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Hormone replacement therapy
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| Home > For doctors > Protocols> Gynaecology |
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Hormone replacement therapy
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Products |
Comments |
| Sequential combined therapy | |
1st choice
Alternatives
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Nuvelle is recommended as an alternative to Prempak-C for those in whom it is unsuitable and those objecting to conjugated oestrogens (obtained from horses). Femoston 2/10 is intended for use when an alternative progestogen is required, also for possible use as an alternative to patches. Femoston 2/20 is included for use where a higher dose of progestogen is needed to help improve cycle control. |
| Continuous combined therapy ("no period" preparations") | |
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Less expensive than Kliofem or Climesse.
Tibolone
is
availabe for limited use in patients
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| Combined patches/patches/tablets | |
1st choice
Alternative
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First choice therapy should be with tablets rather than patches. Nuvelle-TS and Evorel-pak contain matrix-type patches which are preferred to reservoir-type patches as they adhere better and are better tolerated. |
| Oestrogen only tablets | |
1st choice
Alternative
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| Oestrogen patches (NB: first choice therapy should be tablets rather than patches) | |
Twice weekly patches
Once weekly patches
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Matrix-type patches which are preferred to reservoir-type patches as they adhere better and are better tolerated. Usual starting dose 50mcg/day patch but 25mcg/day patch may be needed in some older patients and those who need a reduction in dose due to side effects. |
| Adjunctive progestogens | |
1st choice
Alternative
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Mainly for patients on 25mcg patches who have an intact uterus and therefore need a progestogen. |
| Oestrogens (topical) for postmenopausal atrophic vaginitis | |
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Oestriol cream is preferred to dienoestrol or conjugated oestrogens as systemic absosrption and effects on the endometrium are less. Estring pessaries are also available for patients who find using the cream diffficult. |
Brad Cheek: