Oestrogen and Progestogen for HRT

About Oestrogen and Progestogen for HRT

This belongs to the group of medicines known as Female sex hormones.

Both Oestrogen and Progestogen are female hormones and can be used to treat women's health problems including menopausal disorders.

During the menopause or change, your female hormone levels begin to fall. The menopause normally happens between the ages of 45 and 55, although it can occur earlier or later. HRT (hormone replacement therapy) replaces these hormones. This helps to relieve many of the problems associated with the change, such as hot flushes, and protects against osteoporosis (thinning of the bones). However, other treatments are tried before using HRT to treat osteoporosis.

If you still have your womb you will be given both Oestrogen and Progestogen HRT therapy. The Progestogen is used to protect the lining of the womb; it can be taken for all or only part of your cycle. If however you have had your womb removed (hysterectomy) then you only need Oestrogen HRT therapy. Please see the DIL - Oestrogen for HRT for more information.

Oestrogen can also be spelt estrogen.

Different types of Oestrogen can be used in HRT products. These can include conjugated Oestrogens, estradiol.

Different types of Progestogen can be used in HRT products. These can include medroxyprogesterone acetate; norgestrel; norethisterone; levonorgestrel; dydrogesterone;

Oestrogen and Progestogen for HRT are available in the following forms:

Tablets(continuous) Tablets contain both Oestrogen and Progestogen. Brands available include Premique; Climesse; Elleste-Duet Conti; Femtab Continuous; Indivina; Kliofem; Kliovance; Nuvelle Continuous

Tablets (cyclic) - Two different coloured tablets are in the pack. One colour tablet contains Oestrogen on its own and the other colour tablet contains both Oestrogen and Progestogen. This gives you Progestogen for only part of your cycle. Brands available include Premique cycle; Prempak-C; Climagest; Cyclo-Progynova; Elleste Duet; Femoston; FemTab Sequi; Novofem; Nuvelle. The brands Tridestra and Trisequen contain three different coloured tablets.

Patches (continuous) - Patches contain both Oestrogen and Progestogen, which are absorbed through the skin. Brands available are Evorel conti; Femseven Conti.

Patches (cyclic) - The pack contains two types of patch. One contains Oestrogen only and one contains both Oestrogen and Progestogen. This enables you to have Progestogen for only part of your cycle. Brands available are Estracombi; Evorel Sequi; Femseven Sequi

Tablet and Patch combined - This pack contains a patch containing Oestrogen and tablets containing Progestogen. Brands available include Evorel Pak; Femapak.

Before Taking Oestrogen and Progestogen for HRT

Before taking or using Oestrogen and Progestogen for HRT make sure your doctor or pharmacist knows:

• if you are pregnant, trying for a baby or breast-feeding
• if you have ever had an allergic reaction to this or any other medicine
• if you have any vaginal bleeding for which the cause has not been found
• if you suffer from thrombosis (blood clots), kidney, liver or gall-bladder problems
• if you have prolonged periods of immobilisation (use a wheelchair or confined to bed for example)
• if you suffer from otosclerosis (a disease of the bones of the inner ear causing hearing impairment)
• if you suffer from migraine, epilepsy, diabetes, high blood pressure or porphyria (blood disorder)
• if you have multiple sclerosis (MS), tetany (numbness and tingling in hands, feet and around the mouth)
• if you have cancer of the breast or uterus, or have had it in the past, or have a family history of this condition
• if you suffer with obesity, systemic lupus erythematosus or asthma
• if you have just had a major trauma or been in an accident
• if you have any surgical operations planned or have just had one.
• if you are taking or using any other medicines, including those available to buy without a prescription, herbal and complementary medicines

How to Take Oestrogen and Progestogen for HRT

• Always read the manufacturer's information leaflet, if possible, before beginning treatment. Follow the instructions that you have been given with the medicine carefully.
• Tablets: If you have been prescribed the tablet form they are usually taken once a day. Try to take it at the same time each day to avoid missing a dose. If you have different colour tablets in your pack you will be taking one colour for the first part of your cycle and then the second colour afterwards. Read the instructions carefully so you know which order to take them in. If you forget to take your tablet, read the advice on the manufacturer's leaflet and follow the instructions given. If you are not sure what to do ask your pharmacist.
• Patches: If you have been prescribed the patch form they should be removed after 3-4 days (or once a week in the case of the 7-day patch) and replaced with a fresh patch. If you have two different patches in your pack read the instructions carefully so you know which order to use them in. Only one patch should be worn at a time. Do not place the patch on or near the breast, or under the waistband. The patch should be placed on a clean, dry, unbroken area of the skin below the waist. It is recommended the area be changed each time. If the patch falls off in the bath allow the skin to cool before applying a new patch.
• Tablet and Patch Combination pack: The patch should be applied as above and replaced every 3-4 days. Then one tablet should be taken on days 15 to 28 of your cycle. Read the instructions carefully and if you are not sure when to start taking the tablets ask your pharmacist or doctor.
• Never take or use more than the prescribed dose. If you suspect that you or someone else has taken or used an overdose of Oestrogen and Progestogen contact your doctor or go to the accident and emergency department of your local hospital at once. Always take the container with you, if possible, even if empty.
• This medicine is for you. Never give it to others even if their condition appears to be the same as yours.

