Experiences with

Hormone replacement therapy (HRT)

Oestrogen is used as a type of hormone replacement therapy (HRT). The type of oestrogen most commonly used in HRT is known as estradiol.

It's used to treat symptoms of the menopause. It also helps prevent weakening bones (osteoporosis) which is common after the menopause.

Menopause is when your periods stop due to lower hormone levels. It usually affects women between the ages of 45 and 55, but it can happen earlier. It affects anyone who has periods.

The fall in the amount of oestrogen your body produces can cause symptoms including hot flushes, low mood and vaginal dryness or irritation. Taking oestrogen as a form of HRT restores your levels of oestrogen and helps to relieve these symptoms.

Taking oestrogen can thicken your womb lining, which slightly increases the risk of womb cancer. If you still have your womb, you'll need to also take a progestogen medicine to protect your womb, such as Utrogestan (micronised progesterone). Alternatively, you can take a combined medicine that contains both oestrogen and progestogen.

If you've had a hysterectomy to remove your womb you can usually take oestrogen without progestogen.

Oestrogen is only available on prescription. It comes as tablets that you swallow and patches, gels or sprays that you put on your skin.

Brand names include Elleste Solo, Bedol, Progynova and Zumenon tablets, Evorel, Estradot, Estraderm, Femseven and Progynovna patches, Oestrogel and Sandrena gel, and Lenzetto spray.

Currently there are supply shortages of some types of HRT. If the medicine you've been prescribed is not available, a pharmacist or doctor will be able to advise you about using a different brand or type of HRT that is suitable for you.

Who can take oestrogen tablets, patches, gel and spray

If you're approaching the menopause and have symptoms (perimenopause) or have already gone through the menopause (post-menopause) you can usually take oestrogen tablets, patches, gel and spray.

Unless you've had a hysterectomy to remove your womb you'll need to take oestrogen with progestogen.

Who may not be able to take oestrogen tablets, patches, gel and spray

Oestrogen tablets, patches, gel and spray are not suitable for everyone. To make sure they're safe for you, tell a doctor or specialist nurse if you:

• have ever had an allergic reaction to oestrogen or any of the ingredients in the tablet, patch, gel or spray, or to any other medicine
• have ever had breast cancer, are having tests for breast cancer, or are considered high risk due to family history
• have ever had any other type of cancer
• have vaginal bleeding with no known cause
• have ever had a blood clot in a vein (thrombosis), such as in the legs (deep vein thrombosis) or the lungs (pulmonary embolism)
• have thrombophilia, a condition that increases the risk of blood clots
• have ever had angina or a heart attack
• have liver problems
• are pregnant or breastfeeding
• have a rare inherited condition called porphyria
• have diabetes
• have high blood pressure
• have migraines or severe headaches

Dosage and strength

Oestrogen (estradiol) tablets come in strengths of 1mg or 2mg. You take them once a day.

The patches release different amounts of estradiol into your body every 24 hours, depending on the brand.

Your dose of oestrogen depends on your symptoms, your age and any other health conditions you have. You'll usually start on a low dose, and it may be increased later, depending on how well it works and whether you get any side effects.

It may take a few weeks before you notice your symptoms improving, and you may get some side effects at first. It's best to keep taking it for at least 3 months, if possible, to see if it helps.

If your symptoms do not improve, your doctor may suggest changing your dose, or changing the type of HRT you're taking.

How to take tablets

Swallow the tablets with a drink of water. Try to take them at the same time each day.

When you first start taking oestrogen tablets, if you're still having regular periods, start taking the tablets between day 1 and day 5 of your period. Then continue to take them every day.

If your periods have stopped or are infrequent, or if you've had a hysterectomy, you can start taking the tablets at any time.

Always follow the instructions on the leaflet that comes with your medicine.

How to use patches

When you first start using oestrogen patches, if you're still having regular periods, start using the patches between day 1 and day 5 of your period.

If your periods have stopped or are infrequent, or if you've had a hysterectomy, you can start using the patches at any time.

Always follow the instructions on the leaflet that comes with your medicine.

Stick the patch onto an area of skin below your waist, such as on your thigh or buttock. Do not put the patch:

• near your breasts
• on top of cuts, spots or irritated skin
• under elasticated or tight areas of clothing
• on creases or folds in your skin
• on your skin if you have recently used cream, talc or moisturiser
• on skin exposed to direct sunlight

Wait at least 1 hour after putting the patch on before you do any activity or exercise that will make you sweat as this can affect how the patch sticks to your skin.

You'll need to change your patch either once or twice a week, depending on the brand. Check the leaflet that comes with your patches.

Make sure you remove the old patch when you put on a new one. Put the new patch on a different area of skin.

If your patch falls off, put a new patch on a different area of skin, and then change it again at the usual time.

Your patch should stay on while bathing or showering but if it does fall off, dry your skin and cool down before putting on a new one.

How to use gel

Oestrogen gel comes in sachets (for example Sandrena) or in a pump dispenser (for example Oestrogel).

Put the gel on once a day. Try to use it at the same time each day.

Your doctor will tell you how many pumps or sachets to use. Follow the instructions that come with the gel.

