgrounds and actually different ethnicities as well. So we’re still exposed to lots of people with lots of different stories, lots of different cultures, lots of different ways that they’ve come to the clinic. You know, I’ve seen a lot of people who it’s been their birthday and Christmas present combined from every single family member because they’re desperate to feel better and they can’t get help on the NHS. And so they’re not all people that have money, but it’s actually still really rewarding because we can help so many different communities. And like you say, there is this ripple effect. We know that every person that we help, they’re often going to educate other people. And a lot of people then say, because I’ve spoken to one of my friends and now she’s gone to her doctor, she’s got more confidence or she’s gone and got HRT elsewhere. So I feel like we’re sort of spreading out a lot more. And I know for some people they feel a bit frustrated seeing my name or listening to our company’s name. But actually, I know that we’re we’re helping far more people than just the people who pay to come and see us, don’t they?

Faiza Kennedy [00:08:54] Yes, I think so. And it’s really lovely when you end up treating a whole friend group. I always love it when they tell me about how they heard about the clinic and what made them make the appointment. But then also on the other side, I found that, you know, in the beginning it can take some time to get the HRT plan right for that individual patient because that’s what we focus on, isn’t it just individualising care, and then afterwards, often GPs will be quite happy to prescribe once the patient stabilised because that can take a little bit of time, can’t it? So I guess it’s just helping. Yes.

Dr Louise Newson [00:09:24] Yeah. One of my friends recently said, oh, HRT prescribing is really easy, it’s just the same for everyone. And I said, no, it’s absolutely not. And during the perimenopause it can be really quite difficult to get the right dose, can’t it, and then know we do spend a lot of time individualising both the type and dose, and it can really change even with the same patient, it can change over the months sometimes. So it’s very important that people are given the right dose, the right type, but we can’t always get the type that we want, can we? And I was thinking about this today actually. So five years ago I was away with my daughter because she was doing a trombone bootcamp in Budapest and there was a shortage of…then it was Evorel patches. And I remember getting hold of somebody in the government to say what’s happening and speaking to a chief pharmacist for NHS England and saying, this is awful, this is outrageous. Actually, I cannot function without my Evorel patches, the Estradot don’t stick on for me, the gel just slides off and I was really worried personally, of course, but I was also worried for my patients and they said, oh, it’s only a short term. And it took a few months of a lot of frustration. And then actually now Evorel’s been taken over by another company, Theramax, and that’s absolutely fine. But I just then thought, goodness me, we’ve only just started to increase prescribing then. Some of my work had only just started. But now we’ve had the Davina documentary, we’ve got a lot more awareness. HRT prescribing has gone from 10% to about 16%. Not 60,16% of menopausal women is still the minority, although we know for the majority of women, HRT has more benefits than risks. And as you know, we don’t none of us who work with us, do any paid work for pharmaceutical companies. But we have met with pharmaceutical companies over the last five years and said the demand is going to increase. It’s going to increase exponentially. What are you doing? How are you going to improve the stocks? And people talked about like a spike. You know, with COVID, we have this sort of spike. I said it’s not a spike. It’s going to continue as women understand the importance of considering hormones for their future health as well. And there is still this, oh, but we can’t. And then some of the way that they look at their stock is looking at what the government predicts. And that isn’t always true because there I guess many people who work or reports the government aren’t that keen about women having HRT. So there’s been this going on, but we felt it and seen it and then there’s been shortages of gel. There’s been shortages of Estradot, there’s been shortages of testosterones, and now there’s shortages of Utrogestan. And it’s incredibly frustrating, isn’t it?

