Estradiol 50 microgram per 24 hour Progynova TS
50micrograms/24hours transdermal patches | 12 patch P £18.90
Estradiol 100 microgram per 24 hour Progynova TS
100micrograms/24hours transdermal patches | 12 patch P £20.70 DT = £20.70
EXCIPIENTS: May contain Propylene glycol
▶ Oestrogel (Besins Healthcare (UK) Ltd)
Estradiol 600 microgram per 1 gram Oestrogel Pump-Pack 0.06%
gel | 80 gram P £4.80 DT = £4.80
▶ Sandrena (Orion Pharma (UK) Ltd)
Estradiol (as Estradiol hemihydrate) 500 microgram Sandrena
500microgram gel sachets | 28 sachet P £5.08 DT = £5.08
Estradiol (as Estradiol hemihydrate) 1 mg Sandrena 1mg gel
sachets | 28 sachet P £5.08 DT = £5.08 | 91 sachet P £17.57
medroxyprogesterone, p. 762 . Estradiol with norethisterone,
p. 762 . Estradiol with norgestrel, p. 763
Short-term treatment of symptoms of oestrogen
deficiency | Osteoporosis prophylaxis if other drugs
▶ Adult (female): 10–50 micrograms daily for 21 days,
repeated after 7-day tablet-free period, to be given
with progestogen for 12–14 days per cycle in women
▶ Adult (female): 10–50 micrograms daily usually on
cyclical basis, initial oestrogen therapy should be
followed by combined oestrogen and progestogen
▶ Adult (female): 20–50 micrograms daily from day 5 to
25 of each cycle, to be given with progestogen, added
either throughout the cycle or from day 15 to 25.
Palliative treatment of prostate cancer
▶ Adult (male): 0.15–1.5 mg daily.
l CONTRA-INDICATIONS Active or recent arterial
thromboembolic disease (e.g. angina or myocardial
infarction). active thrombophlebitis . Acute porphyrias
p. 1058 .Dubin-Johnson and Rotor syndromes (or monitor
closely). gallstones . heart disease associated with
pulmonary hypertension . heart disease associated with
risk of embolus . history during pregnancy of cholestatic
jaundice . history during pregnancy of chorea . history
during pregnancy of pemphigoid gestationis . history
(where liver function tests have failed to return to normal)
risk factors for arterial disease . severe or multiple risk
factors for venous thromboembolism . systemic lupus
erythematosus with (or unknown) antiphospholipid
antibodies .thrombophilic disorder.transient cerebral
ischaemic attacks without headaches . undiagnosed
thromboembolism (unless already on anticoagulant
l CAUTIONS Active trophoblastic disease (until return to
normal of urine- and plasma-gonadotrophin
concentration)—seek specialist advice . cardiovascular
disease (sodium retention with oedema,
thromboembolism). Crohn’s disease . diabetes (increased
risk of heart disease). gene mutations associated with
breast cancer (e.g. BRCA 1) . history of breast nodules or
fibrocystic disease—closely monitor breast status (risk of
breast cancer). history of endometrial hyperplasia . history
of severe depression (especially if induced by hormonal
contraceptive). hyperprolactinaemia (seek specialist
(migraine-like headaches). personal or family history of
thrombotic events). prolonged exposure to unopposed
oestrogens may increase risk of developing endometrial
cancer.risk factors for arterial disease .risk factors for
migraine .risk factors for oestrogen-dependent tumours
(e.g. breast cancer in first-degree relative).risk factors for
venous thromboembolism . sickle-cell disease . undiagnosed breast mass
▶ Other conditions The product literature advises caution in
other conditions including hypertension, renal disease,
asthma, epilepsy, sickle-cell disease, melanoma,
otosclerosis, multiple sclerosis, and systemic lupus
erythematosus (but care required if antiphospholipid
antibodies present, see above). Evidence for caution in
these conditions is unsatisfactory and many women with
these conditions may stand to benefit from treatment.
