No Uterus
(ie had a hysterectomy) 

Oral

• Ellest Solo MX – 40mcg / 80mcg daily
• Elleste solo - 1mg / 2mg daily
• Premarin - 300/625/1.25mcg daily

Patch

• Evorel 25/50/75/100mcg twice weekly
• Estradot 25/37.5/50/775/100mcg twice weekly

Gel

• Oestrogel 1-4 doses daily (starting dose 2)

Oral

• Elleste Duet - 1mg/2mg
• Femoston - 1mg / 2mg

Patch

• Evorel Sequi – twice weekly
• evorel patch combined with utrogestan 100mg x2 capsules at night for 12-14 days

Gel

• Oestrogel 2 pumps daily  combined with utrogestan 100mg x2 capsules at night for 12-14 days

• Kliovance - 1mg daily
  Kliofem - 2mg daily

Patch

• Evorel Conti
• Evorel patch combined with Utrogestan 100mg nightly

Gel

• Oestrogel  2 pumps daily combined with Utrogestan 100mg nightly

• Elleste solo
  (oestradiol)
  1mg & 2mg daily
• Premarin
  (conjugated oestrogens)
  a mixture of oestrogen hormones

• Patients may find this easier to take especially if taking other tablets
• Oral is not recommended as first line

• VTE risk
• Increases sex hormone binding globulin (SHBG) so reduces free androgen index (lowers libido even more)
• Less reliable absorption
• More contraindications (for example obesity, diabetes, gallbladder disease, migraine and so on)

Patches

• Evorel 25 / 50 / 75 / 100mcg patches
  twice a week
• Estradot 25 / 50 / 75 / 100mcg patches
  twice a week (smaller in size)
• Elleste 40 / 80mcg patches twice a week

• Usually stick well and easy to use
• Can swim, shower, bath, swim with them on
• Constant level given so can be better in women with migraines
• Can use more than one which is useful for women with early menopause / primary ovarian insufficiency (POI)

• Some women do not like to have something stuck to their skin
• Can lead to local irritation
• Some women find they do not stick on well or they crinkle (therefore reduced absorption)
• Some women find they have high absorption in hot climates
• Plaster mark on bottom – can be removed with baby oil and dry flannel!

• Oestrogel 2-4 pumps a day
  (young women often higher doses)
• Sandrena sachets 0.5-1mg daily

• Easy to alter dose so women have more control
• Usually absorb really easily
• Can be used with patches to ‘top up’
• Women with cyclical symptoms (including PMS) can use more on the days with worse symptoms. 

• Young women needing higher doses need to use large quantities
• Harder to remember as needed once or twice a day
• Sachets can be hard to open

Oral

Micronised progesterone (Utrogestan)

• Continuos: 100mg capsule each evening
  (licensed for days 1-25 but easier to take every night)
• Cyclical: 2 x 100mg capsules each evening for 2 out of 4 weeks  
  (licensed for days 15-26 but easier to take for 2 weeks)

Norethisterone (Micronor HRT) (unlicensed)

• Continuous: 5mg daily
• Cyclical: 5mg twice daily for 2 out of 4 weeks

• Fewer side effects so better tolerated
• Can improve cardiovascular risk / lipids
• Neutral effect on BP / may reduce BP
• No VTE risk
• No breast cancer risk for first 5 years of taking it (in women over 51 years old)
• Studies have shown some positive effect on bone strength

• Can have more breakthrough bleeding for first 3-6/12
• Can cause some sedation – take at night time
• Needs to be taken on empty stomach (eating food increases absorption)
• Not a contraceptive

Oral tablet can be given vaginally (unlicensed)

• Continuous: Utrogestan tablet given on alternate nights
• Cyclical: Utrogestan tabet given one every night for 12-14 days each month 

• For patients who cannot tolerate oral

• Unlicensed

• Contraceptive
• Treats menorrhagia
• Less risk of bleeding
• Once in-situ, periods may be reduced by >95% by 6 months, and approximately 20% of users will be completely amenorrheic. 
• Needs changing every 4 years (vs license for contraceptive 5 years) 
• Cheapest for NHS

• Systemic side effects in some women (especially first 3-6/12); endometrial atrophy, disturbance of ovulation and the development of hostile cervical mucous
• Spotting can occur in first 3-6/12
• Not every woman’s choice
• Not always available in primary care

• Elleste Duet
  (oestradiol, norethisterone)
• Prempak C
  (conjugated oestrogens, norgestrel)
• Femoston 1/10, 2/10, 2/20
  (oestradiol, didrogesterone)

• Adgyn Combi (oestradiol, norethisterone)
• Climagest (oestradiol, norethisterone)
• Cyclo-Progynova (oestradiol, levonorgestrel)
• Nuvelle (oestradiol, levonorgestrel)
• Nuvelle TS (oestradiol, levonorgestrel)
• Premique (conjugated oestrogens, medroxyprogesterone acetate)
• Premique Cycle (conjugated oestrogens, medroxyprogesterone acetate)
• Trisequence (oestradiol, norethisterone)
• Trisequens Forte (oestradiol, norethisterone)

• Evorel Sequi
  (oestradiol, norethindrone acetate)
• Femseven Sequi
  (oestradiol, levonorgestrel)

• Estracombi (oestradiol, norethindrone acetate)
• Estrapak (oestradiol, norethindrone acetate)
• Evorel-Pak (oestradiol, norethindrone acetate)
• Fempak (oestradiol, didrogesterone)

• Oestrogel 2-4 pumps a day
  & 2 x Utrogestan 100mg capsules each evening for 2 out of 4 weeks

• Elleste Duet Conti
  (oestradiol, norethindrone acetate)
• Kliofem
  (oestradiol, norethisterone)
• Femoston Conti
  (oestradiol, dydrogesterone)

• Climesse (oestradiol, norethindrone acetate)
• Kliovance (oestradiol, norethindrone acetate)
• Nuvelle Continuous (oestradiol, norethindrone)
• Tibolone (see below)

• Evorel Conti
  (oestradiol, norethindrone acetate)

• Use gel

• Oestrogel 2-4 pumps a day
  & Utrogestan 100mg capsule each evening as continuous 

• a synthetic steroid with oestrogenic, progestogenic and androgenic activity.
• As such, it is a type of continuous combined HRT and so is a no bleed preparation.

• Because of its androgenic activity, it has been shown to have a positive effect on libido.
• Tibolone has been shown to be as/or more effective than oestradiol in controlling menopausal symptoms.

• Although 85% of Tibolone users are amenorrhoeic, there is an 11% chance of irregular bleeding, so this may require gynaecological investigation
• Prescribing of Tibolone should take into account the risks of other forms of HRT, such as a possible increase in breast cancer
• Tibolone may enhance the effect of anticoagulants such as warfarin