There is a large variation in the individual's response to different types and routes of estrogen for symptom control. The products are divided into different groups according to dose and route, but for doses, these divisions are arbitrary. Products within the same dosage group are not exactly equivalent. For each type of estrogen, the lowest dose available is included in the "Low dose" group and within each dosage group, change to a different type of estrogen may have a better effect on symptom control. The wide range of types and routes of estrogen and progestogen allows flexibility and enables treatment to be individualised.
HRT preparations: Estrogens
Please note: Patients should consult a health professional to decide on the appropriate treatment option to be prescribed.
The products marked * are licensed for prevention and/or treatment of osteoporosis.
Prices are for 84 tablets, ie 3 months.
a. Low dose - recommended starting dose.
| ELLESTE SOLO | 1mg | estradiol | £5.06 |
| PROGYNOVA | 1mg | estradiol valerate | £7.30 |
| PREMARIN | 0.3mg | conjugated estrogens | £6.07 |
| ZUMENON | 1mg | estradiol | £5.06 |
b. Medium dose
| BEDOL | 2mg | estradiol | £5.06 |
| ELLESTE SOLO* | 2mg | estradiol | £5.06 |
| PREMARIN* | 0.625mg | conjugated estrogens | £4.02 |
| PROGYNOVA* | 2mg | estradiol valerate | £7.30 |
| ZUMENON* | 2mg | estradiol | £6.90 |
c. Higher dose - when symptoms are not controlled by the above.
| PREMARIN* | 1.25mg | conjugated estrogens | £3.58 |
NON-TABLET - Transdermal
Transdermal estrogen only preparations are available as patches, gel, spray or, less commonly, implants. There is no "best". Some women absorb best from patch, others from gel and some from spray. Each have pros and cons and changes may be required.
a. Patches - convenient, twice weekly or weekly but sometimes poor adherence and/or skin irritation. Visibility can be a concern for some women. Can be matrix (M) or reservoir (R) Matrix tend to cause less skin irritation and adhere better. Patches can
be changed once or twice weekly.
Prices are for 4 weeks.
Low dose
| Estraderm MX | 2 x wkly | M | 25 mcg estradiol / 24hrs. | £5.50 |
| Estradot | 2 x wkly | M | 25 mcg estradiol / 24hrs | £5.99 |
| Estradot | 2 x wkly | M | 37.5 mcg estradiol / 24hrs | £6.00 |
| Evorel | 2 x wkly | M | 25 mcg estradiol / 24hrs. | £3.42 |
Medium dose
| Elleste Solo MX | 2 x wkly | M | 40 mcg estradiol / 24hrs. | £5.19 |
| Estraderm MX | 2 x wkly | M | 50 mcg estradiol / 24hrs.* | £5.51 |
| Estradot | 2 x wkly | M | 50 mcg estradiol / 24hrs.* | £6.02 |
| Evorel | 2 x wkly | M | 50 mcg estradiol / 24hrs.* | £3.88 |
| FemSeven | 1 x wkly | M | 50 mcg estradiol / 24hrs.* | £6.04 |
| Progynova TS | 1 x wkly | M | 50 mcg estradiol / 24hrs.* | £6.30 |
High dose
| Elleste Solo MX | 2 x wkly | M | 80 mcg estradiol / 24hrs.* | £5.99 |
| Estraderm MX | 2 x wkly | M | 75 mcg estradiol / 24hrs. | £6.42 |
| Estradot | 2 x wkly | M | 75 mcg estradiol / 24hrs.* | £7.00 |
| Evorel | 2 x wkly | M | 75 mcg estradiol / 24hrs.* | £4.12 |
| FemSeven | 1 x wkly | M | 75 mcg estradiol / 24hrs.* | £6.98 |
Higher dose
| Estraderm MX | 2 x wkly | M | 100 mcg estradiol / 24hrs. | £6.66 |
| Estradot | 2 x wkly | M | 100 mcg estradiol / 24hrs.* | £7.27 |
| Evorel | 2 x wkly | M | 100 mcg estradiol / 24hrs.* | £4.28 |
| FemSeven | 1 x wkly | M | 100 mcg estradiol / 24hrs.* | £7.28 |
| Progynova TS | 1 x wkly | M | 100 mcg estradiol / 24hrs.* | £6.90 |
b. Gels - Invisible, and useful if transdermal treatment is the option preferred but skin irritation occurs with patches. Skin irritation may still occur and daily application is required.
| OESTROGEL | 2* measures once daily (1.5mg estradiol) increased if necessary to max 4 daily (3.0mg estradiol) | £4.20 for 64-dose pump |
| SANDRENA | 1 application daily 0.5mg or 1mg -dose range 0.5 to 1.5mg daily. | £5.08 & £5.85 |
c. Spray - Invisible. Daily application required
| LENZETTO | 1.53mg estradiol per spray. Starting dose once daily to forearm. Up to 3 sprays daily | £3.45- £6.90 |
d. Implants - usually used as a last resort in patients post-hysterectomy when symptoms are not controlled by other means.
| ESTRADIOL IMPLANT | 25, 50 or 100 mg 6 monthly -recommended is 25 or 50mg implant. Limited availability. |
All estrogen only preparations can be used in patients who have not had a hysterectomy, as long as an appropriate progestogen is given in addition.