Alternative options for women taking continuous combined HRT preparations with transdermal oestradiol

Women taking continuous combined HRT preparations with transdermal oestradiol can consider the following options below:

• Evorel Conti patches
  • Evorel Conti patches: Transdermal oestradiol with continuous progestogen (norethisterone)
  • Femseven Conti patches: Transdermal oestradiol with continuous progestogen (levonorgestrel)
  • Alternatively, women can consider transdermal oestradiol delivery with an alternative progestogen by taking oestrogen and progestogen separately:
    • Oestrogen:
      • Evorel 50 patches
      • Estradot 50 patches
      • Estraderm 50 patches
      • Femseven 50 mono patches
      • Or an oestradiol gel preparation such as Oestrogel or Sandrena
        • Oestrogel one measure twice a day equivalent to the oestrogen dose in Evorel Conti
        • Or Sandrena 1mg sachet a day would be equivalent to the oestrogen in Evorel Conti
        • Or oestradiol spray Lenzetto three sprays (40 mcgm) equivalent to the oestrogen dose in Evorel Conti
    • Progestogen:
      • Micronised Progesterone: Utrogestan 100mg orally at night daily on continuous basis
      • Or Provera 5mg orally daily on continuous basis
      • Or Norethisterone 5mg orally daily on continuous basis (1mg would be sufficient for use in a continuous combined regimen but not available in stand-alone preparations)
        • Off license use of norethisterone in progestogen only contraceptive pills (e.g. Noriday 3 x tablets of 350 micrograms a day, will provide 1.05mg of norethisterone) may be considered as an equivalent alternative (1)
      • Or Mirena IUS

Notes:

• earlier studies have reported that desogestrel 150 micrograms is effective as the progestogen component of HRT with no increase in the risk of endometrial hyperplasia. There is lack of evidence on the use of desogestrel 75 micrograms as the progestogen component of HRT
• if desogestrel 75 micrograms is used as contraception in women receiving HRT, it would be recommended to add further progestogen (e.g. Utrogestan 100 mg daily or 200 mg for 12 days a month) to provide adequate endometrial protection

Reference:

• British Menopause Society. HRT preparations and equivalent alternatives Information for GPs and other health professionals (Accessed 27/4/22)