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HRT preparations: for Perimenopause


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

PERI-MENOPAUSAL SEQUENTIAL COMBINED THERAPY

Used in women with an intact uterus (womb) who are not yet postmenopausal, i.e. have some periods due to continuing ovarian function. Products contain daily estrogen and cyclical progestogen.
Progestogens which can be used cyclically are of 3 main types:

  1. Testosterone derived - Norgestrel, Norethisterone acetate and Levonorgestrel.
  2. Less testosterone related - Medroxyprogesterone acetate(MPA).
  3. Least testosterone related - Dydrogesterone and Micronised progesterone (Utrogestan).

Side effects are often experienced during the progestogen phase of treatment and can be reduced by using a product containing a different type or route of progestogen.

Prices are for 84 tablets, ie 3 months.

TABLET

a. Low dose - recommended starting dose.

ELLESTE DUET 1mg Estradiol 1mg
Norethisterone 1mg for 12 days/28
£9.20
FEMOSTON 1/10* Estradiol 1mg
Dydrogesterone 10mg for 14 days/28

£16.16

NOVOFEM* Estradiol 1mg
Norethisterone 1mg for 12 days/28

£11.43

b. Medium dose -

CLINORETTE 2mg Estradiol 2mg
Norethisterone 1mg for 12 days/28
£9.23
CYCLO-PROGYNOVA 2mg* Estradiol valerate 2mg
Norgestrel 0.5mg for 10 days/21, followed by 7 tablet-free days.
£9.33
ELLESTE DUET 2mg* Estradiol 2mg
Norethisterone 1mg for 12 days/28.
£9.20
FEMOSTON 2/10* Estradiol 2mg
Dydrogesterone 10mg for 14 days/28

£16.16

TRISEQUENS* Estradiol 2mg/1mg
Norethisterone 1mg for 10 days/28

£11.10

All the above cause a monthly bleed in 85% of patients.

Long cycle treatment - useful in perimenopausal patients who are having infrequent periods, but may not be sufficiently post menopausal to offer continuous combined therapy to, and will confer a bleed every 3 months. Available is:

TRIDESTRA* Estradiol valerate 2mg
Medroxyprogesterone 20mgs for 14 days/3 month pack.

£20.49

TRANSDERMAL

Prices are for 1 month.

Medium Dose

EVOREL SEQUI* M2 x Weekly Transdermal estradiol 50mcg/24hrs
Trandsermal norethisterone 170mcg/24hrs for 14 days/28

£11.09

FEMSEVEN SEQUI
Currently unavailable
MWeekly Transdermal estradiol 50mcg/24hrs
Transdermal levonorgestrel 10mcg/24hrs for 14 days/28
£13.18

Tailor made sequential combined therapy is useful in patients who develop PMS type symptoms on a fixed HRT, particularly if the regime contains a progestogen of testosterone derivation (norethisterone, norgestrel and levonorgestrel). FEMOSTON, PREMIQUE CYCLE & TRIDESTRA are fixed preparations using the less androgenic medroxyprogesterone acetate or dydrogesterone.

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