▶ Risk of venous thromboembolism Use with caution if any of
following factors present but avoid if two or more factors
. family history of venous thromboembolism in first-degree
relative aged under 45 years (avoid if known
prothrombotic coagulation abnormality e.g. factor V
Leiden or antiphospholipid antibodies (including lupus
. obesity—body mass index 30 kg/m2 (avoid if body mass
index 35 kg/m2 unless no suitable alternative); (In
adolescents, caution if obese according to BMI (adjusted
for age and gender); in those who are markedly obese,
avoid unless no suitable alternative);
. long-term immobilisation e.g. in a wheelchair (avoid if
confined to bed or leg in plaster cast);
. history of superficial thrombophlebitis;
. age over 35 years (avoid if over 50 years);
▶ Risk factors for arterial disease Use with caution if any one of
following factors present but avoid if two or more factors
. family history of arterial disease in first degree relative
aged under 45 years (avoid if atherogenic lipid profile);
. diabetes mellitus (avoid if diabetes complications
. hypertension—blood pressure above systolic 140 mmHg or
diastolic 90 mmHg (avoid if blood pressure above systolic
160 mmHg or diastolic 95 mmHg); (In adolescents, avoid
. smoking (avoid if smoking 40 or more cigarettes daily);
. age over 35 years (avoid if over 50 years);
. obesity (avoid if body mass index 35 kg/m2 unless no
suitable alternative); (In adolescents, caution if obese
according to BMI (adjusted for age and gender); in those
who are markedly obese, avoid unless no suitable
. migraine without aura (avoid if migraine with aura (focal
symptoms), or severe migraine frequently lasting over
BNF 78 Female sex hormone responsive conditions 759
72 hours despite treatment, or migraine treated with
▶ Migraine Women should report any increase in headache
frequency or onset of focal symptoms (discontinue
immediately and refer urgently to neurology expert if focal
neurological symptoms not typical of aura persist for more
l INTERACTIONS → Appendix 1: hormone replacement
l SIDE-EFFECTS Breast abnormalities . cervical mucus
thrombosis . erythema nodosum .feminisation . fluid
disorders . vomiting . weight change
SIDE-EFFECTS, FURTHER INFORMATION Cyclical HRT
(where a progestogen is taken for 12–14 days of each
28-day oestrogen treatment cycle) usually results in
regular withdrawal bleeding towards the end of the
progestogen. Continuous combined HRT commonly
produces irregular breakthrough bleeding in the first
4–6 months of treatment. Bleeding beyond 6 months or
after a spell of amenorrhoea requires further investigation
to exclude serious gynaecological pathology.
l PREGNANCY Not known to be harmful.
l BREAST FEEDING Avoid until weaning or for 6 months
after birth (adverse effects on lactation).
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: tablet, capsule, oral
▶ Ethinylestradiol (Non-proprietary)
Ethinylestradiol 2 microgram Ethinylestradiol 2microgram tablets
Ethinylestradiol 10 microgram Ethinylestradiol 10microgram
tablets | 21 tablet P £200.00 DT = £200.00
Ethinylestradiol 50 microgram Ethinylestradiol 50microgram
tablets | 21 tablet P £200.00 DT = £200.00
Ethinylestradiol 1 mg Ethinylestradiol 1mg tablets | 28 tablet P £200.00 DT = £200.00
Short-term treatment of symptoms of oestrogen
deficiency (including women being treated with
gonadotrophin releasing hormone analogues)|
Osteoporosis prophylaxis in women at high risk of
fractures when other prophylaxis contra-indicated or
l CONTRA-INDICATIONS Active or recent arterial
thromboembolic disease (e.g. angina or myocardial
infarction). active thrombophlebitis . Acute porphyrias
p. 1058 .Dubin-Johnson and Rotor syndrome (or monitor
closely). history of breast cancer. history of cardiovascular
disease . history of cerebrovascular disease . history of
recurrent venous thromboembolism (unless already on
tumours . liver disease (where liver function tests have
vaginal bleeding . untreated endometrial hyperplasia . venous thromboembolism
(or migraine-like headaches). presence of
antiphospholipid antibodies (increased risk of thrombotic
events). prolonged exposure to unopposed oestrogens
may increase risk of developing endometrial cancer.risk
factors for oestrogen-dependent tumours (e.g. breast
cancer in first-degree relative).risk of stroke
▶ Other conditions The product literature advises caution in
other conditions including hypertension, renal disease,
asthma, epilepsy, sickle-cell disease, melanoma,
otosclerosis, multiple sclerosis, and systemic lupus
erythematosus (but care required if antiphospholipid
antibodies present). Evidence for caution in these
conditions is unsatisfactory and many women with these
conditions may stand to benefit from HRT.
l INTERACTIONS → Appendix 1: tibolone
▶ Common or very common Breast abnormalities . cervical
dysplasia . endometrial thickening . gastrointestinal
haemorrhage . vaginal discharge . vaginal haemorrhage . weight increased
▶ Uncommon Oedema . skin reactions
SIDE-EFFECTS, FURTHER INFORMATION Vaginal bleeding
Investigate for endometrial cancer if bleeding continues
beyond 6 months or after stopping treatment.
Reasons to withdraw treatment Withdraw treatment
if signs of thromboembolic disease, abnormal liver
function tests, or signs of cholestatic jaundice.
l PREGNANCY Avoid; toxicity in animal studies.
l HEPATIC IMPAIRMENT Manufacturer advises caution; avoid
Monitoring Patients with renal impairment should be
closely monitored (risk of fluid retention).
l PRESCRIBING AND DISPENSING INFORMATION Unsuitable
for use in the premenopause (unless being treated with
gonadotrophin-releasing hormone analogue) and as (or
Also unsuitable for use within 12 months of last
menstrual period (may cause irregular bleeding).