Faiza Kennedy [00:12:17] Yes, it is. And I mainly feel sorry for women. One of my main things has always been and actually the whole team is, we don’t want patients once they’re on HRT, you definitely don’t want them to have to interrupt their treatment. And if they’re on estrogen, you definitely want them to have progesterone, if they still have a womb or if they’ve had a history of endometriosis or whatever. So it’s so important that the treatment isn’t interrupted. And I was reflecting on this because it’s been a tough few months, you know, with just making sure that treatment isn’t interrupted for patients. And I thought, gosh, but still we’re lucky. At least we have alternatives that are safe, they’re effective. We can talk through different options with patients. I grew up in Africa and our family home is still in Kenya. And I know for a fact that HRT is well, you know, there’s hardly any in Africa. You know, it’s very difficult to get hold of. So I guess on the positive side, isn’t it great that we have these alternatives so we can make sure that patients can continue treatment? But yes, it has been a big challenge. And I guess all the teams in Newson Health have been working so hard in just contacting patients. CloudRx, the pharmacy, have been fantastic. Also contacting patients saying, please let us know if you’re close to running out, let us know. And then we’ve been phoning patients and actually not charging for any of those phone calls and this is the pharmacist in me, Louise. And because I like to call the patients, because I like to know that they know how to use the alternatives and I can explain everything properly and give them the options, because I’ve come across so many times where patients may not use whatever is prescribed in the best way and then they don’t get the best effect from it.

Dr Louise Newson [00:13:57] Yeah, it’s really important because medication, it took me many years to realise that it’s not about just signing a prescription, it’s about compliance and people understanding. So if you don’t understand, you’re not going to do it. The amount of times I did home visits and I’d look at all the medication we’d prescribed from the practice, and then I open the person’s kitchen cupboard and everything would fall out on me because they would never take them, because they didn’t understand how to take them or they didn’t know what they were for. And so it’s really important if we just start at some of the basics, if you don’t mind. So HRT is three letters, hormone replacement therapy, I find that bit frustrating cause we’re not always replacing hormones, we’re just topping up what’s missing, aren’t we? So the main hormone we always prescribe usually is estrogen, isn’t it? So there are different ways if you just can you explain the different ways of having estrogen.

Faiza Kennedy [00:14:44] So mainly you prescribe it transdermally, which means through the skin. So it comes as a gel, patch or a spray. But just going on the example I was saying about making sure we explain things properly, I came across a patient the other day actually where she was applying three pumps on the same arm and wasn’t feeling better, you know, and just explaining actually if you spread it out, the better the absorption because you need a large surface area. There’s practical tips. It’s so important and can make all the difference.

Dr Louise Newson [00:15:11] Yes. Well, I did some training a few years ago to some local GPs we had a whole, in fact it was two hours. So it was an hour of just the theory and then and now more about practical prescribing and everything else. And then about six weeks later the GP phoned me up and he said, I’m a bit confused because you’ve sent someone out from your clinic on Oestrogel and Vagifem, which is a vaginal estrogen. And I said yes, and what else? And he said, well no, that’s all. She’s had a hysterectomy, so she’s just on the estrogen. But why on earth would you give the gel and the vaginal preparation? I said well the vaginal preparation is only for localised symptoms, you know, related to urinary symptoms or vaginal dryness. About a fifth of women have both. He said yes, but she’s on the gel. I said, yes, I don’t really know what else you want me to say. He said, yeah, but surely the gel’s for the vagina as well. And I was, oh dear, which bit of me doing this practical session where we have the placebo gel rubbing on the arm or the leg, did you not understand? And then there was this sort of embarrassed silence at the end of the phone and I thought, gosh. And it is easy to misunderstand when you’re prescribing and you haven’t seen, or you haven’t prescribed something before. And it’s very obvious for us because we’re prescribing it all the time. And, you know, sometimes I say to patients, don’t get too stressed whereabouts on the arm it goes or whereabouts on the legs. I know it’s licenced for the outside of the arms and the inside of the thighs, but I say, you can put it on your face. It doesn’t really matter. It’s just using the skin as a vehicle, isn’t it, to get it into the bloodstream. That’s what we’re doing.

Faiza Kennedy [00:16:41] Yeah, definitely. But I think also, you know, we always like to describe each hormone separately so you can individualise the doses here. But in the first appointment, it’s quite a lot to take in, isn’t there? And yes, you know, we do letters and I’m quite particular about my letters and I try and make it very specific so they know exactly and can refer back to it. But still, I always think, you know, you don’t know because what they’ll remember and, you know, just reinforcing that information is quite useful. So actually all the calls we’ve been doing, like I say, all my team have been doing all of these free of charge. We’ve actually, you know, been able to check in on patients and just reinforce key information, which has been really great.

