Monday, February 12, 2007

HRTs in the UK

Disclaimers: There's a limitation on what information we can provide you, since many non-US pharmaceutical company websites block access to their pages from US-based service providers (and that's where we are). We've collated what information we can gather despite that limited access, but it may be neither fully accurate nor fully up to date. That means we especially rely on you, women in the UK, to feed us additional information and updates. Our email is in the sidebar; please help us out, here.

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.

We've limited this list as much as possible to those preparations that are used for menopause, not the stronger varieties used for oral contraceptives that may be used by very young women in menopause. To look up any additional brand or generic names you may want information about, try searching in the electronic Medicines Compendium and click on the links identified by the squares that say "spc" rather than the ones that say "pil". For more information on packaging, full risk disclaimers and manufacturer, follow the links from each brand name to a full prescribing info listing.

There are many more forms of testosterone licensed for use in the UK than those we've included here, but all of the others are doses appropriate for men in forms that cannot be adequately adjusted downward for the lower amounts safer in women. If you are offered another testosterone, you can also research it in the electronic Medicines Compendium by either brand or generic name.

Update note: All of these links were checked and updated in April, 2010. New additions and deletions may have since occurred. For updated information, check the electronic Medicines Compendium.

Oral bioidentical estrogens:

Oral synthetic estrogens:

Oral bioidentical progesterone:

  • none

Oral synthetic progestins:

Oral combination: bioidentical estrogens plus bioidentical progesterone:

  • none

Oral combination: bioidentical estrogens plus synthetic progestins:

Oral combination: synthetic estrogens plus synthetic progestins:

Patch bioidentical estrogens:

Patch combination: bioidentical estrogen plus synthetic progestin:

Patch/oral combination: bioidentical patch estrogen plus oral synthetic progestin:

Patch bioidentical tesosterone:

Cream/gel bioidentical estrogens:

Cream/gel bioidentical progesterones:

  • none

Cream/gel bioidentical testosterones:

Transdermal/patch synthetic estrogens:

  • none

Subdermal (implanted) bioidentical estrogens:

Subdermal (implanted) bioidentical testosterones:

Vaginal bioidentical estrogens:

Vaginal synthetic estrogens:

Vaginal bioidentical progesterones:

Angeliq contains 1 mg estradiol (as estradiol hemihydrate), considered bioidentical, and 2mg drospirenone, a synthetic progestin that is purported to be closer to progesterone than most synthetics although it has a very low level of androgenic activity. Inert ingredients include Lactose monohydrate, Maize starch, Maize starch, pregelatinised, Povidone, Magnesium stearate, Hypromellose, Macrogol 6000, Talc, Titanium dioxide (E171), Ferric oxide, red (E172). The tablets are film-coated, making them less suitable for dividing into lower dose portions; this hrt is not suitable for transbuccal delivery.

Climagest comes in two doses of bioidentical estradiol valerate, either 1 mg or 2 mg, with 1 mg norethisterone, a synthetic progestin, in 12 of the 28 pills contained in each packet. Norethisterone was first formulated in the 1950s and purportedly has a very low level of androgenic activity. The tablets are film-coated, making them less suitable for dividing into lower dose portions; this hrt is not suitable for transbuccal delivery. Inert ingredients include lactose monohydrate, maize starch, povidone, talc, magnesium stearate, FD &C blue no.2 lake (E132), purified water. hypromellose, propylene glycol, opaspray blue M-1-6516 (E171, E464, E132). Cycling HRTs are not required by women who no longer have a uterus, and so this sort of HRT is rarely used in surgical menopause.

Climaval contains 1 mg or 2 mg bioidentical estradiol valerate. The tablets are film-coated, making them less suitable for dividing into lower dose portions; this hrt is not suitable for transbuccal delivery. Inert ingredients include lactose monohydrate, maize starch, FD & C blue no. 2 lake (E132), povidone (grade 30), purified water, talc (sterilised, white), magnesium stearate, Hypromellose, propylene glycol, Opaspray blue M-1-6517 (E171, E464, E132).

Climesse contains 2 mg estradiol valerate, considered bioidentical, and 0.7 mg norethisterone, a synthetic progestin. This is a non-cycling hrt. Norethisterone was first formulated in the 1950s and purportedly has a very low level of androgenic activity. The tablets are film-coated, making them less suitable for dividing into lower dose portions; this hrt is not suitable for transbuccal delivery. Inert ingredients include: lactose monohydrate, maize starch, povidone, purified water, talc, magnesium stearate, Hypromellose, polyethylene glycol, iron oxide red (E172), titanium dioxide (E171), purified water.

Crinone Vaginal Gel is an 8% bioidentical progesterone gel meant for vaginal application. It is supplied in individual-dose applicators that contain 1.45 g of gel and deliver 1.125g of gel for a dose of 90 mg of progesterone. The manufacturer's dosing schedule instructions are for the use of women who have a uterus; cycling HRTs are not required by women who no longer have a uterus. While the dose can be modified, it is not convenient and requires some care to be accurate. We have no data on whether or not this gel can also be used successfully for non-vaginal transdermal application. Because the formulation is specially designed to adhere and be retained in the vagina, it should not be used concurrently with other vaginal products. While timing of dose can alleviate some of the potential hormone exposure to a partner, the long-lasting nature of this gel may nonetheless make it difficult for a partner to avoid it entirely. There are some drowsiness and balance risks inherent in beginning use of bioidentical progesterones. Inert ingredients include: Glycerin, Light Liquid Paraffin, Hydrogenated Palm Oil Glyceride, Carbopol 974P, Sorbic acid, Polycarbophil, Sodium hydroxide, Purified water.