Getting the most from your treatment

• Before taking any 'over-the-counter' medicines, check with your pharmacist which medicines are safe for you to take alongside Oestrogen and Progestogen for HRT.
• You must keep your regular appointment with your doctor.
• If you wear contact lenses they may become irritating, if this becomes a problem speak to your optician.
• Your medication may cause dizziness, particularly when getting up from a sitting or lying position. Getting up slowly should help.
• Before having any kind of medical treatment including dental treatment or any medical tests you must tell them you are on HRT.
• If you pay for your prescriptions and your pack contains more than one type of tablet or patch then you will have to pay two prescription charges for that item.

For patients who have not had a hysterectomy (removal of the womb)

HRT does not provide contraception. If you are still having menstrual periods you can still become pregnant. If you are under 50 years old you can remain fertile for one year after your menstrual periods have stopped. You should not take the contraceptive pill while you are on HRT, you are advised to use other methods such as condoms or a cap. Ask you pharmacist or doctor for suitable methods of contraception. If you suspect you might be pregnant, stop using this medicine at once and consult you doctor as soon as possible.

If you need to use contraception DO NOT use the rhythm method. Your usual menstrual cycle will become less regular during menopause; therefore this method would be unreliable.

If your HRT is used continuously you may get some irregular menstrual bleeding in the first few months. If you have irregular bleeding in later months consult you doctor.

Benefits of HRT

• There are many benefits of hormone replacement therapy. Replacing the hormones will stop the menopausal symptoms such as hot flushes, night sweats and vaginal dryness.
• HRT can dramatically reduce the development of osteoporosis and the likelihood of broken bones. During the menopause, a type of protein called collagen is lost from the skin. This makes the skin thinner and drier. HRT will slow down the loss of skin elasticity so that you do not appear to age as much.
• If you are using HRT just for the prevention of osteoporosis and are not suffering from menopausal symptoms you should make an early appointment with your doctor to review your treatment.
• If you are using HRT to relieve menopausal symptoms you should continue with your usual doctor's appointments. Report any changes in your wellbeing and lifestyle, as listed in the patient information leaflet, and discuss anything else that concerns you. This is because a recent review of the use of HRT has decided that HRT should only be used short-term for the relief of menopausal symptoms. The same review also decided that other treatments for osteoporosis should be tried before HRT is used.

Risks of HRT

As with all medicines, the benefits of using HRT should be weighed against the problems that it may cause. The Committee for the Safety of Medicines (CSM) has recently issued updated guidelines on the use of HRT. Your doctor will discuss these with you. For short term treatment the benefits of HRT in treating menopausal symptoms can outweigh the problems. If used for a longer time the risk of breast cancer, blood clots, stroke and other adverse effects may increase. Because of this the decision to start HRT needs to be made on an individual basis and treatment should be reviewed at least once a year.

Can Oestrogen and Progestogen for HRT cause problems?

Along with their needed effects, all medicines can cause unwanted side effects, which usually improve as your body adjusts to the new medicine. Speak with your pharmacist or doctor if any of the following side effects continue or become troublesome.

Feeling or being sick, stomach cramps, bloating, weight change, breast enlargement and tenderness, pre-menstrual-like syndrome, swollen ankles, rash, brown blotchy marks on the skin, nose bleeds, change in sexual desire, depression, headaches, migraine, dizziness, leg cramps, contact lenses irritation.

Important: If you experience any of the following contact your doctor IMMEDIATELY: sudden severe chest pains, sudden breathlessness, cough with blood-stained mucus, severe pain in calf of one leg, severe stomach pain, unusual severe prolonged headache, sudden partial or complete loss of vision, sudden disturbance of hearing or other perceptual disorders, severe indigestion, bad fainting or collapsing attacks, first unexpected epileptic attack, weakness, problem with movement, sudden numbness affecting one part or half of the body, severe jaundice (yellowing of the skin and whites of the eyes).

If you experience any other worrying side effects, which you think may be due to this medicine, discuss them with your pharmacist or doctor.

How to store Oestrogen and Progestogen for HRT

• Keep all medicines out of the reach of children.
• Store in a cool, dry place, away from direct heat and light.
• Never keep out of date or unwanted medicines. Discard them safely out of the reach of children or take them to your local pharmacist who will dispose of them for you.

© EMIS 2005   Updated: 26/01/2005