Dr Louise Newson [00:17:21] So, yes.

Faiza Kennedy [00:17:23] I’m trying to find a silver lining with all these shortages.

Dr Louise Newson [00:17:26] Well, you’re great because you’re always so happy. And I know it’s very difficult. So we’ve got estrogen and at the minute there’s no problem with estrogen gel, there’s no shortage, Evorel patches and they come at different strengths, there isn’t a shortage, but Estradot, the small ones are still difficult to get hold of, aren’t they?

Faiza Kennedy [00:17:43] Yes, it’s intermittent and all the strengths aren’t available all of the time. Yeah, so it changes. But yes, hopefully that’s going to improve soon. But on the whole, estrogen is available.

Dr Louise Newson [00:17:56] On the whole estrogen is not so bad and the vaginal preparations of estrogen are fine as well. So the big problem that people are talking about, which is a real problem is Utrogestan, and Utrogestan is micronised progesterone isn’t it? So it’s the body identical progesterone, it’s called micronised because it’s made into very small particles really isn’t it, it’s suspended in oil just to help the absorption. But when you look down the microscope, it’s the same structure as the progesterone people produce from their ovaries when they’re younger. Any other progesterone is a synthetic progestogen, isn’t it? So it’s been chemically modified and it depends on what type of progestins it is at to how it’s been modified, isn’t it?

Faiza Kennedy [00:18:39] Definitely. And having micronised progesterone is first choice, isn’t it? Because then we know it’s safe. It doesn’t affect other things. It doesn’t affect your blood pressure, your cholesterol. And that’s the one women want to be on long term, don’t they?

Dr Louise Newson [00:18:51] So yeah, because the studies have shown that it doesn’t have a clot risk, it doesn’t have a cardiovascular risk, it’s probably even mutual or beneficial on blood pressure as well. And it has less side effects actually, because you’re giving the proper progesterone. The alternatives which there are. And you know, years ago we used to prescribe all the time, the synthetic progestogens. It’s only now you can have Utrogestan and it’s easier, but the synthetic progestogens can come as tablets, can’t they, and they do have a small risk associated with them, small risk of clots, small risk of heart disease, which sounds more scary than it is actually, because for a lot of people their background risk is very low. So increasing a low risk is still a low risk, isn’t it? And then the whole breast cancer risk has only ever been shown with synthetic progestogens. But again, it’s never been shown to be statistically significant and the risk is far lower than it is with other risk factors for breast cancer, for example, not exercising or being overweight or drinking moderate amounts of alcohol, all those are still really low risk factors, but they’re actually more than taking a synthetic progestogen. And then we’ve also got the Mirena coil haven’t we? So can you explain the bit about the Mirena coil?

Faiza Kennedy [00:20:12]  The Mirena coil is, you know, I would say in terms of safety and efficacy on the same level as Utrogestan, would you say Louise? And the great thing about that is that, you know, it can be left in place and replaced every five years, so you kind of forget about it and it just helps to balance the effect of estrogen on the lining of the womb, keeps it nice and thin. And so in that way, yes, you don’t have an additional thing to think about to take or insert into the vagina. So it’s great from that perspective and a lot of our patients quite like that because it’s also has a two-in-one effect, isn’t it, because it can act as the contraceptive if you’re perimenopausal, for example.

Dr Louise Newson [00:20:49] And it often means that women don’t have periods, which again is really nice. One of the problems often is people actually getting the Mirena coil because there’s been a real restriction in their use in general practice and in the NHS, a lot of clinics would only give them for contraception. So if you’re in your fifties and you’re having one replaced maybe or inserted for the first time and don’t need contraception, it can be difficult. And you know, we do have Mirena coil clinics running throughout our clinic and people sometimes travel for miles actually just to come and have a Mirena coil. But that is actually really good. People – I was talking to a lady yesterday and she said, oh, no, I don’t fancy that. And I say, have you seen the size? They’re really small. It’s actually not a difficult procedure. You want obviously someone who’s used to putting them in and once they’re in, people really don’t remember, you know, they don’t feel them or anything else. And, and if people don’t get on with them, they can be very easily removed.

