Vaginal Progestogens

Vaginal Progestogens in HRT

Vaginal progestogens are used when a local effect on the womb lining is needed, without affecting the whole body. They are especially useful for women who are sensitive to oral progestogens or who are using low-dose oestrogen for vaginal symptoms but still need protection for their uterus.

Why are vaginal progestogens used?

• They deliver progesterone directly to the uterus, helping to protect the womb lining from thickening.
• They have minimal absorption into the bloodstream, which means fewer whole-body side effects.
• They are often used in women who experience vaginal symptoms such as dryness, discomfort, or atrophy during menopause.

Examples Available in the NHS

• Utrogestan® (micronised progesterone):

  • Available in both oral and vaginal capsule form.
  • Derived from natural progesterone.
  • Often used vaginally when systemic side effects are a concern.

• Other vaginal preparations:

  • May include progesterone creams or pessaries, though these are less commonly prescribed and may be used off-label.
  • Availability may vary depending on local NHS prescribing policies.

Benefits

• Fewer systemic side effects: Less likely to cause mood changes, bloating, or breast tenderness.
• Targeted action: Acts directly on the womb lining, reducing cancer risk without affecting other organs.
• Suitable for sensitive patients: Ideal for those who cannot tolerate oral progestogens.

Potential Drawbacks

• Requires vaginal insertion: May be inconvenient or uncomfortable for some women.
• Less familiar: Not all patients are aware of this option, and it may require more explanation.
• Availability: Some forms may not be routinely stocked or may require specialist prescribing.

When Might Vaginal Progestogens Be Recommended?

You may be offered vaginal progestogens if:

• You have vaginal symptoms and want a local treatment.
• You are sensitive to oral progestogens or have had side effects.
• You are using low-dose oestrogen for local symptoms but still need womb protection.
• You have liver disease or clotting risk, and oral progestogens are not suitable.

Duration of Use

• Vaginal progestogens can be used long-term as part of your HRT regimen.
• They should be reviewed regularly to ensure they continue to meet your needs.

Key Safety Message

If you have a uterus and are prescribed HRT, you must remain on progestogen to protect your womb lining.

Vaginal progestogens offer a safe and effective alternative to oral forms, especially for women who need a localised approach.

Never stop taking progestogen without medical advice.