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Switching HRT to an equivalent

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 Sequential Combined (uterus intact and having a monthly bleed)
  • Evorel Sequi & Femseven Sequi
  • Opportunistic review – are they still having monthly bleeds?
  • Replace with
Rx Utrogestan 100mg x 56 - 2 od for 2 out of 4 weeks 
Oestrogel 160g – 2 pumps daily (=56 days supply)
  • Utrogestan is licensed for days 15-26 but easier to take for 2 weeks
Continuous combined (uterus intact but no monthly bleed)
  • Evorel Conti & Femseven Conti
  • Opportunistic review: Have they had a hysterectomy?
  • Replace with
Rx Utrogestan 100mg x 56 – 1 od
Oestrogel 160g – 2 pumps daily (= 56 days supply)
  • Utrogestanlic is lisensed for days 1-25 but easier to take every night
Oestrogen only 
  • Evorel 25 = oestrogel 1 pump daily = sandrena 500mcg sachet daily
  • Evorel 50= oestrogel 2 pump daily = sandrena 1mg sachet daily
  • Evorel 75 = oestrogel 3 pump daily = sandrena 1.5mg sachet daily
  • Evorel 100 = oestrogel 4 pump daily = sandrena 2mg sachets daily
Vaginal Atrophy

Ovestin cream (1 applicatorful contains 500 micrograms estriol)

Blissel gel (1 applicatorful contains 50 micrograms estriol)

Imvaggis pessary (1 pessary contains 30 micrograms estriol)

Vagifem vagifem pessaries  (1 pessary contains 10 mcg estradiol)

 

 

 

  • Vaginal oestrogen can be given on alternate nights as continuous  and one every night for 12-14 days each month as cyclical off license

 

From emc and https://pcwhf.co.uk/wp-content/uploads/2019/01/PCWHF-Easy-HRT-prescribing-guide-31_01.pdf

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