Faiza Kennedy [00:21:43] Mm hmm. Yeah. Absolutley. But I suppose it’s patient choice isn’t it, again, so nice that we have these different options. But yes, Mirena is one of my favourites. Just because you can forget about it for five years and not have to think about it.

Dr Louise Newson [00:21:55] Absolutely. And then the other option, of there are different preparations of progesterone, which some people might not realise. So in the UK we can only have the oral as the Utrogestan. But for many years actually for women who don’t tolerate Utrogestan orally, we can use the oral Utrogestan capsules vaginally and they sort of just melt into the vagina, and then you have a higher concentration actually in the womb, which is where you need it. And women often have less side effects. So we’ve done that for many years anyway. Obviously, if you can’t get the Utrogestan it doesn’t matter whether it’s oral or vaginal you just can’t use it, but there are alternative progesterones we can use vaginally.

Faiza Kennedy [00:22:37] Yes, there’s two in the main that we’ve been using is Cyclogest, which comes as a pessary and also Lutigest and the great thing is that they are body identical progesterone as well. So essentially the woman is getting the same ingredient. And those calls we’ve been making to patients just to explain how to use them if they’ve been used to using Utrogestan orally it’s quite a change.

Dr Louise Newson [00:22:59] So with the pessaries, they come as a 200 milligrams. So they can if people are having 100 vaginally, they can be cut in half very easily. And they are very small actually aren’t they?

Faiza Kennedy [00:23:10] Yes, they are very small and very malleable and easy to cut. So this is what we explain when we call and explain what the alternatives are or what the options are. And the vast majority of patients have chosen Cyclogest or Lutigest. And that’s fine. At least we’ve got something so they don’t have to interrupt their treatment.

Dr Louise Newson [00:23:26] Yeah, absolutely. And using it vaginally, some people are quite scared that it’s going to disappear or if they’re going to insert it too far. But you can’t insert it too far and it usually just melts very easily. People don’t usually get a discharge or anything, and if they are using something like Vagifem or another vaginal hormonal preparation, it’s quite safe to use the two, isn’t it?

Faiza Kennedy [00:23:48] Yeah, absolutely. And we normally would say use the progesterone first and then the vaginal estrogen afterwards or opposite ends of the day. That’s fine too. And I guess this is why it’s simple. I felt it’s so important to call patients and we’ve been doing that during the shortages just so we can answer some of these practical questions and make sure patients understand fully.

Dr Louise Newson [00:24:09] Yeah. And then the other alternative, so there are always alternatives. And so it’s I think it’s really lovely for patients. No, I never want to leave my consulting room until they know there’s an alternative of anything, because people, if they get side effects or whatever, it’s quite nice to know. So there is a capsule called Bijuve, which is an oral body identical combination, and so it contains lowish dose, one milligram of estradiol, which is equivalent-ish to about 50 microgram patches, or two pumps of gel. I say ish because it all depends how it’s absorbed into the body, of course, but it also contains 100 milligrams of Utrogestan. So it’s a way of getting it. You can’t split it out. It’s all there as a combination. It’s been around, in America, it’s called by Bijuva, and it’s been around for quite a long time. It’s Bijuve over here. Quite a few NHS areas are still unable to prescribe it because it’s not in the formulary, which is very frustrating. But we can prescribe it through the clinic and in some areas they can prescribe it and that can be quite a good combination oral preparation can’t it, for some people? And it’s not been shown to be associated with risk of clots like the synthetic progestogens as well. So sometimes if people are using that or taking it, they might have to reduce the dose of their estrogen a little bit depending on the way how it’s absorbed. So that’s an option. And then there are combination patches that we sometimes use as well which contain estrogen and it’s a synthetic progestogen, but it’s through the skin. There probably is a small risk, you know, this risk of clot and heart disease, but it’s very, very low, especially because it’s low dose that’s absorbed. But again, these combination patches only contain 50 micrograms of estrogen. So sometimes with people they still need more estrogen.

