North East and North Cumbria
ICS Formulary
 
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6 Endocrine system
06-04-01-02 Progestogens

Norethisterone 5mg tablets
First Choice
  • Should NOT be prescribed for menstrual delay for non clinical reasons.

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Levonorgestrel Mirena®
Formulary
  • Levonorgestrel 52mg in a T-shaped intra-uterine system. 
  • For idiopathic menorrhagia. Especially in women requiring (reversible) contraception. Also used for protection with endometrial hyperplasia during oestrogen replacement therapy. Lasts for up to 5 years - for use in accordance with agreed guidelines.

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Medroxyprogesterone Acetate
Formulary

Approved Medroxyprogesterone formulations include:

  • 2.5mg, 5mg, and 10mg tablets (sometimes used as a progestogen component of HRT).
  • 100mg & 200mg tablets (for use in malignant disease see section 8.3.2).
  • 50mg in ml injection - see sections 7.3.2.2 for use of  medroxyprogesterone acetate injection in contraception.

Should NOT be prescribed for menstrual delay for non clinical reasons.


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Micronised progesterone Utrogestan®
Formulary
  • 100mg oral capsules Green
  • Approved for:
    • adjunctive use with estrogen in post-menopausal women with an intact uterus, as hormone replacement therapy (HRT)
    • Perimenopause (off-label)
    • Premature ovarian insufficiency (off-label)
    • Adolescents undergoing pubertal induction following chemotherapy (off-label)



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Progesterone
Formulary
  • Approved formulations include:
    • 200mg & 400mg pessaries (Cyclogest®) Green plus
      • To support the pregnancies of women who have a history of miscarriage or premature labour as per NICE NG25: Preterm labour and birth AND NICE NG126: Ectopic pregnancy and miscarriage: diagnosis and initial management.
    • 200mg vaginal capsules (Utrogestran®) Green plus
      • To support the pregnancies of women who have a history of miscarriage or premature labour as per NICE NG25: Preterm labour and birth AND NICE NG126: Ectopic pregnancy and miscarriage: diagnosis and initial management.
    • 25mg SC/IM injection (Lubion®) Red
      • Approved for luteal support in patients who have had a previous failed biochemical pregnancy in a froxen embryo transfer (FET) cycle
  • CD&TV Red for Luteal Phase support following IVF.
    • Full course to be supplied by hospital

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Ulipristal Esmya®
Formulary
  • 5mg tablets
    • Approved for the pre-operative treatment of uterine fibroids for one 3 month course, as per its product licence.
    • Approved for the medical treatment of uterine fibroids in women unsuitable for surgery, up to a maximum of four 3 month intermittent courses, as per its product licence and reviewed regularly.
    • Contraindicated in women with underlying liver disorders.  
    • Requirements for liver function monitoring before, during, and after treatment
Link  MHRA Drug Safety Update (Feb 2021): Ulipristal acetate 5mg (Esmya): further restrictions due to risk of serious liver injury

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