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Home Formulary 6.0 Endocrine 6.4 Sex hormones 6.4.1 Hormone replacement therapy (HRT) for menopausal symptoms 6.4.1b Women who have had a total hysterectomy or who have a Mirena® Intra Uterine System (IUS) in situ < 5 years

6.4.1b Women who have had a total hysterectomy or who have a Mirena® Intra Uterine System (IUS) in situ < 5 years

HRT shortages – if products are unavailable see SPS website for current availability and alternative products

Unopposed oestrogens (oral)

ChoiceDrug

1st choices

Elleste-Solo® 1mg, 2mg (estradiol) tablets
Or
Zumenon® 1mg, 2mg (estradiol) tablets

Unopposed oestrogens (transdermal)

ChoiceDrug
1st choiceEvorel® patches 50micrograms, 25micrograms, 75micrograms, 100micrograms/24 hours (estradiol)

Unopposed oestrogens (gel)

ChoiceDrug
1st choicesOestrogel® pump-pack 0.06% gel
Or
Sandrena® gel sachets 500micrograms, 1mg

Unopposed oestrogens (spray)

ChoiceDrug
1st choiceLenzetto® 1.53mg/dose transdermal spray

Prescribing Notes

  • HRT preparations should be brand prescribed to aid product identification.
  • It is recommended that the lowest dose of HRT based on relieving menopausal symptoms should be prescribed.
  • For women with an early menopause (<45 years), consider the higher dose of oestrogen for bone protection.
  • Mirena® is licensed for 4 years for endometrial protection during oestrogen replacement therapy (i.e. Mirena® provides the progestogen component of HRT). In practice, it is used for up to 5 years, providing the woman is not experiencing bleeding.

Preparations for vaginal atrophy

See section 7.2.1

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