Cyclogest is a suppository (pessary) for vaginal or rectal use containing bioidentical progesterone. It comes in 200mg and 400mg doses. The manufacturer's dosing schedule instructions are for the treatment of pms in women who have a uterus; cycling HRTs are not required by women who no longer have a uterus. This dose is much higher than that typically used in surgical menopause, but women have reported cutting this product down to provide a source of dose-modifiable bioidentical progesterone. While the dose can be modified, the process is not convenient and requires some care to be accurate. When used vaginally, dose timing precautions may be necessary to avoid exposing a partner to the hormone it contains. The only listed added inert ingredient is vegetable fat.

Cyclo-Progynova is a combined hrt meant to be cycled, with 11 pills containing 1mg estradiol valerate, a bioidentical estrogen, followed by 10 pills containing 250 micrograms levonorgestrel, a synthetic progestin, plus 1mg estradiol valerate; this sequence of pills is meant to be followed by a 7-day hormone-free period to produce a 28-day cycle. A higher dose pack is also available, containing 2mg estradiol valerate with 500 micrograms norgestrel in 10 of the pills. Inert ingredients include: lactose, maize starch, povidone, talc, magnesium stearate [E572], sucrose, calcium carbonate [E170], polyethylene glycol 6000, montan glycol wax, titanium dioxide [E171], yellow ferric oxide [E172], red brown ferric oxide [E172], glycerin. Cycling HRTs are not required by women who no longer have a uterus, and a cycle that includes a period without any hormonal support is not likely to be especially comfortable for any woman in surgical menopause.

Elleste Solo is biodentical estradiol hemihydrate in tablets for oral use that come in 1 mg and 2 mg doses. It's possible, since the hemihydrate form of estradiol is known to be used in vaginal hrts, that one could also use this hrt transbuccally, but we don't have user information on whether or not this actually delivers satisfactorily. The tablets are film-coated but may be divided for dose customization. Inert tablet contents are lactose monohydrate, maize starch, povidone 25, talc (purified), magnesium stearate; the coating contains hydroxypropylmethyl cellulose (E464), titanium dioxide (E171), macrogol 400.

Elleste Solo is a biodentical estradiol hemihydrate patch that comes in 40 microgram and 80 microgram doses (the dose references the amount calibrated to be delivered per day, not the total amount of estrogen contained in an unused patch) in an acrylic matrix adhesive. The size of the patch is porportional to the dose and it is meant to be changed twice a week. The manufacturer recommends placement on the lower back or buttocks; placement elsewhere can change effective dose delivery. For more on patch application, delivery dynamics, dose adjustments and other patch concerns, please see the "Troubleshooting patches" section of this website.

Estraderm contains bioidentical estradiol that delivers 25, 50, 75, or 100 micrograms/day via an acrylic matrix adhesive. The size of the patch is porportional to the dose and it is meant to be changed twice a week. The manufacturer recommends sites below the waistline, but suggests that wrinkling may be minimized by placing the patch on the buttocks. Inert ingredients include Acrylate, methacrylate, isopropyl palmitate, polyethylene terephthalate, ethylenevinylacetate copolymer, silicone coating (on the inner side of the protective release liner which is removed before patch application). For more on patch application, delivery dynamics, dose adjustments and other patch concerns, please see the "Troubleshooting patches" section of this website.

Estradiol implants come in 25 and 50 mg doses (a 100mg dose product has been discontinued) and contain bioidentical estradiol valerate. According to the manufacturer, this product reaches its maximum release "in a few weeks and shows a slow and gradual decline to about 6 months." The implant is placed with a large needle, following local anesthesia (a numbing shot), under the skin of the buttocks or lower abdomen. Once implanted the dose cannot be altered and it is not easily removed. The manufacturer claims that overdose cannot occur and that even if levels are above that needed, uncomfortable symptoms will not occur. This is directly contradicted by the experience of many women, and in fact it's unusual for women to stay on the implant for more than a few doses. There is more on the benefits and drawbacks of this route elsewhere on this site. The manufacturer's prescribing information sheet specifically states that it contains no inert ingredients (although we have a hard time visualizing how this can be).

Estradot provides bioidentical estradiol hemihydrate in a silicone/acrylic matrix patch meant to be changed twice weekly. The doses are: 0.39 mg estradiol (25 microgram estradiol per 24 hours), 0.585 mg estradiol (37.5 microgram estradiol per 24 hours), 0.78 mg estradiol (50 microgram estradiol per 24 hours), 1.17 mg estradiol (75 microgram estradiol per 24 hours), 1.56 mg estradiol (100 microgram estradiol per 24 hours). The physical size of the patch is proportional to the dose. The manufacturer notes that the lower two doses are not to be used for osteoporosis treatment, although that is likely to be a matter of legality, not the case that lower doses have no effect whatsoever on bone density (in the US, those lower doses have been accepted by the US FDA as effective for bone maintenance). The manufacturer recommends placement on the abdomen. Inert ingrediets are listed as: (Adhesive matrix) acrylic adhesive, silicone adhesive, oleyl alcohol, dipropylene glycol, povidone (E1201); (Backing layer) ethylene/vinyl acetate copolymer, polyethylene, vinylidene/vinyl chloride copolymer, polyethylene, ethylene/vinyl acetate copolymer co-extruded film; (Release liner) fluoropolymer-coated polyester film. For more on patch application, delivery dynamics, dose adjustments and other patch concerns, please see the "Troubleshooting patches" section of this website.