1. Wash your hands.
2. Squeeze the right amount of gel onto your hand.
3. Gently rub the gel over a large area of clean, dry skin, on your lower body or arms – check the instructions for where you can use it.
4. Wait up to 5 minutes for the gel to dry before getting dressed.
5. Do not wash the area for at least 1 hour.
6. Wash your hands after putting on the gel.

Do not use the same area of skin 2 days in a row. Do not use the gel on skin near your breasts or genitals.

How to use spray

Oestrogen spray is called by the brand name Lenzetto.

The usual dose is 1 to 3 sprays, once a day, at the same time each day. Your doctor will tell you how many sprays to use.

1. Take off the cover and put the cone flat against your skin, on your inner forearm.
2. Press the button fully down once.
3. If you need to use more than 1 spray, move the cone to a different place on your arm for each spray.
4. Allow up to 2 minutes for the spray to dry before getting dressed.
5. Do not wash the area for at least 1 hour.

How long to take it for

It's common to take HRT for 2 to 5 years to treat menopause symptoms, but sometimes you may need to take it for longer.

If you have premature menopause (premature ovarian insufficiency, or POI), where your periods stop before the age of 40, or early menopause where your periods stop before the age of 45, you'll usually be advised to take HRT at least until you're 51 years old, which is the average age of menopause.

How long you take HRT for depends on the benefits and risks to you. Ask your doctor for advice.

If you forget to take it

If you forget your daily dose of oestrogen tablets, gel or spray, just skip the missed dose and take or use your next dose at the usual time.

If you forget to put on a patch, change your patch as soon as you remember and then change it again on the usual day.

Never take or use 2 doses at the same time. Never take or use an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to help you remember to take your medicine.

If you take or use too much

Taking or using an extra dose of oestrogen is unlikely to harm you.

If you're worried, talk to a doctor or pharmacist for advice.

Stopping oestrogen

Talk to your doctor if you're thinking of stopping your oestrogen. They may suggest that you reduce your dose gradually, to help prevent your menopause symptoms coming back.

If you're having problems with side effects, your doctor might suggest changing your dose, or switching to another type of HRT.

Common side effects

These common side effects of oestrogen tablets, patches, gel and spray happen in more than 1 in 100 people. There are things you can do to help cope with them:

Speak to a pharmacist or doctor if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Serious side effects from oestrogen are rare.

Call a doctor or call 111 for advice now if you have pain, redness or swelling in one of your legs, usually in your calf – this could be a sign of deep vein thrombosis (DVT).

Speak to a GP if you have:

• a lump or changes in your breasts, especially dimpling of the skin, changes in the nipple or any lumps you can see or feel – this could be a sign of breast cancer
• any changes in vaginal bleeding after you have been taking oestrogen for more than a few months – this could be a sign of womb cancer

It's important to attend your breast screening (mammogram) appointments while you're taking HRT.

• you have pain in your chest and breathlessness – this could be a sign of a blood clot in your lungs (pulmonary embolism) or heart problems
• you have difficulty speaking or moving your arm or leg, or your face has dropped on one side – this could be a sign of a stroke

Meds - serious side effects A&E safety messaging

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to oestrogen.

Meds New IA (H4) - serious allergic reaction

These are not all the side effects of oestrogen tablets, patches, gel and spray. For a full list see the leaflet inside your medicines packet.

Oestrogen tablets, patches gel and spray and pregnancy

Oestrogen tablets, patches gel and spray are not known to be harmful in pregnancy, but if you get pregnant while taking HRT then stop taking it and speak to your doctor.

Levels of oestrogen and progesterone are naturally high during pregnancy, so you will not need HRT.

Oestrogen tablets, patches gel and spray and breastfeeding

There is not much information on taking oestrogen for HRT while breastfeeding. Most of the information comes from the use of other types of oestrogen as a contraceptive.

If you're breastfeeding and need to use HRT, oestrogen tablets, patches, gel or spray are not usually prescribed, unless a specialist recommends it.

Oestrogen tablets, patches gel and spray and fertility

Taking oestrogen as HRT is unlikely to affect your fertility.

Oestrogen tablets, patches, gel and spray do not act as a contraceptive.

Even if you think that you've gone through the menopause, unless you've had a hysterectomy there's a small chance that you could become pregnant.

You're advised to use contraception for at least 1 year from your last period if you're over 50 years old and for 2 years if you're under 50 years old. Discuss this with your doctor or family planning practitioner.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

There are some medicines that may affect how oestrogen works.

Tell your doctor or pharmacist if you're taking:

• medicines for epilepsy, such as phenytoin, carbamazepine or phenobarbital
• certain medicines for infections, such as rifampicin, rifabutin, nevirapine, efavirenz, ritonavir or nelfinavir

Mixing oestrogen tablets, patches, gel and spray with herbal remedies and supplements

There are several different herbal products sold to help relieve menopause symptoms. These include evening primrose oil, soya, red clover, black cohosh, ginseng and St John's wort.

All of these products might affect other medicines you're taking, so it's important to check with your doctor or pharmacist before starting to take them.

