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Off-label use.

Levonorgestrel recommended for replacement every 5 years (off-label use) as per BMS: https://thebms.org.uk/wp-content/uploads/2023/04/14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf

• Mirena - licensed for endometrial protection but only for a duration of 4 years. Agreed to use for a duration of 5 years before replacement (off-label).

Off-label use.

Off-label use.

Off-label use

Progesterone pessaries have not been agreed for use as endometrial protection.

Off-label use.

Safety Notice:

Unopposed oestrogen replacement is associated with a significant increase in the risk of endometrial hyperplasia that is both dose and duration dependent with exposure between one and three years. Non-hysterectomised women require progestogen administered for 12–14 days in a sequential regimen and daily in a continuous combined regimen to minimise the risk of endometrial hyperplasia and endometrial cancer associated with unopposed estrogen exposure. Healthcare Professionals should be aware of BMS guidance when prescribing HRT.

High dose oestrogen - The Surrey Heartlands Area Prescribing Committee does not support prescribing of HRT with oestrogen doses above those specified in the license. This is because there is insufficient evidence of efficacy or safety to support this. Specialists may prescribe higher doses of oestrogens with the appropriate opposing progestogen doses but need to retain prescribing responsibility and not transfer prescribing to primary care. Where specialists take the responsibility of initiating higher doses of oestrogens, they should do so for a limited period of time and retain prescribing responsibility for both oestrogens and associated progestogens. They should be aware of the BMS guidance with regards to requiring increased doses of progestogens to ensure adequate endometrial protection.