Estring is a silicone ring that dispenses bioidentical estradiol hemihydrate. It contains 2.0 mg of the estrogen and is worn continuously in the vagina for a period of three months. It is only used to treat vaginal atrophy, and is not meant to be deliver systemic HRT. Nonetheless because some estrogen can escape from local tissues, especially when vaginal atrophy is already present, it may cause a few symptoms of hormonal fluctation early in use and it is not considered safe for use by women who cannot use systemic HRTs. Use of progesterone or a progestin is not required by women who have a uterus and use this product because the dose is so low. In dimensions the ring is: outer diameter - 55 mm; cross sectional diameter - 9 mm; core diameter - 2 mm. It is folded into a figure-eight shape for insertion and rides in the area of the cervix or cervical cuff, much like a diaphragm without a center. Women with severe atrophy may require health professional assistance or demonstration of insertion the first time it is used, and some women complain, especially early in use, of feeling as though it's not far enough in or feels as though it might be going to fall out. Some women also notice a feeling of bladder pressure, although that tends to disappear in a few days. More rarely, some women report cramping with the use of a ring, especially when they have irritable bowel syndrome or endometriosis; these women often abandon the use of the ring if symptoms do not resolve within a week or two. The ring should not be used while other vaginal treatment is in place (such as creams). The UK data sheet does not include the information that it can be left in place during intercourse, but the American one does—although it can also be removed and then replaced afterwards if prefered.

Ethinyloestradiol is a synthetic estrogen in doses of 10 mcg, 50mcg and 1mg. The tablets are uncoated and may be divided for dose adjustment; there is no evidence that this estrogen may be taken transbuccally. Inert ingredients include Lactose, Starch Maize, Magnesium Stearate, IMS 99%, Purified water. This is an entirely different synthetic from those found in Premarin and is metabolized relatively more rapidly; therefore this synthetic may provide a different range of effects for women exploring this type of HRT.

Evorel is a bioidentical estradiol acrylic matrix patch the size of which is proportional to the dose. It comes in four sizes: 1.6 mg estradiol (25 micrograms of estradiol in 24 hours), 3.2 mg estradiol (50 micrograms of estradiol in 24 hours), 4.8 mg estradiol (75 micrograms of estradiol in 24 hours, and 6.4 mg estradiol (100 micrograms of estradiol in 24 hours). The manufacturer notes that the lowest dose has not yet been demonstrated to be effective in prevention of osteoporosis (although it has been in the US). Placement is specified as simply below the waist. The inert ingredients are listed as Adhesive acrylic polymer, Guar gum (meyprogat 90), Hostaphan MN19 (polyester film - removed before application). For more on patch application, delivery dynamics, dose adjustments and other patch concerns, please see the "Troubleshooting patches" section of this website.

Evorel Conti is a matrix patch containing 3.2 mg of estradiol hemihydrate, a bioidentical estrogen, plus 11.2 mg of norethisterone acetate, a synthetic progestin, providing a nominal dose of 50 micrograms of estradiol and 170 micrograms of norethisterone acetate per 24 hours. It is meant to be changed twice a week and the hormone blend is used continuously rather than cycled. The manufacturer recommends application to the trunk below the waist. Inert ingredients listed are: (Adhesive:) acrylate-vinylacetate copolymer, Guar gum, (Backing film:) polyethylene terephthalate foil, (Release liner:) siliconised polyethylene terephthalate foil (removed before application). For more on patch application, delivery dynamics, dose adjustments and other patch concerns, please see the "Troubleshooting patches" section of this website.

Evorel Sequi is a cycling series of matrix patches, each of which is meant to be changed twice weekly. For two weeks the patch used contains the bioidentical estrogen 3.2 mg of estradiol hemihydrate (50 micrograms of estradiol per 24 hours) and for two weeks the patch contains 3.2 mg of estradiol hemihydrate plus 11.2 mg of norethisterone acetate (170 micrograms of norethisterone acetate per 24 hours), a synthetic progestin. The manufacturer recommends application to the trunk below the waist. Inert ingredients listed are: (Adhesive:) acrylate-vinylacetate copolymer, Guar gum, (Backing film:) polyethylene terephthalate foil, (Release liner:) siliconised polyethylene terephthalate foil (removed before application). Cycling HRTs are not required by women who no longer have a uterus, and so this patch is rarely used in surgical menopause. For more on patch application, delivery dynamics, dose adjustments and other patch concerns, please see the "Troubleshooting patches" section of this website.

Femapak is a combination of a matrix patch containing 1.25 mg bioidentical estradiol (40 micrograms per 24 hours) that is used continuously through the month and 14 10 mg Dydrogesterone, a synthetic progestin, oral tablets that are taken one daily for two weeks. A higher strength version is also available that contains double the estrogen dose (80 mcg/24 hours) with the same progestin dose and schedule. The patch is meant to be changed twice a week and the manufacturer recommends placement on the lower back or buttocks. Inert ingredients of the patch are listed as: Diethyltoluamide, Acrylic adhesive (Dow Corning MG-0560), Acrylic thickener (Acrysol 33), (Backing:) Polyester film, (Release liner:) Aluminised/Polyester film. Inert ingredients of the tablets are listed as: Lactose, Hypromellose, Maize starch, Colloidal anhydrous silica, Magnesium stearate, Macrogol 400, Titanium dioxide (E171). Cycling HRTs are not required by women who no longer have a uterus, and so this sort of HRT is rarely used in surgical menopause. For more on patch application, delivery dynamics, dose adjustments and other patch concerns, please see the "Troubleshooting patches" section of this website.

Fematrix is a matrix patch containing either 1.25 mg of bioidentical estradiol (40 micrograms per 24 hours) or 2.5 mg of bioidentical estradiol (80 micrograms per 24 hours). It is meant to be changed twice weekly and the manufacturer recommends placement on the lower back or buttocks. Inert ingredients of the patch are listed as: Diethyltoluamide, Acrylic adhesive (Dow Corning MG-0560), Acrylic thickener (Acrysol 33), (Backing:) Polyester, (Release liner: ) siliconised/Aluminised/Polyester. For more on patch application, delivery dynamics, dose adjustments and other patch concerns, please see the "Troubleshooting patches" section of this website.