It's not possible to say that other herbal remedies and supplements are safe to take with oestrogen. They're not tested in the same way as pharmacy or prescription medicines. They're generally not tested for the effect they can have on other medicines.

Meds New IA (H2) - Cautions with other medicines alert

Vaginal oestrogen is a hormone replacement therapy (HRT) medicine that contains the hormone oestrogen. It's used to treat the vaginal dryness and irritation that can happen during the menopause.

Menopause is when your periods stop due to lower hormone levels. It usually affects women between the ages of 45 and 55, but it can happen earlier. It affects anyone who has periods.

The fall in the amount of oestrogen your body produces can cause symptoms. Using vaginal oestrogen can help dryness and irritation but it will not treat other symptoms of the menopause such as hot flushes, mood swings or problems sleeping (insomnia).

Vaginal oestrogen comes as a tablet, pessary, cream, gel or ring that you insert into your vagina. Using oestrogen inside the vagina only is called local HRT.

Usually, if you take or use oestrogen you must also use a progestogen alongside it, to protect your womb. But with vaginal oestrogen, little of the medicine gets into the rest of your body, so you do not need to take progestogen.

If vaginal oestrogen is not enough to treat your symptoms, you can also use a higher dose of HRT.

Vaginal oestrogen is only available on prescription, except the brand Gina (vaginal tablets) which you can buy from a pharmacy.

Other brands of vaginal oestrogen include Vagifem and Vagirux vaginal tablets, Estring vaginal ring, Imvaggis pessaries, Blissel vaginal gel and Ovestin vaginal cream.

Currently there are shortages of some types of HRT. If the medicine you've been prescribed is not available, a pharmacist or doctor will be able to advise you about using a different brand or type of HRT that is suitable for you.

Who can use vaginal oestrogen

If you're approaching the menopause and have symptoms (perimenopause) or have already gone through the menopause (post-menopause) you can usually use vaginal oestrogen.

Who may not be able to use vaginal oestrogen

Vaginal oestrogen is not suitable for everyone. To make sure it's safe for you, tell a doctor or specialist nurse if you:

• have ever had an allergic reaction to oestrogen or any other medicine
• have ever had breast cancer, are having tests for breast cancer, or are at high risk due to family history
• have ever had any other type of cancer
• have vaginal bleeding with no known cause
• have ever had a blood clot in a vein (thrombosis), such as in the legs (deep vein thrombosis) or the lungs (pulmonary embolism)
• have or have recently had a problem caused by blood clots blocking the arteries, such as a heart attack, stroke or angina
• have liver problems
• could be pregnant
• have a rare inherited condition called porphyria
• have diabetes
• have high blood pressure
• have migraines or severe headaches

Dosage

Your dose of vaginal oestrogen depends on the type of medicine you're using:

• vaginal tablets (Gina, Vagifem, Vagirux) – insert 1 tablet a day for 2 weeks, then 1 tablet twice a week
• a vaginal ring (Estring) – insert 1 vaginal ring into the vagina for 3 months
• vaginal gel (Blissel) – insert 1 dose of gel a day for 3 weeks, then 1 dose twice a week
• vaginal pessaries (Imvaggis) – insert 1 pessary a day for 3 weeks, then 1 pessary twice a week
• vaginal cream (Ovestin) – insert 1 dose of cream a day for up to 4 weeks, then you can reduce your dose gradually depending on symptoms

How to use vaginal oestrogen

Using vaginal oestrogen tablets

1. Wash your hands and get yourself into a comfortable position. You can either stand up or lie down.
2. Open the pack and remove the applicator. The tablet should already be inside it.
3. Hold the applicator so one finger can press the applicator plunger.
4. Insert the applicator carefully into your vagina. You can do this either standing up or lying down. Try to insert about half of the applicator and only go as far as you're comfortable with.
5. Press the applicator plunger until you feel it click. This lets you know that the tablet has been released. The tablet will then attach itself to your vaginal wall.
6. Gently remove the applicator and throw it away.

Using vaginal gel

Your gel will come in a tube. It will also come with a plunger and a small, empty tube (cannula) to help you insert the gel.

1. Wash your hands and remove the tube cap. If it's the first time you're using the tube, pierce the seal on the neck of the tube but do not use it if the seal is broken.
2. Insert the plunger into the cannula and screw the end of the cannula onto the neck of the tube.
3. Squeeze the gel into the applicator until it reaches the filling mark. The plunger will stop at that mark.
4. Unscrew the cannula from the tube and replace the cap on the tube.
5. Get into a comfortable position, either standing or lying down, and insert the end of the applicator into your vagina.
6. Push the plunger all the way down.
7. Gently remove the applicator. Throw the cannula away and rinse the plunger with warm and clean water so you can use it again.

Using vaginal pessaries

1. Wash your hands and get yourself into a comfortable position, either standing up or lying down.
2. Remove the pessary from its foil pack.
3. Standing up or lying down, gently insert the pessary as far into your vagina as you can.
4. Wash your hands. If you're using Vagirux, you can use the applicator again. If you're using Vagifem, throw the applicator away.

