Combination (estrogen plus progestagen) HRTs

There are a few hrt products that combine estrogen with progesterone (or a progestin—a synthetic progesterone). The advantage of this is having only one product to remember to take, and it may cost somewhat less than two separate prescriptions. The primary disadvantage of a combo product is that if the dose of one hormone is wrong or the relative proportions are not in balance for our body's needs, we can't adjust either hormone individually.

All of these combination products are prescription-only; there is no actual comparable available over the counter.

Use these links in the list below to go directly to a particular product, or peruse the entire list to look over the range available. This is not a definitive list, even for the US. New HRTs are being licensed all the time, and as older ones fall out of patent life, the generic versions come onto the market. We can't cover all of the generics, so you may need to figure out the proprietary form they are modeled on and work from that product information.  If you are having trouble opening an hrt link, try going to either drugstore.com or rxlist.com and doing a direct search there for either the brand or generic name. These sites generally publish the full FDA prescribing information accurately and fully.

Note: Most pharmaceutical companies limit access to product websites according to the country a woman is browsing from. Because of this, it can be difficult to get information from the manufacturers about HRTs not specifically sold in our home countries. Many companies have dropped publication of their prescribing information brochures or have hidden them behind restricted professional access. We have linked to other sites that publish this where we can find them, and provided several references for most HRTs because so many links are lost over time. Some of the brand names in the discussion are direct links to pdf brochure downloads; you will need a program capable of reading a pdf file to open them. Where actual prescribing information is not available, we have linked to reputable sites providing their own discussion of the HRT. The information linked to and provided here may not contain everything a woman needs to know to use any particular HRT safely and effectively; please review use instructions and characteristics with your physician and pharmacist when beginning any new HRT.  

Oral synthetic:

Oral human-identical:

  • compounded pill—basically human-identical estrogen(s) plus progesterone (see discussions under separate ingredients)

Patch synthetic:

Transbuccal human-identical:

  • compounded troche—basically human-identical estrogen(s) plus progesterone (see discussions under separate ingredients)

Transdermal human-identical:

  • compounded cream or gel—basically human-identical estrogen(s) plus progesterone (see discussions under separate ingredients)
Activella tablets contains human-identical estradiol plus norethindrone acetate, a progestin, plus lactose monohydrate, starch (corn), copovidone, talc, magnesium stearate, hydroxypropyl methylcellulose and triacetin. It comes in two different dose strengths: that with 1mg estradiol plus 0.5 mg norethindrone acetate or 0.5 mg of estradiol and 0.1 mg of norethindrone acetate. Note that the two dose forms swap out the relative preponderance of the two ingredients rather than represent an increase or decrease of both. This means that if you are trying to increase or reduce one ingredient, the other dose will also increase or decrease the other ingredient to the opposite relationship. It is a coated tablet, which generally means that it's inadvisable to split it to alter the dose although we don't have definitive information either way on this question. (more information)

CombiPatch is a transdermal patch containing 0.62 or 0.51 mg human-identical estradiol plus 2.7 or 4.8 mg (respectively) of norethindrone acetate(a progestin). If you look at that closely, you'll see that the larger patch actually contains less estrogen and more progestin compared to the smaller one, so if you are having problems with unmet estrogen needs on the smaller patch, increasing dose to the larger patch may not help and may actually worsen the situation. The patch dimensions are proportional to the dose and while the manufacturer does not recommend it, pharmacists say it may be cut to modify the dose. It is changed twice weekly. Following patch removal, circulating estrogens drop to pre-application levels in about eight hours and the progestin is eliminated in 48 hours. The manufacturer only specifies the lower abdomen as a suitable location, and includes no testing data on other locations. The warning label also includes a comment that the patch (not the wearer) should not be exposed to the sun for "prolonged periods of time" but doesn't explain why. Please see the Troubleshooting patches section of this site for details on using and adjusting patches. (more information)

Femhrt tablets contain either 1 mg or 0.5mg of norethindrone acetate, a progestin, plus 0.005 mg or 0.0025 mg (respectively) ethinyl estradiol, a synthetic estrogen, in a white uncoated pill that also contains calcium stearate, lactose monohydrate, microcrystalline cellulose, and cornstarch. Note that in contrast to some other combo hrts, the two dose forms are in fact actual multiples of both constituents, preserving the same relationship between the two. Women who must take synthetics seem to have fewer undesirable effects on this one than on some of the other synthetics. (more information)

Prefest is a cyclical hormone dosing package with three days of 1 mg of human-identical estradiol and three days of 1 mg estradiol plus 0.09 mg of a synthetic progestin, norgestimate. Where there is no particular medical objective in cycling hormones in surgical menopause, women tend to be more comfortable on a steady dose. In cases where high doses of progestins must be used, however, some women conceivably might find that taking them only half the time is more comfortable for them—we haven't heard of any, but that doesn't mean it's impossible. That aside, the progestin norgestimate is a testosterone derivative, and as such may raise your serum testosterone levels and your testosterone risk factors. (more information)

Premphase cycles between two weeks of plain 0.625 mg Premarin and two weeks of Prempro (0.625 mg of conjugated estrogens plus 5 mg of medroxyprogesterone acetate). Where there is no particular medical objective in cycling hormones in surgical menopause, women tend to be more comfortable on a steady dose. In cases where high doses of progestins must be used, however, some women conceivably might find that taking them only half the time is more comfortable for them—we haven't heard of any, but that doesn't mean it's impossible. This adds the potential trauma of cycling to everything else you could say about Prempro (see below). (more information)

Prempro consists of varying doses of Premarin plus Provera (medroxyprogesterone acetate, a progestin). These are provided in the relative ratios of 0.3 mg/1.5 mg, 0.45 mg/1.5 mg, 0.625 mg/2.5 mg, and 0.625 mg/5 mg plus calcium phosphate tribasic, calcium sulfate, carnauba wax, cellulose, glyceryl monooleate, lactose, magnesium stearate, methylcellulose, pharmaceutical glaze, polyethylene glycol, sucrose, povidone, titanium dioxide, yellow ferric oxide or red ferric oxide or FD&C Blue No. 2. It is now the HRT associated with the early end of the Woman's Health Initiative study following demonstration of an unacceptable level of breast cancer risk for participants.