If transferring from cyclical HRT, start at end of
regimen; if transferring from continuous-combined HRT,
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Tibolone 2.5 mg Tibolone 2.5mg tablets | 28 tablet P £10.36–
£11.90 DT = £7.66 | 84 tablet P £31.08–£35.10
▶ Livial (Merck Sharp & Dohme Ltd)
Tibolone 2.5 mg Livial 2.5mg tablets | 28 tablet P £10.36 DT =
760 Sex hormone responsive conditions BNF 78
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, conjugated oestrogens (equine) p. 754,
medroxyprogesterone acetate p. 810.
Menopausal symptoms in women with a uterus
▶ Adult: 1 tablet daily continuously
l INTERACTIONS → Appendix 1: hormone replacement
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Conjugated oestrogens 300 microgram, Medroxyprogesterone
acetate 1.5 mg Premique Low Dose 0.3mg/1.5mg modified-release
tablets | 84 tablet P £6.52 DT = £6.52
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, estradiol p. 756.
Menopausal symptoms in women with a uterus
▶ Adult: 1 tablet daily for 14 days, white tablet to be
taken and started within 5 days of onset of
menstruation (or any time if cycles have ceased or are
infrequent), then 1 tablet daily for 14 days, grey tablet
to be taken, subsequent courses repeated without
interval, Femoston ® 1 mg/10 mg given initially and
Femoston ® 2 mg/10 mg substituted if symptoms not
Osteoporosis prophylaxis in women with a uterus
▶ Adult: 1 tablet daily for 14 days, white tablet to be
taken and started within 5 days of onset of
menstruation (or any time if cycles have ceased or are
infrequent), then 1 tablet daily for 14 days, grey tablet
to be taken, subsequent courses repeated without
Menopausal symptoms in women with a uterus
▶ Adult: 1 tablet daily for 14 days, red tablet to be taken
and started within 5 days of onset of menstruation (or
any time if cycles have ceased or are infrequent), then
1 tablet daily for 14 days, yellow tablet to be taken,
subsequent courses repeated without interval,
Femoston ® 1 mg/10 mg given initially and Femoston ®
2 mg/10 mg substituted if symptoms not controlled
Osteoporosis prophylaxis in women with a uterus
▶ Adult: 1 tablet daily for 14 days, red tablet to be taken
and started within 5 days of onset of menstruation (or
any time if cycles have ceased or are infrequent), then
1 tablet daily for 14 days, yellow tablet to be taken,
subsequent courses repeated without interval
Menopausal symptoms in women with a uterus whose last
menstrual period occurred over 12 months previously
▶ Adult: 1 tablet daily continuously, if changing from
cyclical HRT begin treatment the day after finishing
oestrogen plus progestogen phase
Menopausal symptoms in women with a uterus whose last
menstrual period occurred over 12 months previously |
Osteoporosis prophylaxis in women with a uterus whose
last menstrual period occurred over 12 months
▶ Adult: 1 tablet daily continuously, if changing from
cyclical HRT begin treatment the day after finishing
oestrogen plus progestogen phase
l CONTRA-INDICATIONS Acute porphyrias p. 1058 . genital
or breast cancer. history during pregnancy of idiopathic
l CAUTIONS Conditions that may worsen with fluid
retention e.g. epilepsy, hypertension, migraine, asthma, or
cardiac dysfunction . diabetes (progestogens can decrease
glucose tolerance). history of depression . in those
susceptible to thromboembolism (particular caution with
l INTERACTIONS → Appendix 1: hormone replacement
haemorrhage . skin reactions . vomiting . vulvovaginal
▶ Uncommon Cystitis-like symptom . embolism and
thrombosis . gallbladder disorder. hepatic function
abnormal . hypertension . libido disorder. peripheral
vascular disease .tumour growth . varicose veins
▶ Rare or very rare Angioedema . myocardial infarction
l RENAL IMPAIRMENT Use with caution.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Femoston 1/10mg tablets | 84 tablet P £16.16
Femoston 2/10mg tablets | 84 tablet P £16.16
Estradiol 500 microgram, Dydrogesterone 2.5 mg Femoston-conti
0.5mg/2.5mg tablets | 84 tablet P £24.43 DT = £24.43
Estradiol 1 mg, Dydrogesterone 5 mg Femoston-conti 1mg/5mg
tablets | 84 tablet P £24.43 DT = £24.43
BNF 78 Female sex hormone responsive conditions 761
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, estradiol p. 756, levonorgestrel p. 806.