Using vaginal cream

1. Wash your hands and remove the cap from the tube. If it's the first time you're using the tube, pierce the seal on the neck of the tube but do not use it if the seal is broken.
2. Screw the end of the applicator onto the tube.
3. Squeeze the cream into the applicator to the red ring mark. The plunger will automatically stop at that mark.
4. Get into a comfortable position, either standing up or lying down. Gently insert the applicator into your vagina and push the plunger as far as it will go.
5. Remove the applicator and take the plunger out of it. Wash the applicator and plunger in hot, soapy water so you can use it again.

Using a vaginal ring

1. Wash your hands then find a position you feel comfortable in, either standing up or lying down.
2. With one hand, squeeze the ring into an oval shape and gently push it into your vagina. Do this in the direction of upwards, backwards and towards the small of your back.
3. Wash your hands when you've finished.

You can use your vaginal ring for up to 3 months. After that, you'll need to remove it and replace it with a new one.

If your ring falls out, rinse it in lukewarm water and insert it back into your vagina.

If you're going to have sex, you can either leave the ring in place, or remove it if you find it uncomfortable.

You may notice that the ring shifts when you have a poo. If this happens, you can easily push the ring back into position with your finger. If you're constipated or know you're going to find it difficult to poo, it's best to remove the ring completely and then put it back afterwards.

How long to use it for

You'll usually be recommended to take HRT for between 2 and 5 years to relieve symptoms but you may need to take it for longer, and there is no set limit on how long you can take it.

It's recommended that you speak to your doctor at least once a year, to check whether the benefits of using vaginal oestrogen still outweigh the risks.

If you forget to use it

No matter what form of vaginal oestrogen you use, never insert 2 doses at the same time. Never insert an extra dose to make up for a forgotten one.

If a doctor has advised you to use vaginal oestrogen regularly and you often forget doses, it may help to set an alarm to remind you. You could also ask a pharmacist for advice on other ways to help you remember to use your medicine.

Vaginal tablets and cream

Insert your missed tablet or dose of cream as soon as you remember.

Pessaries

If you forget to insert your pessary during your 3 weeks of daily treatment, skip the missed dose then insert your next pessary at the usual time.

If you forget to insert one of your 2 pessaries during your 1 week of treatment, insert the forgotten dose as soon as possible.

Gel

Insert your missed dose of gel as soon as you remember, unless it's been over 12 hours since your last dose. In this case, wait until the next one.

If you insert too much

Inserting an extra dose of vaginal oestrogen is unlikely to harm you. If you're worried, talk to a doctor or pharmacist for advice.

Common side effects

These common side effects of vaginal oestrogen happen in more than 1 in 100 people. There are things you can do to help cope with them:

Speak to a pharmacist or doctor if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Serious side effects from vaginal oestrogen are rare.

See your doctor if you:

• find a lump or changes in your breasts, especially dimpling of the skin, changes in the nipple or any lumps you can see or feel – this could be a sign of breast cancer
• experience any changes in vaginal bleeding after you have been taking oestrogen for more than a few months – this could be a sign of womb cancer

Call a doctor or call 111 for advice now if you have pain, redness or swelling in one of your legs – this could be a sign of deep vein thrombosis (DVT).

It's important to attend your breast screening (mammogram) appointments while you're taking HRT.

• you get a pain in your chest and breathlessness – this could be a sign of a blood clot in your lungs (pulmonary embolism) or heart problems
• have difficulty speaking, or moving your arm or leg, or your face has dropped on one side – this could be a sign of a stroke

Meds - serious side effects A&E safety messaging

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to vaginal oestrogen.

Meds New IA (H4) - serious allergic reaction

These are not all the side effects of vaginal oestrogen. For a full list, see the leaflet inside your medicines packet.

Vaginal oestrogen and pregnancy

Vaginal oestrogen is not known to be harmful in pregnancy but if you think you might be pregnant, stop using it and talk to your doctor.

Vaginal oestrogen and breastfeeding

There is not much information about using vaginal oestrogen for HRT while breastfeeding. Most information comes from the use of other forms of oestrogen as a contraceptive.

If you're breastfeeding and need to use HRT, vaginal oestrogen is not usually prescribed, unless a specialist recommends it.

Talk to your doctor about non-hormonal preparations which might be more suitable while you're breastfeeding.

Vaginal oestrogen and fertility

Using vaginal oestrogen is unlikely to affect your fertility.

Vaginal oestrogen does not act as a contraceptive.

Even if you think that you've gone through the menopause, there's a small chance that you could become pregnant. You're advised to use contraception for at least 1 year from your last period if you're over 50 years old and for 2 years if you're under 50 years old. Discuss this with your doctor or family planning practitioner.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

It's unlikely that vaginal oestrogen will either affect how well other medicines work or be affected by taking other medicines.

Mixing vaginal oestrogen with herbal remedies and supplements

There are several different herbal products sold to help relieve menopause symptoms. These include evening primrose oil, soya, red clover, black cohosh, ginseng and St John's wort.

All of these products might affect other medicine you're taking, so it's important to check with your doctor or pharmacist before starting to take them.

It's not possible to say that other herbal remedies and supplements are safe to take with vaginal oestrogen. They're not tested in the same way as pharmacy or prescription medicines. They're generally not tested for the effect they can have on other medicines.