Femoston contains either 1 mg or 2 mg of estradiol hemihydrate, a bioidentical estrogen, plus, in 14 of the month's tablets, 10 mg dydrogesterone, a synthetic progestin. Inert ingredients listed include: Lactose, Hypromellose, Maize starch, Colloidal anhydrous silica, Magnesium stearate, Hypromellose, Macrogol 400, Titanium dioxide (E171), Iron oxide black (E172). The tablets are film-coated, making them unsuitable for dividing; this hrt is not suitable for transbuccal delivery. Cycling HRTs are not required by women who no longer have a uterus, and so this sort of HRT is rarely used in surgical menopause.

Femoston-conti contains 1 mg bioidentical estradiol hemihydrate and 5 mg dydrogesterone, a synthetic progestin. Inert ingredients listed include: Lactose monohydrate, Hypromellose, Maize starch, Colloidal anhydrous silica, Magnesium stearate, Hypromellose, Macrogol 400, Titanium dioxide (E171), Iron oxides, yellow and red (E172). The tablets are film-coated, making them unsuitable for dividings; this hrt is not suitable for transbuccal delivery.

Femseven is a bioidentical estrogen patch that comes in doses of 1.5 mg estradiol hemihydrate (50 microgram of estradiol in 24 hours), 2.25 mg estradiol hemihydrate (75 microgram of estradiol in 24 hours), or 3.00 mg estradiol hemihydrate (100 microgram of estradiol in 24 hours). The area of the releasing surface is 30 cm2. It is meant to be changed every seven days. It is probably a matrix patch but this is not explicit in the data sheet; the size is proportional to dose. The manufacturer recommends placement below the waist on the buttocks, hip or abdomen, and emphasis is placed on holding the new patch in place long enough for the adhesive to warm through. Inert ingredients as listed as: (Backing layer:) Transparent polyethylene terephthalate (PET) foil, (Adhesive matrix:) Styrene-isoprene block copolymer, glycerine esters of completely hydrogenated resins. For more on patch application, delivery dynamics, dose adjustments and other patch concerns, please see the "Troubleshooting patches" section of this website.

FemSeven Conti is a matrix patch for continuous use that contains 1.5 mg of estradiol hemihydrate (50 micrograms of estradiol per 24 hours), a bioidentical estrogen and 0.525 mg levonorgestrel (7 micrograms of levonorgestrel per 24 hours), a synthetic progestin. It is meant to be changed every seven days. The manufacturer recommends placement on the buttocks or hip, and emphasis is placed on holding the new patch in place long enough for the adhesive to warm through. Inert ingredients as listed as: (Backing layer:) Polyethylene terephthalate (PET) foil, (Adhesive matrix:) Styrene-isoprene-styrene block copolymer, glycerine esters of completely hydrogenated resins, (Protective liner:) Siliconized polyethylene terephthalate (PET) foil. For more on patch application, delivery dynamics, dose adjustments and other patch concerns, please see the "Troubleshooting patches" section of this website.

FemSeven Sequi is a matrix patch for cycling hormones that contains a bioidentical estrogen and a synthetic progestin. For two weeks out of the month a patch is used that contains 1.5 mg of estradiol hemihydrate (50 micrograms of estradiol per 24 hours); for the other two months a patch is used that contains 1.5 mg of estradiol hemihydrate (50 micrograms per 24 hours) and 1.5 mg of levonorgestrel (10 micrograms per 24 hours). It is meant to be changed every seven days. The manufacturer recommends placement on the buttocks or hip, and emphasis is placed on holding the new patch in place long enough for the adhesive to warm through. Inert ingredients as listed as: (Backing layer:) Polyethylene terephthalate (PET) foil, (Adhesive matrix:) Styrene-isoprene-styrene block copolymer, glycerine esters of completely hydrogenated resins, (Protective liner:) Siliconized polyethylene terephthalate (PET) foil. For more on patch application, delivery dynamics, dose adjustments and other patch concerns, please see the "Troubleshooting patches" section of this website. Cycling HRTs are not required by women who no longer have a uterus, and so this patch is rarely used in surgical menopause.

FemTab contains oral bioidentical estradiol valerate in doses of 1.0 mg or 2.0 mg. It is not coated and may be suitable for dividing. There is no information on whether or not it can be absorbed transbuccally. Inert ingredients are listed as including: Lactose monohydrate, Maize Starch, Povidone 25000, Talc, Magnesium Stearate [E572], Sucrose, Povidone 700,000, Macrogol 6000, Calcium Carbonate [E170], Titanium Dioxide [E171], Glycerol 85% [E422], Montan Glycol Wax, Indigo Carmine [E132], Purified Water. Note: as of April 2010, this is no longer listed in the UK Electronic Medicines Comendium.

FemTab Sequi is a cycled HRT consisting of a bioidentical estrogen and a synthetic progestin. The dosing schedule calls for 16 days of estradiol valerate 2.0mg and then 12 days of estradiol valerate 2.0mg plus levonorgestrel 75 micrograms. Inert ingredients are listed as including: lactose, maize starch, povidone 25 000, povidone 700 000, talcum, magnesium stearate (E572), sucrose, macrogol 6000 (polyethylene glycol 6000), calcium carbonate (E170), glycerol (E422), montan glycol wax, yellow and red ferric oxide pigments (E172), titanium dioxide (E171). Cycling HRTs are not required by women who no longer have a uterus, and so this HRT is rarely used in surgical menopause.