Menopausal symptoms in women with a uterus whose last
menstrual period occurred over 12 months previously
▶ Adult: Apply 1 patch once weekly continuously
Menopausal symptoms in women with a uterus
▶ Adult: Apply 1 patch once weekly for 2 weeks, phase
1 patches to be applied, then apply 1 patch once weekly
for 2 weeks, phase 2 patches to be applied, subsequent
courses are repeated without interval
l INTERACTIONS → Appendix 1: hormone replacement
l PATIENT AND CARER ADVICE Patient counselling is advised
for estradiol with levonorgestrel patches (application).
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ FemSeven Conti (Theramex HQ UK Ltd)
Levonorgestrel 7 microgram per 24 hour, Estradiol 50 microgram
per 24 hour FemSeven Conti patches | 4 patch P £15.48 DT =
£15.48 | 12 patch P £44.12 DT = £44.12
▶ FemSeven Sequi (Theramex HQ UK Ltd)
FemSeven Sequi patches | 4 patch P £13.18 | 12 patch P £37.54
Estradiol with medroxyprogesterone
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, estradiol p. 756, medroxyprogesterone
Menopausal symptoms in women with a uterus whose last
menstrual period occurred over 3 years previously |
Osteoporosis prophylaxis in women with a uterus whose
last menstrual period occurred over 3 years previously
▶ Adult: Initially 1/2.5 mg daily taken continuously,
adjust according to response, to be started at end of
scheduled bleed if changing from cyclical HRT
Menopausal symptoms in women with a uterus |
Osteoporosis prophylaxis in women with a uterus
▶ Adult: 1 tablet daily for 70 days, white tablet to be
taken, then 1 tablet daily for 14 days, blue tablet to be
taken, then 1 tablet daily for 7 days, yellow tablet to be
taken, subsequent courses are repeated without
l INTERACTIONS → Appendix 1: hormone replacement
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
▶ Indivina (Orion Pharma (UK) Ltd)
Estradiol valerate 1 mg, Medroxyprogesterone acetate
2.5 mg Indivina 1mg/2.5mg tablets | 84 tablet P £20.58 DT =
Estradiol valerate 2 mg, Medroxyprogesterone acetate
5 mg Indivina 2mg/5mg tablets | 84 tablet P £20.58 DT = £20.58
Estradiol valerate 1 mg, Medroxyprogesterone acetate
5 mg Indivina 1mg/5mg tablets | 84 tablet P £20.58 DT = £20.58
▶ Tridestra (Orion Pharma (UK) Ltd)
Tridestra tablets | 91 tablet P £20.49
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, estradiol p. 756, norethisterone p. 764.
▶ Adult: 1 tablet daily for 16 days, grey tablet to be taken
and started on day 1 of menstruation (or at any time if
cycles have ceased or are infrequent), then 1 tablet
daily for 12 days, white tablet to be taken, subsequent
courses are repeated without interval
Menopausal symptoms (if symptoms not controlled with
▶ Adult: 1 tablet daily for 16 days, blue tablet to be taken
and started on day 1 of menstruation (or at any time if
cycles have ceased or are infrequent), then 1 tablet
daily for 12 days, white tablet to be taken, subsequent
courses are repeated without interval
Menopausal symptoms in women with a uterus whose last
menstrual period occurred over 12 months previously |
Osteoporosis prophylaxis in women with a uterus whose
last menstrual period occurred over 12 months
▶ Adult: 1 tablet daily continuously
Menopausal symptoms in women with a uterus |
Osteoporosis prophylaxis in women with a uterus
▶ Adult: 1 tablet daily for 16 days, white tablets to be
taken, starting on day 5 of menstruation (or at any time
if cycles have ceased or are infrequent), then 1 tablet
daily for 12 days, pink tablets to be taken, subsequent
courses repeated without interval
▶ Adult: 1 tablet daily for 16 days, white tablet to be
taken and started on day 1 of menstruation (or at any
time if cycles have ceased or are infrequent), then
1 tablet daily for 12 days, green tablets to be taken,
subsequent courses are repeated without interval
Menopausal symptoms | Osteoporosis prophylaxis
▶ Adult: 1 tablet daily for 16 days, orange tablet to be
taken, to be started on day 1 of menstruation (or at any
time if cycles have ceased or are infrequent), then
762 Sex hormone responsive conditions BNF 78
1 tablet daily for 12 days, grey tablet to be taken,
subsequent courses are repeated without interval
Menopausal symptoms in women with a uterus whose last
menstrual period occurred over 12 months previously |
Osteoporosis prophylaxis in women with a uterus whose
last menstrual period occurred over 12 months
▶ Adult: 1 tablet daily continuous basis, if changing from
cyclical HRT begin treatment at the end of scheduled
Menopausal symptoms in women with a uterus |
Osteoporosis prophylaxis in women with a uterus
▶ Adult: Apply 1 patch twice weekly continuously
Menopausal symptoms in women with a uterus |
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