Meds New IA (H2) - Cautions with other medicines alert

Continuous combined hormone replacement therapy (HRT) is a medicine used to treat hot flushes, mood swings, vaginal dryness and other symptoms of the menopause.

It can also prevent weakening bones (oesteoporosis) which is common after the menopause.

Menopause is when your periods stop due to lower hormone levels. It usually affects women between the ages of 45 and 55, but it can happen earlier. It affects anyone who has periods.

Your doctor will usually recommended continuous combined HRT if you are post-menopause (you have not had a period for 1 year or more).

It is not suitable if you have menopause symptoms but are still having periods (perimenopause), or within 12 months of your last period, because it may cause irregular bleeding. In these cases your doctor will usually recommend sequential combined HRT instead.

Menopause symptoms are caused by a drop in the levels of oestrogen and progesterone produced in the ovaries. There are different types of oestrogen and progesterone, called oestrogens and progestogens. Combined HRT uses both to raise the levels of these hormones in your body.

It's important to take both oestrogen and progestogen, unless you've had a hysterectomy (surgery to remove your womb). This is because taking oestrogen-based HRT on its own can thicken the womb lining. This slightly increases the risk of womb cancer. Taking progestogen together with oestrogen reduces the risk.

Continuous combined HRT is only available on prescription. It comes as tablets, capsules and patches.

Currently there are supply shortages of some types of HRT. If the medicine you've been prescribed is not available, a pharmacist or doctor will be able to advise you about using a different brand or type of HRT that is suitable for you.

Who can take continuous combined HRT

If you still have a womb and have not had a period for a year (post-menopause) you can usually take continuous combined HRT.

If you've had a hysterectomy to remove your womb, you can usually take oestrogen without progestogen.

Who may not be able to take continuous combined HRT

Continuous combined HRT is not suitable for everyone. To make sure it's safe for you, tell your doctor before taking it if you:

• have ever had an allergic reaction to oestrogen or progestogen, or any other medicine
• have ever had breast cancer, are having tests for breast cancer, or are considered high risk due to family history
• have a type of cancer that is sensitive to oestrogens, such as cancer of the womb lining (endometrium), or if you're having tests for this
• have thickening of the lining of the womb (endometrial hyperplasia) which has not been treated
• have any unexplained vaginal bleeding
• have ever had a blood clot in a vein (thrombosis), such as in your legs (DVT – deep vein thrombosis) or your lungs (pulmonary embolism)
• have problems with your blood which increases the likelihood of developing a blood clot (thrombosis)
• have ever had liver disease and your liver function tests are not back to normal
• have or recently had a condition caused by blood clots in the arteries, such as a heart attack, stroke or angina
• have a rare inherited condition called porphyria
• are pregnant or breastfeeding
• have high blood pressure (hypertension)
• have diabetes
• have an underactive thyroid
• have ever had migraines or severe headaches
• have lupus
• have epilepsy
• have asthma
• are very obese
• have dementia

If you get any of these conditions after you start taking continuous combined HRT, stop taking it and speak to your doctor.

Dosage

Continuous combined HRT tablets and capsules contain an oestrogen called estradiol, and a progestogen. The doses of oestrogen and progestogen in your HRT will depend on the brand.

How to take or use it

How to take continuous combined HRT tablets and capsules

The tablets and capsules include the brands Elleste Duet Conti, Kliofem, Kliovance, Femoston-conti, Indivina and Bijuve.

Take continuous combined HRT tablets or capsules once a day. It's best to take them at the same time each day.

Swallow the tablet or capsule whole with a drink of water. Check your medicine packet to see if you need to take it with food.

Take your tablet or capsule without a break between packs.

How to use continuous combined HRT patches

The patches include the brands Evorel Conti and FemSeven Conti.

Stick the patch onto an area of skin below your waist, such as on your thigh or buttocks. Do not put the patch:

• near your breasts
• on top of cuts, spots or irritated skin
• under elasticated or tight areas of clothing
• on creases or folds in your skin
• on your skin if you have recently used cream, talc or moisturiser
• on skin exposed to direct sunlight

Wait at least 1 hour after putting the patch on before you try any activity or exercise that will make you sweat as this can affect how the patch sticks to your skin.

Change the patch once or twice a week (depending on the brand you use). Try to do this on the same day or days every week. This may mean that 1 patch is on for 3 days and the next patch for 4 days. For example, if you put on a patch on a Monday, change it on Thursday, and again on the following Monday.

Your patch should stay on while bathing or showering but if it does fall off, dry your skin and cool down before putting on a new one.

If your patch falls off or you need to replace it during the week, put the new patch in a different place.

Changing from another type of HRT

If you're switching to patches from another type of HRT, such as tablets, when to start your patches will depend on which medicine you're switching from.

You can start to use your patches straight away if:

• your periods have stopped and you have not been taking HRT
• you're switching from another type of continuous combined HRT

If you have been using sequential combined HRT (taking your progestogen only on some days, and having a break), wait until the end of the cycle of your current medicine before using your new patches.