Harmogen containspiperazine estrone sulphate, which metabolizes into bioidentical estrone. The dose of 1.5 mg is the metabolic equivalent of 0.93 mg estrone. Because this is the inactive form of estrogen, women who take it must be able to convert it to the active estradiol; for women who find estradiol too stimulating, this may be a gentler hrt. Inert ingredients are listed as including: Lactose (monohydrate), Lactose (anhydrous), Dibasic potassium phosphate, Tromethamine, Hydroxypropyl cellulose, Sodium starch glycollate, Microcrystalline cellulose, Colloidal silicon dioxide, Magnesium stearate, Hydrogenated vegetable oil wax, Dye E110, Purified water, Alcohol 200 proof.

Hormonin is an unusual HRT that provides a blend of the three major bioidentical estrogens: Estrone 1.4 mg (61%), Estradiol 0.6 mg (26%), and Estriol 0.27mg (12%), making for a non-custom tri-est equivalent. Inert ingredients are listed as including: Sunset yellow, Amaranth, Lactose, Potato starch, Magnesium stearate, Methyl alcohol,Chloroform.

Indivina contains a combination of bioidentical estrogen with synthetic progestin taken on a continuous schedule. There are three dose strengths: Estradiol valerate 1 mg plus Medroxyprogesterone acetate 2.5 mg; Estradiol valerate 1 mg plus Medroxyprogesterone acetate 5 mg; and Estradiol valerate 2 mg plus Medroxyprogesterone acetate 5 mg. The lowest of the three is designated by the manufacturer as the starting dose. Inert ingredients are listed as including: Lactose monohydrate, maize starch, elatine, magnesium stearate.

Intrinsa is a matrix patch that contains 8.4 mg testosterone and provides 300 micrograms of testosterone per 24 hours; it is meant to be changed twice a week. Inert ingredients are listed as: (Backing layer:) Translucent polyethylene backing film printed with proprietary ink containing sunset yellow FCF (E110), latolrubine BK (E180) and copper phthalocyanine blue pigment; (Self adhesive matrix drug layer:) Sorbitan oleate, Acrylic co-polymer adhesive containing 2-Ethylhexylacrylate – 1-Vinyl-2-pyrrolidone co-polymer; (Protective release liner:) Siliconised polyester film.

Kliofem contains a combination of bioidentical estrogen with synthetic progestin taken on a continuous schedule: Estradiol 2 mg plus Norethisterone acetate 1 mg. Inert ingredients are listed as including: Lactose monohydrate, Maize starch, Gelatin, Talc, Magnesium stearate, Methyl hydroxypropyl cellulose (E464), Titanium dioxide (E171), Iron oxide (E172), Propylene glycol, Purified water.

Kliovance contains a combination of bioidentical estrogen with synthetic progestin taken on a continuous schedule: estradiol hemihydrate 1.0 mg plus norethisterone acetate 0.5 mg. Inert ingredients are listed as including: Lactose monohydrate, Maize starch, Copovidone, Talc, Magnesium stearate, Hypromellose, Triacetin, Talc.

Livial contains 2.5mg of tibolone, a steroid (hormone) that is referred to as "gonadomimetic" because it can carry out some of the actions of all three sex hormones (estrogen, progesterone, testosterone). It's main difference from estrogen is that it is designed to produce an overall lower level of endometrial stimulation (due to its progestagenic qualities), thus ostensibly making it suitable for use by women with endometriosis. It is also said not to stimulate an increase in sex hormone binding globulin (SHBG), thus interfering less with the activity of a woman's own testosterone. In fact, one of the most common negative effects of this HRT is "the greasies"—the typical picture of mild testosterone excess in overall hormone balance. The manufacturer has demonstrated that it reduces hot flashes and can help prevent osteoporosis. Breast density increases are, according to the manufacturer, not seen with Livial as they are with estrogens. The contraindications and risk profile are nonetheless similar to estrogen HRTs, and the data sheet does include a recommendation that a progestagen be used cyclically by women with a uterus (research). Because this is not a direct hormone analog, women considering its use would be well-advised to read the current research and use precautions available (we've got a number of them in our bookmark account). Inert ingredients are listed as including: Potato starch, magnesium stearate, ascorbyl palmitate and lactose.

Novofem combines a bioidentical estrogen with a synthetic progestin in a cycling dose schedule. A month's schedule include 16 days of estradiol hemihydrate 1 mg and 12 days of estradiol hemihydrate 1 mg plus norethisterone acetate 1 mg. Cycling HRTs are not required by women who no longer have a uterus, and so this HRT is rarely used in surgical menopause. Inert ingredients are listed as including: Lactose monohydrate, Maize starch, Gelatin, Talc, Magnesium stearate, Hypromellose, triacetin, red iron oxide (E 172), titanium dioxide (E 171), propylene glycol.

Nuvelle Continuous contains a combination of bioidentical estrogen with synthetic progestin taken on a continuous schedule: estradiol hemihydrate 2.0 mg plus norethisterone acetate 1.0 mg. Inert ingredients are listed as including: lactose monohydrate, maize starch, pre-gelatinized maize starch, povidone 25 000, talc, magnesium stearate (E572), methylhydroxypropyl cellulose, macrogol 6000, titanium dioxide (E171), ferric oxide pigment, red (E172).

