Elleste Solo pack = £2.8; ‘50’ patch (releasing approx. 50 micr- c MX (Meda) A

6 Elleste Solo pack = £2.86; ‘50’ patch (releasing approx. 50 micr- c MX (Meda) A

ograms/24 hours), 8-patch pack = £3.24, 24-patch (releasing approx. 40 micrograms/24 hours), net price

pack = £9.72; ‘75’ patch (releasing approx. 75 micr- 8-patch pack = £5.19; MX 80 patch (releasing approx.

Patches , self-adhesive, estradiol, MX 40 patch

ograms/24 hours), 8-patch pack = £3.44; ‘100’ patch

80 micrograms/24 hours), 8-patch pack = £5.99. (releasing approx. 100 micrograms/24 hours), 8-patch Counselling, administration.

pack = £3.57. Counselling, administration Dose menopausal symptoms and osteoporosis prophylaxis

Dose menopausal symptoms (and osteoporosis prophylaxis in case of Elleste Solo MX 80

only; see section 6.6), 1 patch to be (except Evorel 25 ; see section 6.6), 1 patch to be applied twice weekly continuously, with cyclical progestogen for at least 12 days applied twice weekly continuously starting within 5 days of onset of menstruation (or at any time if cycles have ceased or are

of each cycle in women with a uterus; therapy should be initiated with ‘50’ patch for first month, subsequently adjusted to lowest

infrequent); with cyclical progestogen for 12–14 days of each cycle in women with a uterus; therapy should be initiated with MX 40 in

effective dose

those with menopausal symptoms, prolonged oestrogen defi- ciency or anticipated intolerance to higher strength, dosage may

A dose

Fematrix c (Solvay) be increased if required, subsequently adjusted to lowest effective

Fematrix c 40 patch , self-adhesive, estradiol, ‘40’ patch (releasing approx. 40 micrograms/24 hours). Estraderm MX c (Novartis) A Net price 8-patch pack = £4.95. Counselling, admin-

Patches , self-adhesive, estradiol, MX 25 patch

istration

(releasing approx. 25 micrograms/24 hours), net price Dose menopausal symptoms, 1 patch to be applied twice weekly 8-patch pack = £5.72, 24-patch pack = £17.15; MX 50

continuously starting within 5 days of onset of menstruation (or at

patch any time if cycles have ceased or are infrequent), with cyclical (releasing approx. 50 micrograms/24 hours), 8-

progestogen for 12–14 days of each cycle in women with a uterus; patch pack = £5.74, 24-patch pack = £17.15, 20-patch

‘80’ patch may be used if required (subsequently adjusted to lowest pack (hosp. only) = £13.04; MX 75 patch (releasing

effective dose)

approx. 75 micrograms/24 hours), 8-patch pack = Fematrix c 80 patch , self-adhesive, estradiol (releas- £6.69, 24-patch pack = £20.08; MX 100 patch (releas-

ing approx. 80 micrograms/24 hours). Net price 8- ing approx. 100 micrograms/24 hours), 8-patch pack

patch pack = £5.40. Counselling, administration = £6.94, 24-patch pack = £20.83. Counselling,

Dose menopausal symptoms and osteoporosis prophylaxis (see administration

section 6.6), as for Fematrix 40 ; therapy should be initiated with Dose menopausal symptoms (and osteoporosis prophylaxis in

40 in those with menopausal symptoms, prolonged case of Estraderm MX 50 and 75 only; see section 6.6), 1 patch to

Fematrix

oestrogen deficiency or anticipated intolerance to higher strength be applied twice weekly continuously, with cyclical progestogen

for 12 days of each cycle in women with a uterus; therapy should

be initiated with MX 50 for first month, subsequently adjusted to c FemSeven (Merck) A lowest effective dose

Patches , self-adhesive, estradiol, ‘50’ patch (releasing

c Estraderm TTS approx. 50 micrograms/24 hours), net price 4-patch (Novartis) A pack = £6.04, 12-patch pack = £18.02; ‘75’ patch Patches , self-adhesive, estradiol, TTS 25 patch

(releasing approx. 75 micrograms/24 hours), net price (releasing approx. 25 micrograms/24 hours), net

4-patch pack = £6.98; ‘100’ patch (releasing approx.

BNF 57

6.4.1 Female sex hormones 401

100 micrograms/24 hours), net price 4-patch pack = Estradiol, estriol and estrone £7.28. Counselling, administration Dose

Hormonin c (Shire) A menopausal symptoms and osteoporosis prophylaxis (see section 6.6), 1 patch to be applied once a week continuously, with

Tablets , pink, estradiol 600 micrograms, estriol cyclical progestogen for at least 10 days of each cycle in women

270 micrograms, estrone 1.4 mg. Net price 84-tab with a uterus; therapy should be initiated with FemSeven 50 pack = £6.61

patches for the first few months, subsequently adjusted according Dose menopausal symptoms and osteoporosis prophylaxis (see to response

section 6.6), 1–2 tablets daily, with cyclical progestogen for 12–14

c Oestrogel days of each cycle in women with a uterus (Ferring) A Note Hormonin tablets can be given continuously or cyclically Gel , estradiol 0.06%, net price 64-dose pump pack =

(21 days out of 28)

£7.39. Counselling, administration Dose menopausal symptoms and osteoporosis prophylaxis (see

Estriol only

section 6.6), 2 measures (estradiol 1.5 mg) to be applied over an

area twice that of the template provided once daily continuously, c Ovestin (Organon) A starting within 5 days of menstruation (or anytime if cycles have

Tablets , scored, estriol 1 mg. Net price 30-tab pack = ceased or are infrequent), with cyclical progestogen for 12 days of