How long to take it for

It's common to take HRT for between 2 and 5 years to treat menopause symptoms, but sometimes you may need to take it for longer. Talk to your GP about how long they recommend you take the treatment.

How long you take HRT for depends on the benefits and risks to you. Ask your doctor for advice.

If you have premature menopause (where your periods stop before the age of 40) or early menopause (where your periods stop before the age of 45), you'll usually be advised to take HRT at least until you're 51, which is the average age of menopause.

If you have a hysterectomy to remove your womb, you'll need to stop taking combined HRT. You may be able to take oestrogen-only HRT instead.

If you forget to take it

If you forget to take your continuous combined HRT tablet or capsule, take it as soon as you remember, unless it's less than 12 hours until your next dose. In this case, skip the forgotten dose and take the next dose at the usual time. You may have some vaginal bleeding or spotting.

Do not take 2 doses to make up for a missed dose.

If you forget to change your HRT patch, change it as soon as you remember and apply the next one at the usual time. If it's almost time for the next patch, skip the missed one and then change the patch on the usual day. You may have some vaginal bleeding or spotting.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicines.

If you take too much

Taking an extra dose of continuous combined HRT is unlikely to harm you. If you're worried, talk to a doctor or pharmacist for advice.

Stopping continuous combined HRT

Talk to your doctor if you're thinking of stopping taking continuous combined HRT. They may suggest that you reduce your dose gradually, to help prevent your menopause symptoms coming back.

If you're having problems with side effects, your doctor might suggest changing your dose, or switching to another type of HRT.

Common side effects

There are things you can do to help cope with these common side effects of continuous combined HRT:

Speak to a pharmacist or doctor if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Serious side effects from continuous combined HRT are rare.

Call a doctor or call 111 for advice now if you have pain, redness or swelling in one of your legs, usually in your calf – this could be a sign of deep vein thrombosis (DVT).

Speak to your doctor if you have:

• a lump or changes in your breasts, especially dimpling of the skin, changes in the nipple or any lumps you can see or feel – this could be a sign of breast cancer
• any changes in vaginal bleeding after you have been taking HRT for more than a few months – this could be a sign of womb cancer

It's important to attend your breast screening (mammogram) appointments while you're taking HRT.

• you have pain in your chest and breathlessness – this could be a sign of a blood clot in your lungs (pulmonary embolism) or heart problems
• you have difficulty speaking or moving your arm or leg, or your face has dropped on one side – this could be a sign of a stroke

Meds - serious side effects A&E safety messaging

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to continuous combined HRT.

Meds New IA (H4) - serious allergic reaction

These are not all the side effects of continuous combined HRT. For a full list see the leaflet inside your medicines packet.

Continuous combined HRT and pregnancy

Continuous combined HRT is not known to be harmful in pregnancy, but if you think you might be pregnant, stop taking it and speak to your doctor.

Levels of oestrogen and progesterone are naturally high during pregnancy and HRT is not needed.

Continuous combined HRT and breastfeeding

Most of the information about taking oestrogen and progestogen while breastfeeding comes from research into the combined contraceptive pill. The combined contraceptive pill uses different types of oestrogen. There is no information about taking combined HRT while breastfeeding.

If you are breastfeeding, combined HRT is not usually prescribed, unless a specialist recommends it.

Continuous combined HRT and fertility

Taking continuous combined HRT is unlikely to affect your fertility.

Although continuous combined HRT contains progesterone it does not act as contraception.

Even if you think that you have gone through the menopause, there's a small chance that you could become pregnant. You are advised to use contraception for at least 1 year from your last period if you are over 50 and for 2 years if you are under 50. Discuss this with your doctor or family planning practitioner.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

There are some medicines that may affect how continuous combined HRT tablets and capsules work because they can sometimes cause irregular bleeding. HRT can also affect how some medicines work by making them less effective. For example, some HRT can cause epilepsy to be less well controlled.

Tell your doctor or pharmacist if you're taking any other medicines, including:

• epilepsy medicines
• some antibiotics
• medicines for tuberculosis
• medicines for HIV

HRT skin patches are less likely to be affected by other medicines.

Mixing continuous combined HRT with herbal remedies and supplements

St John's wort may stop HRT tablets and capsules from working as well. HRT patches will be less affected by this.

It's not possible to say that other herbal remedies and supplements are safe to take with HRT. They're not tested in the same way as pharmacy or prescription medicines. They're generally not tested for the effect they can have on other medicines.

Any herbal product may affect other medicines you're taking, so it's important to check with your doctor or pharmacist before starting to take them.

Meds New IA (H2) - Cautions with other medicines alert

Sequential combined hormone replacement therapy (HRT) is a medicine that contains the hormones oestrogen and progestogen. It's used to treat menopause symptoms.

Menopause is when your periods stop due to lower hormone levels. It usually affects women between the ages of 45 and 55, but it can happen earlier. It affects anyone who has periods.

As you reach the menopause your ovaries gradually begin to produce less oestrogen and progestogen. This can cause symptoms such as hot flushes, mood swings and vaginal dryness.

Taking HRT can help these symptoms and help prevent other conditions such as weakening of the bones (osteoporosis), which is common after the menopause.

