Utrogestan petition. ‘Women can’t get the safest HRT’

A woman has launched a petition for NHS Lothian to make the hormone treatment Utrogestan prescribable, after she was shocked to find the only way for her to get this form of “micronised progesterone” was to pay for it.  

Micronised progesterone is available in two forms, the Mirena coil, prescribed across Scotland, and in capsule form, Utrogestan.

Caroline Phipps-Urch, yoga-teacher who runs regular menopause workshops as one half of The Menopause Sisters said, “Women make up half of the population and this is something all women will go through whether they have a hysterectomy, go through menopause due to other treatment and 1 in a 100 women are under 40 and yet we can’t get the safest form of HRT to help us unless we choose to have the coil.”  

In an interview in the Herald magazine tomorrow, she talks about how the perimenopause has impacted on her and her family.

The website The Menopause Doctor, run by menopause specialist Dr Louise Newson advises, that the “body identical” micronised progesterone which goes under the brand name Utrogestan is “better tolerated as well as having a lower risk of breast cancer compared to synthetic progestogens.” 

READ MORE: Hormone pills for the menopause could cut UTI risk

Phipps-Urch, who is perimenopausal, had done research into the best HRT to take given her personal situation before she went to her doctor to seek a prescription. “Women who still have their uterus need to take progesterone as well oestrogen as part of their HRT to protect the lining of the womb. The safest option for the progesterone component is micronised progesterone which is body identical – so the closest you can get to the progesterone actually produced by your body. I don’t want a Mirena coil which is a personal choice (they are licensed for use for 5 years as part of HRT) so the alternative is Utrogestan, a tablet form.” 

Her GP, she said was “incredibly supportive” but informed her that she could not get HRT on the NHS and would have to go privately and pay for an appointment as well as the prescription.   

The availability of Utrogestan varies hugely across the country. NHS Grampian, for instance, has Utrogestan on its green list as available for general use. NHS Highlands added it to its formulary last year.  

The reason for this seeming postcode lottery is that the Scottish Medicines Consortium, when it assessed Utrogestan in 2009, did not recommend it for routine use, principally due to cost. 

A spokesperson for the Scottish Medicines Consortium (SMC) said: “SMC assessed micronised progesterone (Utrogestan) capsules for adjunctive use with oestrogen in post-menopausal women with an intact uterus (HRT) in 2009. Unfortunately, after careful consideration, SMC was unable to recommend it for routine use, as the evidence from the company was not strong enough to be certain that the medicine offered value for money to NHSScotland.”

“Where a medicine is not recommended by SMC, the company is encouraged to make an improved resubmission at any time. We are reliant on the company to provide evidence of the clinical and cost effectiveness of a medicine, as this information forms the basis of our assessment process. As such, we are unable to reassess a medicine unless we are provided with this information from the company, in the form of a resubmission.”

“All NHS boards In Scotland have procedures in place to consider requests for the use of a medicine (which has not been recommended by SMC) in an individual patient when a doctor feels this would be appropriate.”

Stephen McBurney, Associate Director of Pharmacy, NHS Lothian, said: “Micronised progesterone (Utrogestan) capsules for use with estrogen in post-menopausal women are not routinely available in the NHS in Scotland because the product is not recommended for use by the Scottish Medicines Consortium.

“All health boards, including NHS Lothian, have procedures in place to consider requests when a healthcare professional feels another medicine would be right for a particular person. This includes medicines that are not recommended by SMC. For such medicines, an application can be made by a clinician to the NHS board Patient Treatment Request panel, for a patient where there are no approved medicines suitable for the patient or where the approved ones are not suitable.”

Since the 2009 SMC decision some boards have decided to add it to their formulary, some not. Meanwhile, individuals living in those boards who have not made this decision have also been successful in getting their GPs to prescribe this form of HRT. Some boards, for instance NHS Forth valley, describe it as “not routinely available” – and even in NHS Lothian it has been prescribed to some women. A freedom of information request answered by NHS Lothian in November 2020 listed 495 women as having been prescribed it between 2016 and 2020. 

In 2017 Utrogestan was approved by the SMC for use in fertility treatment. It is also commonly prescribed in England where HRT is still subject to prescription fees. 

Phipps-Urch said, “I believe this decision has been influenced by cost: Utrogestan is approx. £59 per patient per year versus £21 for Mirena coil per patient per 5 years. There are many long term health benefits for the women who would like to take HRT including a reduced risk of osteoporosis and heart disease potentially saving the NHS money.”  

Phipps-Urch and her family are one of a number of families interviewed in tomorrow’s article in The Herald magazine.

 

The Herald Scotland

The Herald Scotland

The Herald is a Scottish broadsheet newspaper founded in 1783. The Herald is the longest running national newspaper in the world and is the eighth oldest daily paper in the world. The title was simplified from The Glasgow Herald in 1992