NHS Tayside Flowchart for Systemic HRT Prescribing

Abbreviations:
BSO- bilateral oophorectomy
CE- conjugated estrogen
E- estradiol
IUS- Intrauterine system
LMP- last menstrual period
P- progestogen
¹ Consider giving continuous combined HRT to women who had a hysterectomy for endometriosis, at
least in their first postoperative year. Give three months of sequential HRT after a subtotal
hysterectomy. If there is no vaginal bleeding change to estrogen-only HRT.
² Give cyclical progestogen for 12-14 days every 28 days.
³ The Mirena® IUS (52 mg LNG) is the only IUS licensed as part of HRT and needs to be changed every 5
years.

In general, start with a low dose preparation for symptom control. Women with premature ovarian
insufficiency (POI) (< 40 years), early menopause (between 40- 44 years) or surgical menopause,
medium or higher doses are generally required for symptom control.

NHS Tayside Formulary HRT choices

Type First Choice Second choice*

Estradiol only HRT
Transdermal Evorel® patch FemSeven® patch
estradiol patches 25 mcg, 50 mcg, 75 mcg or 100 mcg/24 h 50 mcg, 75 mcg or 100 mcg/24 h
Transdermal Oestrogel® (0.06%)
estradiol gel (1-4 measures≈ 0.75- 3 mg)
-
Oral estradiol Elleste Solo®
1 mg or 2 mg
-
Sequential combined HRT
Sequential combined Evorel Sequi®1 FemSeven Sequi®2
patches (50 mcg/ 170 mcg) (50 mcg/ 10 mcg)
Sequential combined Elleste Duet®¹ Femoston®3
tablets 1mg/1 mg or 2 mg/1 mg 1 mg/10 mg or 2 mg/10 mg
Continuous combined HRT
Continuous combined Evorel Conti®¹ FemSeven Conti®²
patches (50 mcg/170 mcg) (50 mcg/7 mcg)
Continuous combined Kliovance®¹(1 mg/0.5 mg) Femoston Conti®³
tablets Kliofem®¹ (2 mg/1 mg) (≈ Elleste Duet Conti®) (0.5mg/2.5mg) or (1mg/5mg)
Progestogen as part of HRT (for endometrial protection)
IUS Mirena® (52 mg LNG)
-
4
Progestogen Provera®
tablets 2.5 mg, 5 mg or 10 mg
-
Other
Synthetic steroid Livial®5 (2.5 mg)
-
* “Second choice” due cost implications

For any query: please contact Dr Heike Gleser, consultant SRH, NHS Tayside at heikegleser@nhs.net
(Date: 10/2017)

1
Estradiol and norethisterone
2
Estradiol and levonorgestrel
3
Estradiol and dydrogesterone
4
Medroxyprogesterone acetate
5 Tibolone
1