A doctor will usually recommend sequential combined HRT if you have menopause symptoms but you're still having periods, or your last period was less than 12 months ago.

Sequential combined HRT involves taking oestrogen every day and taking progestogen for 10 to 14 days of each 28-day cycle. You'll usually have withdrawal bleeding at the end of each course of progestogen.

This is different to continuous combined HRT, where you take both oestrogen and progestogen every day with no monthly bleeding. Continuous combined HRT is usually prescribed after you have not had a period for 1 year or more.

You'll need to take combined HRT if you still have a womb. This is because taking oestrogen on its own can thicken the womb lining, which slightly increases the risk of womb cancer. Taking progestogen together with oestrogen reduces the risk.

Sequential combined HRT is only available on prescription. It comes as tablets or skin patches.

Brands include Elleste Duet, Clinorette, Femoston, Novofem, Tridesta and Trisequens tablets, and Evorel Sequi and FemSeven Sequi patches.

Currently there are supply shortages of some types of HRT. If the medicine you've been prescribed is not available, a pharmacist or doctor will be able to advise you about using a different brand or type of HRT that is suitable for you.

Who can take sequential combined HRT

If you're still having periods (perimenopausal) or had your last period less than 1 year ago you can usually take sequential combined HRT.

Sequential combined HRT is not suitable if you've had a hysterectomy to remove your womb.

Who may not be able to take sequential combined HRT

Sequential combined HRT is not suitable for everyone. To make sure it's safe for you, tell your doctor before taking it if you:

• have ever had an allergic reaction to any medicine containing oestrogen or progestogen, or anything contained in the patches or tablets
• have ever had breast cancer, are having tests for breast cancer, or are at high risk due to family history
• have a type of cancer that is sensitive to oestrogens, such as cancer of the womb lining (endometrium), if you're having tests for this, or if you're at high risk of getting it
• have vaginal bleeding with no known cause
• have ever had a blood clot in a vein (thrombosis), such as in the legs (deep vein thrombosis) or the lungs (pulmonary embolism)
• have problems with your blood which may cause a blood clot
• have a rare inherited condition called porphyria
• have or have recently had a problem caused by blood clots blocking the arteries, such as a heart attack, stroke or angina
• have thickening of the lining of the womb (endometrial hyperplasia) that has not been treated, or fibroids or endometriosis
• have ever had a problem with your liver
• have high blood pressure
• have diabetes
• have an underactive thyroid
• have ever had migraines or severe headaches
• have lupus
• have epilepsy
• have asthma
• are living with obesity
• have dementia

If you get any of these conditions after you start taking sequential combined HRT, stop taking it and speak to your doctor.

Dosage

Sequential combined HRT is taken in 28-day cycles. This means that you take oestrogen every day, but you only take it with progestogen for 10 to 14 days of your cycle. You then repeat the cycle without a break.

You'll usually have withdrawal bleeding at the end of each course of progestogen.

The tablets and patches come in different strengths. Your doctor will prescribe the right dose for you, depending on your symptoms, your age and any other health conditions you have.

Changes to your dose

You'll usually start on a low dose, and it may be increased later, depending on how well it works and whether you get any side effects.

If you're having side effects from taking HRT and think you may need to change your dose, speak to your doctor.

How to take it

How to take sequential combined HRT tablets

You take sequential combined HRT tablets every day without a break.

Try to take them at around the same time each day.

You can take them with or without food.

Each pack contains 2 or 3 different types of tablets, in different colours. It's important to follow the instructions on the pack and in the leaflet to make sure you take them on the correct days.

How to use sequential combined HRT patches

You put sequential combined HRT patches on your skin, and change them once or twice a week, depending on which type of patch you have.

Each pack contains 2 different types of patch, containing either oestrogen only, or oestrogen and progestogen. It's important to follow the instructions on the pack and in the leaflet to make sure you use the patches on the correct days.

Put the patch on skin below your waist, such as your buttocks, hips or thighs. Do not put them near your breasts.

Put them on skin that is clean, dry and healthy.

Each time you change your patch, put the new one in a different place below your waist.

You can leave the patch on while you have a bath or shower. If it falls off, wait until your skin has cooled down, then put on another patch. If a patch falls off early for any other reason, put a new patch on straight away. Then continue to change the patches on the usual day.

How long to take or use it for

It's common to take or use HRT for between 2 and 5 years to treat menopause symptoms, but sometimes you may need to take it for longer. How long you take it for depends on the benefits and risks to you. Ask your doctor for advice.

If you have premature menopause (where your periods stop before the age of 40) or early menopause (where your periods stop before the age of 45), you'll usually be advised to take HRT at least until you're 51 years old. This is the average age of menopause.

If you have a hysterectomy to remove your womb, you'll need to stop taking combined HRT. You may be able to take oestrogen-only HRT instead.

If you forget to take or use it

If you forget to take your sequential combined HRT tablet, take it as soon as you remember, unless it's less than 12 hours until your next dose. In this case, skip the forgotten dose and take the next dose at the usual time. You may have some vaginal bleeding or spotting.

Do not take 2 doses to make up for a missed dose.

