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The BMS guidance did not say by how much the dose of oral progestogen should be increased a document published by the Primary Care Womens Health Society (PCWHS) suggested that a pragmatic approach would be to use the same increases as we would use for women taking a higher than usual dose of oestrogen, but also pointed out that the lack of data to guide this and emphasised that the levonorgestrel intrauterine device gives the best endometrial protection and should be recommended in this situation