Before taking HRT containing oestrogen and progestogen

Before taking HRT containing oestrogen and progestogen make sure your doctor or pharmacist knows:

• If you are pregnant, trying for a baby or breast-feeding.
• If you suffer from migraine-like headaches.
• If you have diabetes.
• If you, or a close relative, has had breast lumps or cancer.
• If you know you have fibroids in the uterus or endometriosis.
• If you, or a close relative, has ever suffered from thrombosis (blood clots).
• If you suffer from varicose veins.
• If you have prolonged periods of immobilisation (for example if you use a wheelchair or are confined to bed).
• If you suffer with obesity.
• If you have just had a major trauma or been in an accident.
• If you have any surgical operations planned, or have just had an operation.
• If you have angina or have recently had a heart attack.
• If you have any vaginal bleeding for which the cause has not been found.
• If you have liver problems.
• If you have porphyria (a rare blood disorder).
• If you are taking other medicines, including those available to buy without a prescription, herbal or complementary medicines.
• If you have ever had an allergic reaction to this or any other medicine.

How to take/use HRT containing oestrogen and progestogen

• Before beginning treatment, read the manufacturer's printed information leaflet.
• Follow the instructions given by your doctor 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.

Getting the most from your treatment

• If you are having any treatment like an operation or dental treatment, tell the person carrying out the treatment that you are taking HRT.
• Keep your regular doctor's appointment as your doctor will want to review the need for HRT. This is because a recent review of the use of HRT has decided that treatment should only be used short-term. Report to your doctor any changes in your wellbeing and lifestyle, as listed in the patient information leaflet, and discuss anything else that concerns you.
• If you buy any medicines, check with a pharmacist that they are safe to take with HRT.
• If you wear contact lenses they may become irritating, if this becomes a problem speak to your optician.
• 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.
• You may get some irregular menstrual bleeding in the first few months of taking HRT. If you have irregular bleeding in later months, speak to your doctor.
• HRT does not provide contraception. If you are having menstrual periods you can still become pregnant. If you are under 50 you can remain fertile for two years after your menstrual periods have stopped, and if you are over 50 years you can remain fertile for one year after your periods have stopped. You should not take the contraceptive pill while you are on HRT, and you are advised to use other methods such as condoms or a cap. DO NOT use the rhythm method as your usual menstrual cycle will become less regular during the menopause and make this method unreliable. If you suspect you might be pregnant, stop using this medicine at once and consult you doctor as soon as possible.

Can HRT containing oestrogen and progestogen cause problems?

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 issued guidelines on the use of HRT which your doctor will discuss 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 your treatment should be reviewed at least once a year.

• severe pain in the calf of a leg
• yellowing of the skin or whites of the eyes
• a severe skin rash

If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

How to store HRT containing oestrogen and progestogen

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

References

• British National Formulary; 57th Edition (March 2009) British Medical Association and Royal Pharmaceutical Society of Great Britain, London.