Ortho-Gynest is a pessary for vaginal use that contains 0.5 mg of bioidentical estriol meant to be used in the treatment or prevention of urogenital atrophy. Estriol is a waste product of estrogen metabolism that has very weakly active properties in urogenital tissues (vagina, bladder, surrounding support structures). Because it has little action in other tissues, some practioners feel that this estrogen is less carcinogenic than more active forms; at the same time, because it is so weak, it may provide insufficient strength for some women's needs. The manufacturer recommends daily dosing until recovery is achieved and then twice-weekly use for maintenance.The manufacturer suggests that treatment should be discontinued after about three to six months to assess whether further use is required but in surgical menopause it is unlikely needed treatment will be only short term. Dose customization is achieved by altering the amount and/or frequency of the maintenance dose. Inert ingredients are listed as: Benzoic acid, Butylated hydroxytoluene, Polyethylene glycol 400, Polyethylene glycol 1000, Sorbitan monostearate, Witepsol S 55. As with all vaginal estrogens, care with timing of use and handwashing will help prevent exposure of a partner to this hormone.

Ovestin Cream is a preparation of bioidentical estriol meant to be used in the treatment or prevention of urogenital atrophy. Estriol is a waste product of estrogen metabolism that has very weakly active properties in urogenital tissues (vagina, bladder, surrounding support structures). Because it has little action in other tissues, some practioners feel that this estrogen is less carcinogenic than more active forms; at the same time, because it is so weak, it may provide insufficient strength for some women's needs. The nominal dose recommended by the manufacturer is 0.5gm, measured by a provided applicator. Dosing is recommended to be daily for two to three weeks and then twice a week thereafter for maintenance. The manufacturer suggests that treatment should be discontinued after about three months to assess whether further use is required but in surgical menopause it is unlikely that treatment will be only short term. Dose customization is achieved by altering the amount and/or frequency of the maintenance dose. Inert ingredients are listed as including: octyldodecanol; cetyl palmitate; glycerin; cetyl alcohol; stearyl alcohol; Polysorbate 60; sorbitan stearate; chlorhexidine dihydrochloride; lactic acid; sodium hydroxide to pH 4, purified water. As with all vaginal estrogens, care with timing of use and handwashing will help prevent exposure of a partner to this hormone.

Premarin is the great-grandmother of prescription estrogens and once was the most widely-prescribed drug in the US. It comes as a non-dividable coated pill in 0.625 or 1.25 mg dose strengths. The active ingredient is listed as conjugated equine estrogens. It is derived from the urine of pregnant mares (hence the name), leading to ethical objections to its use by some women. It contains a large number of hormonal compounds that are capable of acting in some ways like estrogen and some compounds that are testosterone-related but not testosterone. There used to be a listing that compared what's in Premarin with what Cenestin, a plant-based comparable, contains at the Cenestin website, but it has since been removed. We've transcribed it and posted the list for you. The US FDA has asked the manufacturer for a full identification of everything that's in Premarin—which the manufacturer admitted they haven't quite worked out yet. Because it's not bioidentical, it doesn't work the same way or break down the same way as our own estrogens. This can be good or bad, depending upon your needs. One thing peculiar to Premarin that may be relevant as you deal with its various effects or change from it to another form of HRT is that Premarin stays in the body for a considerable period of time after you take it, and the longer you take it, the longer it takes to wear off. For someone who has taken it for only weeks, this clearance is weeks as well; if you've taken it for years, it may take months to fully leave your system. This means that as you switch, you'll have to gradually increase your new HRT as the Premarin wanes—and you may have hot flashes from that dose fluctuation the whole time. While Premarin has the highest rate of side effects in women we've heard from who are having problems with their HRT, obviously a lot of other women are doing just fine on it. Conjugated estrogens taken orally have also been linked to a higher incidence of hypertension, although studies provide conflicting data on this. We've seen it observed by other health professionals that women taking Premarin are often taking a number of other drugs for "other" problems like asthma, depression, allergies, etc. (that all have hormonal links), but it's hard to guess whether that might have to do with the hormone form or the doctor's style. Many doctors will only prescribe Premarin for HRT because it's the one all the studies have been done on and thus it's the one most "proven." However, you have to keep in mind that these studies were paid for by Premarin's manufacturer, who have been agressively pursuing the market since the Women's Health Initiative study led to such losses for their product. As part of their marketing efforts, Wyeth is presently seeking to have compounding of HRTs significantly restricted by the FDA. (more information) The UK version lists the inert ingredients as, for Premarin 0.625mg: Calcium sulphate, carnauba wax, microcrystalline cellulose, glyceryl mono-oleate, lactose, magnesium stearate, methylcellulose, macrogol, shellac solution (pharmaceutical glaze), sucrose, titanium dioxide (E171), and opalux maroon colour AS-3910 (Opalux maroon colour contains sucrose, purified water, erythrosine (E127), titanium dioxide (E171), sunset yellow (E110), indigo carmine (E132), polyvinylpyrrolidone and sodium benzoate) and for Premarin 1.25mg: Calcium sulphate, carnauba wax, microcrystalline cellulose, glyceryl mono-oleate, lactose, magnesium stearate, methylcellulose, macrogol, shellac solution (pharmaceutical glaze), sucrose, titanium dioxide (E171), colours E110, E104.

Premarin vaginal cream contains 0.625 mg conjugated estrogens (per gram of cream) in a nonliquefying base containing cetyl esters wax, cetyl alcohol, white wax, glyceryl monostearate, propylene glycol monostearate, methyl stearate, benzyl alcohol, sodium lauryl sulfate, glycerin, and mineral oil. The usual recommended dose is 1 to 2g daily administered intravaginally; the cream comes with a calibrated applicator. It carries the same profile as oral Premarin but at this dose is unlikely to have systemic effect. It is intended for local treatment of genitourinary tissues. As a class, vaginal creams tend to be messier delivery systems than the newer pills or rings designed for the same purpose, but can be given as a more intensive treatment rather than being restricted to low maintenance doses. Customization of the maintenance dose is achieved by adjusting both the amount used and the frequency of dosing: in long term use in surgical meno it is typical to use just a "dab" a couple times a week.

