When to increase the progestogen dose

WHEN TO INCREASE THE PROGESTOGEN / PROGESTERONE DOSE:

For women that require high doses of oestrogen, the progestogen dose should be increased in line with this, to ensure adequate endometrial protection. 

Although a formal consensus on what defines a 'high dose of oestrogen' is not currently available, most menopause specialists agree that doses that exceed the product licence for Oestrogel or for patches are high.

If a woman has risk factors for endometrial hyperplasia however, there should be consideration to increase the progestogen dose earlier than this. For example when using a 75-100mcg patch or 3-4 pumps of Oestrogel. 

An exception to the above is if an in date 52mg levonorgestrel-intrauterine system (IUD) is in place. For these individuals, additional progestogen does not usually need to be prescribed when higher oestrogen doses are used.