Faiza Kennedy [00:26:01] Yes. And if you want to titrate, it’s much easier sometimes to have the product separately so that you can individualise treatment, can’t you, Because then you’re actually you can’t have any more estrogen because the skin is a barrier and sometimes you will need more depending on how you absorb.

Dr Louise Newson [00:26:15] Absolutely. So it really varies and sometimes it can take a while to get the right one. And I always say to people, when you change, just try and bear with it for a good two or three months, because sometimes people get side effects initially and then they settle down. So there are choices, there are options, there’s more information on the balance website as well. And we’ve received some information about alternatives to Utragestan. One of the reasons there is a shortness, obviously because there’s increased demand. But they’ve built a new factory and supposed to be in full swing by the end of the year. So I think this is going to be an intermittent problem. I must say that Besins are trying as hard as they are. There is still stock, but obviously they’ve got to distribute it throughout everybody. And we really shouldn’t be advising that people have estrogen on their own. It’s okay for a few weeks, they might get bleeding, but certainly any more than that it does help protect the lining of the womb having progesterone. So it really shouldn’t be having estrogen on its own if at all possible.

Faiza Kennedy [00:27:17] There is stock and it is coming in, which is really reassuring. And also we are trying to find other pharmacies that have stock just so that we can get HRT for our patients. But you know, it’s not as if there’s no stock, it’s just that for a while we might have to be careful about, you know, making sure everyone has some treatment to continue with.

Dr Louise Newson [00:27:35] Yeah. And at the minute the guidelines are we should only prescribe two months of Utrogestan at a time. So that’s two months, whether it’s NHS or private. Of course, if you have one of the alternatives, you can have longer. So anybody who’s listening and is struggling, it would be worth probably going to see a pharmacist first find out where our stock is. They often know more actually the pharmacist than just going to your GP. And then obviously read some information, empower yourself with knowledge, and then decide which alternative is best for you. And then it’s easier that way. And then going pre-armed with the information. So you can then have a shared decision making consultation with your GP rather than your poor GP who might not necessarily know all the alternatives. So having information is really good. So, so very grateful. Faiza, for your time to do this podcast at very short notice. But before we end, just three take home tips I always ask for. So I’m very keen to ask for three tips for people that are struggling or worried about the Utrogestan shortage. What three things would you say to them?

Faiza Kennedy [00:28:39] So the first one I would say is just the intention of the serious shortage protocol of only having two months is just so everyone has treatment and no one’s treatment is interrupted. So please only order what you need. You know, it is frustrating that you have to do it every two months, but hopefully this will get us out of it and the manufacturers will catch up. And then second, I would say just be organised. Make sure you allow enough time as well so you know, when you’ve got about two weeks of treatment left, that’s the time to order some more, just in case you have to have a phone call for an alternative and go through that. So leave plenty of time and don’t wait till the last minute to order and just make sure you’ve got enough of both, you know, estrogen, progesterone if you’re on both treatments. And then last but not least, I would say, you know, we’re here to help. The pharmacy will communicate to us. If you let them know that you’re close to running out of treatment, you know, you can contact us as well. So as long as you’ve had an annual review or been seen in the last 12 months, we’re absolutely happy to help you prescribe an alternative or even if you get your prescriptions through the GP and just come and see us for annual review, that’s fine. We can always recommend different options for you to discuss these. GP That’s fine too. So we’re here to help. Just get in touch.

Dr Louise Newson [00:29:54] Very good. So, absolutely. So if you’re our patient, obviously get in touch. But if you’re not our patients, there’s lots of free information available on the balance website and hopefully we won’t be having more of these conversations. But the good thing is it means that more people are taking HRT, meaning that future health for those women will improve. So there are good points as well. So thank you again so much and it’s been great having you on the podcast today. So thanks, Faiza.

Dr Louise Newson [00:30:26] For more information about the perimenopause and menopause, please visit my website www.balance-menopause.com. Or you can download the free balance app, which is available to download from the App Store or from Google Play.

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