Premique contains conjugated estrogens (Premarin) 0.625mg and medroxyprogesterone acetate (Provera) 5.0mg. It is also available as Premique Low Dose with 0.3 mg conjugated estrogens with 1.5 mg medroxyprogesterone acetate. Inert ingredients include: (tablet core:) Lactose monohydrate, Methylcellulose , Magnesium stearate, Calcium phosphate tribasic, (tablet coating:) Calcium sulphate anhydrous, Macrogol, Glyceryl mono-oleate, Shellac,Microcrystalline cellulose, Sucrose, Titanium dioxide, Povidone, Carnauba wax, Colour (E132), (for tablets marked with '0.625/5':) Stearic acid, Edible Ink (iron oxide black (E172), shellac, purified water, ethanol, N-butyl alcohol, propylene glycol, ethyl acetate). It also comes in a special package as Premique Cycle, which is composed of 14 tablets containing 0.625mg conjugated estrogens and 14 combination tablets containing 0.625mg conjugated estrogens and 10mg MPA; this form is rarely used in surgical menopause as there is no need to cycle hormones without a uterus.

Prempak-C comes in two different strengths. Prempak-C 0.625mg consists of 28 tablets containing 0.625mg conjugated estrogens and 12 tablets containing 0.15mg norgestrel, a synthetic progestin more commonly used in oral contraceptives. Prempak-C 1.25mg consists of 28 tablets containing 1.25mg conjugated estrogens and 12 tablets containing 0.15mg norgestrel. This hrt is meant for women who have a uterus; there is no need to cycle hormones without a uterus.

Progynova provides bioidentical estradiol valerate in 1.0 mg and 2.0 mg doses. Inert ingredients are listed as including: Lactose monohydrate, Maize Starch, Povidone 25000, Talc, Magnesium Stearate [E572], Sucrose, Povidone 700,000, Macrogol 6000, Calcium Carbonate [E170], Titanium Dioxide [E171], Glycerol 85% [E422], Montan Glycol Wax, Indigo Carmine [E132], Purified Water.

Progynova is also the name of a bioidentical estrogen matrix patch that comes in two dose strengths: 3.9mg estradiol hemihydrate (50 micrograms of estradiol per 24 hours) or 7.8 mg estradiol hemihydrate (100 micrograms of estradiol per 24 hours). The patches are meant to be changed weekly. The manufacturer recommends placement on the trunk or buttocks. Inert ingredients are listed as including: Isooctyl acrylate/acrylamide/vinyl acetate copolymer, ethyl oleate, isopropyl myristate, glycerol monolaurate mounted on a polyester release liner and protected with a polyethylene backing film. For more on patch application, delivery dynamics, dose adjustments and other patch concerns, please see the "Troubleshooting patches" section of this website.

Provera contains medroxyprogesterone acetate and comes in 2.5, 5, and 10mg doses (as well as 100, 200, and 400mg tablets that are used for other purposes than menopause). Inert ingredients are listed as: Lactose, Sucrose, Maize Starch, Liquid Paraffin, Talc, Calcium Stearate, Purified Water with the addition of E110 in the 2.5 mg, FD & C Blue No. 2 Aluminium Lake in the 5 mg, and no coloring in the 10mg. MPA is synthesized from progesterone (we don't know whose). It is shown to be effective in reducing hot flashes and decreasing the rate of bone loss. It is less likely to cause your HDL (good) cholesterol to drop than other progestins. It also has an anti-testosterone effect and can decrease libido. As with the estrogen/Premarin linking problem, some doctors hear only "Provera" when you say "progesterone." Provera is one of the hormones involved in the Women's Health Initiative study that was discontinued due to excessive risk and subsequent research is indicating that some of the risks may have been due at least as much to the provera as the premarin.

Sandrena gel is bioidentical estrogen gel for transdermal application. It comes in two dose strengths: 0.5 mg estradiol hemihydrate or 1.0 mg estradiol hemihydrate (the latter dose being designated by the manufacturer as the "usual starting dose"). The gel comes in individual dose packets, with the application instructions that it be "applied once daily on the skin of the lower trunk of the right or left thigh, on alternate days. The application surface should be 1-2 times the size of a hand. Sandrena should not be applied on the breasts, on the face or irritated skin. After application the gel should be allowed to dry for a few minutes and the application site should not be washed within 1 hour. Contact of the gel with eyes should be avoided. Hands should be washed after application. The dose can be divided, but care is needed to do so accurately. Inert ingredients are listed as: Carbomer 974P, Trolamine, Propylene glycol, Ethanol 96%, Aq. purif. - Purified water.

Testim is a form of bioidentical testosterone HRT intended and licensed for men. Nonetheless, the hormone it contains is the same as female-produced testosterone. The problem with preparations developed for the male market is that they contain too much testosterone for a woman's level of needs. Because testosterone causes some of the most serious—and irreversible— effects when taken in excess of need, this isn't to be taken lightly. Testogel comes in 50 mg dose packets, each measuring 5 gm of gel each. That means that for a dose of 1 mg, you would need to divide the dose up in some fashion that would let you use only 1/50 of that packet. So not only do you need to be sure that you are taking a female-appropriate dose, but you need to be able to do some fairly delicate measuring to be sure of getting only the amount you want. It's not impossible, but it's not trivial, either. Don't try to do the math on this alone—have your pharmacist confirm any dose calculations to make sure that both of you are in agreement over where those slippery decimal points belong and exactly how much volume your dose should be measured out as. This is when a syringe rather than a measuring spoon is more or less obligatory. We have a discussion of female-appropriate dose and testosterone balancing elsewhere on this site. The application instructions are pertinent to male use; check with your doctor for female-use customization or, if you think he's just giving you the same ones as in the linked data sheet that are for men, review the material in the testosterone section of our website. Inert ingredients are listed as: Purified water, Pentadecalactone, Carbomer 980, Carbomer 1342, Propylene glycol, Glycerol, Macrogol 1000, Ethanol, Trometamol.

