IT Department Normal emis 3 15 2004-11-12T19:53:00Z 2004-11-24T13:24:00Z 2004-11-24T13:34:00Z 1 390 2224 Wyeth UK 18 5 2609 10.6626

For new patients initiating therapy and to assist changes of preparation for clinical problems.

 

 

 

                 HRT

 

 

      TABLETS

 

 

       PATCHES

 

         REASONS TO

  COMMENCE/SWITCH

 

 

 

SEQUENTIAL PREPARATIONS.

For patients with intact uterus – under 54 yrs and less than 1 yr amenorrhoea

Prempak-C

Conj oest 0.625mg/1.25mg &  Norgestrel 150mcg c19

Premique Cycle

Conj oest 0.625mg & Medroxyprogesterone 10mg c21

Cyclo-Progynova

Oestradiol 1mg/2mg & Levonorgerstrel 0.25mg/0.5mg c19

Femoston

Oestradiol 1mg/2mg & Dydrogesterone 10mg  or 2mg Oestradiol &  Dydrogesterone 20mg c21

 

 

 

 

 

 

Evorel Sequi

Oestradiol 50mcg & Norethisterone 170mcg c19

Matrix patch

 

 

If continuous side effect consider a lower dose oestrogen, or change   oestrogen in oral preparation, if symptoms persist change route.

 

Switch progestogen therapy from  C19  to C21 if patient has PMS type/ cyclical  symptoms

 

 

CONTINUOUS COMBINED PREPARATIONS.

Period free HRT for patients with intact uterus – patients should be 1 yr amenorrhoea or over 54 yrs if currently on sequential

 

 

Gonadomimetic

Premique

Conj oest 0.3mg & 1.5mg  Medroxyprogesterone acetate   or  conj oest 0.625mg & Medroxyprogesterone 5mg c21

Kliovance/Kliofem

Oestradiol 1mg/2mg &  Norethisterone 0.5mg/1mg c19

Femoston Conti

Oestradiol 1mg &  Dydrogesterone 5mg  c21

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Livial

Tibolone 2.5mg (cost)

 

 

 

Evorel Conti

Oestradiol 50mcg & Norethisterone 170mcg c19

Matrix patch

 

 

 

 

 

 

 

 

If switching from SCT remain on same oestrogen.

 

 

If persistent breast tenderness either periodically or continually, complaining of headaches or other symptoms then switch to a different oestrogen or to a patch.

 

 

 

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Use Livial only where primary symptom is low libido, breast tenderness or break through bleeding

 

UNOPPOSED OESTROGEN

Hysterectomised women ONLY

Premarin

Conj oest 0.625mg/1.25mg

Elleste Solo

Oestradiol 1mg/2mg

 

Evorel

Oestradiol 25mcg/50mcg/75mcg/100mcg

Matrix patch

 

 

If continuous side effect consider a lower dose oestrogen, or change   oestrogen in oral preparation, if symptoms persist change route.

 

TOPICAL

For relief of vaginal symptoms only

 

 

 

Ortho-Gynest cream

Oestriol 0.01%

 

 

Review at 3-6 month intervals and do not use for more than 2 years if patient still has an intact uterus.

 

Adjunctive progestogens – Micronor (noresthisterone 1mg) or Duphaston (dydrogesterone 10mg)

C19 progestogen- good for breakthrough bleeding or reduced libido.

C21 progestogen – good for cyclical side effects.