Perimenopausal patients

PERI-MENOPAUSAL SEQUENTIAL COMBINED THERAPY

Used in women with an intact uterus, who are not yet post menopausal i.e. have continuing ovarian function. Products contain daily estrogen and cyclical progestogen. Progestogens are of 3 main types:

1. Testosterone derived progestogens, e.g. norgestrel, norethisterone acetate (NETA) and levonorgestrel.
2. Medroxyprogesterone acetate (MPA).
3. Dydrogesterone (duphaston).

ORAL

a. Low dose - useful in patients at early stage of ovarian decline to top up estrogen levels and provide adequate progestogen.

b. Medium dose -