Testogel is a form of bioidentical testosterone HRT intended and licensed for men. Nonetheless, the hormone it contains is the same as female-produced testosterone. The problem with preparations developed for the male market is that they contain too much testosterone for a woman's level of needs. Because testosterone causes some of the most serious—and irreversible— effects when taken in excess of need, this isn't to be taken lightly. Testogel comes in 50 mg dose packets, each measuring 5 gm of gel each. That means that for a dose of 1 mg, you would need to divide the dose up in some fashion that would let you use only 1/50 of that packet. So not only do you need to be sure that you are taking a female-appropriate dose, but you need to be able to do some fairly delicate measuring to be sure of getting only the amount you want. It's not impossible, but it's not trivial, either. Don't try to do the math on this alone—have your pharmacist confirm any dose calculations to make sure that both of you are in agreement over where those slippery decimal points belong and exactly how much volume your dose should be measured out as. This is when a syringe rather than a measuring spoon is more or less obligatory. We have a discussion of female-appropriate dose and testosterone balancing elsewhere on this site. The application instructions are pertinent to male use; check with your doctor for female-use customization or, if you think he's just giving you the same ones as in the linked data sheet that are for men, review the material in the testosterone section of our website. Inert ingredients are listed as: Carbomer 980, Isopropyl myristate, Ethanol 96%, Sodium hydroxide, Purified water.

Testosterone implant is the only testosterone-containing hrt that is actually licensed for use by women in the UK. It contains 100mg of bioidentical testosterone, in compliance with the authorization that menopausal women may receive "implants of testosterone (in a dose of 50–100 mg every 4–8 months) as an adjunct to hormone replacement therapy" (sorry: the original link for that has disappeared and we can't find it again from the US). The implants are to be inserted below the skin in the lower abdomen or buttocks and are intended to release 0.5mg daily over 30 weeks. A 200mg implant is also available and its product literature does seem to indicate approval for women, but its dose falls outside the recommended limits according to the Formulary. It would deliver 1mg daily over its projected 30-week lifespan—a level rather likely to put most women into excess. In any case, implants have specific limitations, not the least of which is their inability to be removed or altered to control the dose; there is more on the benefits and drawbacks of this route elsewhere on this site. The manufacturer's prescribing information sheet specifically states that it contains no inert ingredients (although we have a hard time visualizing how this can be).

Tridestra is a combination of bioidentical estrogen plus synthetic progestin that is given on a quarterly rather than monthly schedule. The recommended dosing is 70 days of 2 mg estradiol valerate, followed by 14 days of 2 mg of estradiol valerate and 20 mg of medroxyprogesterone acetate, followed by seven days of a non-hormonal sugar pill. Cycling HRTs are not required by women who no longer have a uterus, and a cycle that includes a period without any hormonal support is not likely to be especially comfortable for any woman in surgical menopause. Inert ingredients are listed as: Lactose, Maize starch, Gelatine, Purified water, Magnesium stearate, Talc, Indigo carmine (E132), Yellow iron oxide (E172).

Trisequens combines a bioidentical estrogen and synthetic progestin in a three-phase dose schedule: 12 days of Estradiol hemihydrate 2mg, followed by 10 days of Estradiol hemihydrate 2mg plus Norethisterone acetate EP 1mg, followed by 6 days of Estradiol hemihydrate 1mg. Inert ingredients are listed as: Lactose monohydrate, Maize starch, Gelatin, Talc, Magnesium stearate, Hypromellose, Purified water, Indigo carmine (E132), Titanium dioxide (E171), Macrogol 400, Triacetin, Iron oxide (E172), Propylene glycol. Note: some lists also show a higher dose product called Trisequens Forte, but we are no longer able to locate a full description for it.

Vagifem is a bioidentical estrogen tablet for vaginal application. It contains 25 micrograms of estradiol. This is not a systemic hrt but rather is meant to be entirely absorbed locally for treatment of urogenital atrophy, without systemic effect. Nonetheless because some estrogen can escape from local tissues, especially when vaginal atrophy is already present, it may cause a few symptoms of hormonal fluctation early in use and it is not considered safe for use by women who cannot use systemic HRTs. Use of progesterone or a progestin is not required by women who have a uterus and use this product because the dose is so low. The recommended dose schedule is one tablet daily for two weeks followed by a maintenance dose of two tablets per week. The manufacturer suggests that "treatment should be discontinued after about three months to assess whether further therapy is necessary" but in surgical menopause it is unlikely that treatment will be only short term. Dose customization is achieved by altering the frequency of the maintenance dose. Because the dose is low, severe or longstanding atrophy may take more than the two-week period of intensive dosing to respond to treatment. Inert ingredients are listed as: Methyl hydroxypropyl cellulose (E464), Lactose, Maize starch, Magnesium stearate, Polyethylene glycol 6000, Purified water. The data sheet lists no recommendations regarding the use of this product by sexually active women, but wisdom would dictate defering the dose until after intercourse to avoid potential exposure to a partner.

Zumenon is a bioidentical estrogen available in two doses: 1 mg estradiol valerate and 2 mg estradiol hemihydrate. Inert ingredients are listed as: Lactose, Hypromellose, Maize Starch, Colloidal anhydrous silica, magnesium stearate, Hypromellose, Macrogol 400, Titanium dioxide (E171).

Posted by Framboise Surmeno at 2:22 PM
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