£3.91. Label: 25

each cycle in women with a uterus; for menopausal symptoms Dose genito-urinary symptoms associated with oestrogen-defi- may be increased if necessary after 1 month to max. 4 measures daily

ciency states, 0.5–3 mg daily, as single dose, for up to 1 month, then 0.5–1 mg daily until restoration of epithelial integrity (short-

Counselling Apply gel to clean, dry, intact skin such as arms, term use); infertility due to poor cervical penetration, 0.25–1 mg shoulders or inner thighs and allow to dry for 5 minutes before

daily on days 6–15 of cycle covering with clothing. Not to be applied on or near breasts or on vulval region. Avoid skin contact with another person (particularly male) and avoid other skin products or washing the area for at

Estropipate only

least 1 hour after application Harmogen c (Pharmacia) A Progynova c (Schering Health) A Tablets , peach, scored, estropipate 1.5 mg. Net price Tablets , both s/c, estradiol valerate 1 mg (beige), net

28-tab pack = £3.77 Dose menopausal symptoms and osteoporosis prophylaxis (see

section 6.6), 1.5 mg daily continuously (with cyclical progestogen pack = £6.56

for 10–13 days of each cycle in women with a uterus); up to 3 mg Dose menopausal symptoms, 1–2 mg daily continuously; osteo-

daily (in single or divided doses) for vasomotor symptoms and porosis prophylaxis (see section 6.6), 2 mg daily continuously;

menopausal vaginitis

with cyclical progestogen for 12 days of each cycle in women with a uterus

Progynova c TS (Schering Health) A

Patches , self-adhesive, Progynova c TS 50 (releasing

TIBOLONE

estradiol approx. 50 micrograms/24 hours), net price

Indications

short-term treatment of symptoms of

12-patch pack = £16.71; Progynova c

oestrogen deficiency (including women being treated estradiol approx. 100 micrograms/24 hours), 12-

TS 100 (releasing

with gonadotrophin releasing hormone analogues);

Endocrine

patch pack = £18.39. Counselling, administration osteoporosis prophylaxis in women at risk of fractures Dose menopausal symptoms and osteoporosis prophylaxis (Progynova

(second-line)

TS 50 only; see section 6.6), 1 patch to be applied once a week continuously or 1 patch per week for 3 weeks

Cautions see notes above and under Oestrogens for followed by a 7-day patch-free interval (cyclical); with cyclical

HRT; vaginal bleeding (investigate for endometrial

syst

progestogen for 12–14 days of each cycle in women with a uterus; cancer if bleeding continues beyond 6 months or after in those with menopausal symptoms, therapy should be initiated

stopping treatment); renal impairment, history of liver

em

with Progynova TS 50 , dosage may be increased if required, subsequently adjusted to lowest effective dose

disease (Appendix 2), epilepsy, migraine, diabetes Note Women receiving Progynova

TS 100 patches for meno- mellitus, hypercholesterolaemia; withdraw if signs of pausal symptoms may continue with this strength for osteoporosis

thromboembolic disease, abnormal liver function prophylaxis (see section 6.6)

tests or cholestatic jaundice; see also Note below; interactions: Appendix 1 (tibolone)

Gel , estradiol (0.1%), 500 microgram/500 mg sachet, see notes above and under net price 28-sachet pack = £5.28, 1 mg/1 g sachet, 28-

Sandrena c (Organon) A Contra-indications

Oestrogens for HRT; hormone-dependent tumours, sachet pack = £6.08. Counselling, administration

history of cardiovascular or cerebrovascular disease

(e.g. thrombophlebitis, thromboembolism), uninvesti- Dose menopausal symptoms, estradiol 1 mg (1 g gel) to be

Excipients include propylene glycol (see section 13.1.3)

gated vaginal bleeding, severe liver disease, applied once daily over area 1–2 times size of hand; with cyclical

pregnancy, breast-feeding progestogen for 12–14 days of each cycle in women with a uterus;

dose may be adjusted after 2–3 cycles to a usual dose of estradiol Side-effects see notes above; also abdominal pain, 0.5–1.5 mg (0.5–1.5 g gel) daily

weight changes, vaginal bleeding, leucorrhoea, facial Counselling Apply gel to intact areas of skin such as lower trunk

hair, and rarely amnesia; gastro-intestinal distur- or thighs, using right and left sides on alternate days. Wash hands

bances, oedema, dizziness, headache, migraine, after application. Not to be applied on the breasts or face and avoid contact with eyes. Allow area of application to dry for 5

depression, breast cancer (see notes above and sec- minutes and do not wash area for at least 1 hour

tion 6.4.1.1), arthralgia, myalgia, visual disturbances, seborrhoeic dermatitis, rash and pruritus also Zumenon c (Solvay) A reported

Tablets , f/c, estradiol 1 mg, net price 84-tab pack =

Dose

£6.89; 2 mg (red), 84-tab pack = £6.89

2.5 mg daily

Dose menopausal symptoms, initially 1 mg daily starting on day Note Unsuitable for use in the premenopause (unless being 5 of menstruation (or any time if cycles have ceased or are

treated with gonadotrophin-releasing hormone analogue) infrequent) adjusted to 1–4 mg daily according to response;

and as (or with) an oral contraceptive; also unsuitable for use osteoporosis prophylaxis (see section 6.6), 2 mg daily; with

within 12 months of last menstrual period (may cause cyclical progestogen for 10–14 days of each cycle in women with a

irregular bleeding); induce withdrawal bleed with progesto- uterus

gen if transferring from another form of HRT

6.4.1 Female sex hormones BNF 57 Livial c (Organon) A

RALOXIFENE HYDROCHLORIDE

Tablets , tibolone 2.5 mg. Net price 28-tab pack =

Indications treatment and prevention of postmeno- pausal osteoporosis

Cautions risk factors for venous thromboembolism