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HRT preparations: for Postmenopause


Please note: Patients should consult a health professional to decide on the appropriate treatment option to be prescribed.

POST MENOPAUSAL -
Continuous combined therapies.

"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age. The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved. When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin. Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy. Start with low dose preparations and increase as necessary for symptom control. The products marked * are licensed for osteoporosis treatment/prevention.
See below: WHY AND WHEN TO OFFER CONTINUOUS COMBINED THERAPY.

Prices for 84 tablets--3 months

TABLETS

a. Ultra low dose

Femoston conti low dose Estradiol 0.5mg, Dydrogesterone 2.5mg £24.43

 

b. Low dose

FEMOSTON CONTI* 1 mg estradiol & 5mg dydrogesterone daily

£24.43

INDIVINA 1+2.5* 1mg estradiol valerate & 2.5mg MPA daily

£20.58

INDIVINA 1+5* 1mg estradiol valerate & 5mg MPA daily

£20.58

KLIOVANCE* 1mg estradiol & 0.5 mgs norethisterone daily.

£13.20

PREMIQUE LOW DOSE 0.3mg conjugated estrogen & 1.5mg MPA daily £6.52

c. Medium dose

INDIVINA 2+5* 2mgs estradiol valerate & 5 mg MPA daily.

£20.58

d. Higher dose

ELLESTE DUET CONTI* 2 mgs estradiol & 1 mg norethisterone daily £17.02
KLIOFEM* 2 mgs estradiol & 1 mg norethisterone daily

£17.02

NUVELLE CONTINUOUS* 2 mgs estradiol &1mg norethisterone daily

£17.02

e. Gonadomimetic

LIVIAL* (TIBOLONE) 2.5mg gonadomimetic synthetic preparation with weak estrogenic, progestogenic & androgenic properties

£31.08

Because of its androgenic component, Livial can be particularly helpful for postmenopausal patients with reduced libido.
--

f. Conjugated estrogens with bazedoxifene acetate.
Tissue Selective Estrogen Complex (TSEC). Bazedoxifene prevents estrogen stimulating the womb lining, but is not progestogen and not associated with progestogenic side effects. Indicated for women in whom progestogen containing therapy is not appropriate.

DUAVIVE 0.45mg conjugated estrogens & 20mg bazedoxifene acetate

£45.00

TRANSDERMAL - PATCH

Prices for 3 months

EVOREL CONTI* 2 x Weekly M Transdermal estradiol 50mcg & transdermal norethisterone 170 mcg for 28 days

£37.22

FEMSEVEN CONTI
Currently unavailable
Weekly M 50mcg estradiol and 7mcg levonorgestrel per 24 hours

£44.12

 

Tailored continuous combined effect allows flexibility but is less convenient to take. Use any continuous  tablet or non-tablet estrogen with one of the following:-

PROVERA Medroxyprogesterone 2.5 or 5 mgs daily
UTROGESTAN Micronised progesterone 100mg at bedtime from day 1 to 25 of each 28 day cycle, though taken every day is often recommended

Usually start with the lowest dose of progestogen and increase if persistent bleeding. Patients should be advised to expect some bleeding in the first few months of treatment, but should have settled by six months. Any bleeding persisting beyond 6 months of continuous combined therapy, or bleeding occurring at a later date, should be investigated.

WHY & WHEN TO CONSIDER CONTINUOUS COMBINED THERAPY


Why?

When?

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