6.4.1.1b Women who have had a hysterectomy or who have a Mirena® Intra Uterine System (ISU) in situ

Unopposed oestrogens (oral)

ChoiceDrugDosage
1st choice Elleste-Solo® 1mg, 2mg (estradiol) tablets

Dose:
Elleste-Solo® 1mg tablets - menopausal symptoms,
1 mg daily

Elleste-Solo® 2mg tablets - menopausal symptoms not controlled with lower strength and osteoporosis prophylaxis (see section 6.6), 2 mg daily

Unopposed oestrogens (transdermal)

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

Dose:
Menopausal symptoms and osteoporosis prophylaxis (see section 6.6), 1 patch to be applied twice weekly continuously

Therapy should be initiated with Evorel® 50 patch; subsequently adjust according to response; dose may be reduced to Evorel® 25 patch after first month if necessary for menopausal symptoms only

Unopposed oestrogens (gel)

ChoiceDrugDosage
1st choiceOestrogel® 0.06% gel

Dose:
Menopausal symptoms and osteoporosis prophylaxis (see section 6.6), 2 measures (estradiol 1.5 mg) to be applied over an area twice that of the template provided once daily continuously; for menopausal symptoms may be increased if necessary after 1 month to max. 4 measures daily

 

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
  • Women with an early menopause (<45 years), especially if surgically induced, require the higher dose of oestrogen to control their vasomotor symptoms and 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