If you're using patches and forget to change it, change it as soon as you remember and then change it again on the usual day. If it's almost time for the next patch, skip the missed one, and then change the patch on the usual day. You may have some vaginal bleeding or spotting.

If you take too much

Taking an extra dose of HRT is unlikely to harm you.

If you take too many tablets, you may feel sick or be sick.

If you're worried, or have any unusual symptoms after taking too much HRT, talk to a doctor or pharmacist for advice.

Stopping sequential combined HRT

Talk to your doctor if you're thinking of stopping taking sequential combined HRT. They may suggest you reduce your dose gradually, to help prevent your menopause symptoms coming back.

If you're having problems with side effects, your doctor might suggest changing your dose, or switching to another type of HRT.

Common side effects

There are things you can do to cope with these common side effects of sequential combined HRT:

Speak to a pharmacist or doctor if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Serious side effects from sequential combined HRT are rare.

Call a doctor or call 111 for advice now if you have pain, redness or swelling in one of your legs, usually in your calf – this could be a sign of deep vein thrombosis (DVT).

Speak to your doctor if you have:

• a lump or changes in your breasts – especially dimpling of the skin, changes in the nipple or any lumps you can see or feel – this could be a sign of breast cancer
• any changes in vaginal bleeding after you have been taking HRT for more than a few months – this could be a sign of womb cancer

It's important to attend your breast screening (mammogram) appointments while you're taking HRT.

• you have pain in your chest and breathlessness – this could be a sign of a blood clot in your lungs (pulmonary embolism) or heart problems
• you have difficulty speaking or moving your arm, or or your face has dropped on one side – this could be a sign of a stroke

Meds - serious side effects A&E safety messaging

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to sequential combined HRT.

Meds New IA (H4) - serious allergic reaction

These are not all the side effects of sequential combined HRT. For a full list see the leaflet inside your medicine's packet.

Sequential combined HRT and pregnancy

Do not take sequential combined HRT if you're pregnant or might become pregnant.

It is not known to be harmful in pregnancy, but if you think you might be pregnant, stop taking it and speak to your doctor.

If you're pregnant then your levels of oestrogen and progesterone will be high and you will not need to take HRT.

Sequential combined HRT and breastfeeding

Most of the information about taking oestrogen and progestogen while breastfeeding comes from research into the combined contraceptive pill. The combined contraceptive pill uses different types of oestrogen and sometimes different types of progesterone.

There is no information about taking sequential combined HRT while breastfeeding.

If you're breastfeeding, sequential combined HRT is not usually prescribed, unless a specialist recommends it.

Sequential combined HRT and fertility

Sequential combined HRT does not affect your fertility.

There's a chance that you could become pregnant while taking HRT as it does not act as contraception.

Even if you think that you've gone through the menopause, there's a small chance that you could become pregnant. You're advised to use contraception for at least 1 year from your last period if you're over 50 years old and for 2 years if you're under 50 years old. Discuss this with your doctor or family planning practitioner.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

There are some medicines that may affect how your HRT works because they can sometimes cause irregular bleeding.

Tell your doctor or pharmacist if you're taking any other medicines, including:

• epilepsy medicines
• some antibiotics
• medicines for tuberculosis
• medicines for HIV

Mixing sequential combined HRT with herbal remedies and supplements

There are several different herbal products sold to help relieve menopause symptoms. These include evening primrose oil, soya, red clover, black cohosh, ginseng and St John's wort.

Herbal remedies containing St John's wort may affect the way your HRT works and make it less effective.

It's not possible to say that other herbal remedies and supplements are safe to take with HRT. They're not tested in the same way as pharmacy or prescription medicines. They're generally not tested for the effect they can have on other medicines.

Any herbal product may affect other medicines you're taking, so it's important to check with your doctor or pharmacist before starting to take them.

Meds New IA (H2) - Cautions with other medicines alert

Tibolone is a type of hormone replacement therapy (HRT) that contains a synthetic (artificial) hormone. Your body breaks down tibolone to make substances that work in a similar way to the hormones oestrogen, progesterone and testosterone.

Tibolone helps to improve menopause symptoms, such as hot flushes, low mood and vaginal dryness or irritation.

Menopause is when your periods stop due to lower hormone levels. It usually affects women between the ages of 45 and 55, but it can happen earlier. It affects anyone who has periods.

Your hormone levels also fall if you have surgery to remove your ovaries, or if you take medicines called gonadorelin analogues, such as leuprorelin for endometriosis.

Tibolone helps restore your hormone levels.

It can also be prescribed to help stop your bones getting thinner after the menopause (osteoporosis).

Tibolone works in a similar way to taking combined HRT containing oestrogen and progestogen. Some studies have suggested it may not be as effective as combined HRT as it may not increase your oestrogen levels as much.

It's only suitable if you had your last period more than a year ago (post-menopause). However, if you've had surgery to remove your ovaries or you're taking gonadorelin analogues you can start taking it straight away.

Tibolone is only available on prescription. It comes as tablets.

Who can take tibolone

You can usually take tibolone if you:

• have menopause symptoms and had your last period more than 1 year ago
• had your last period more than 1 year ago and are at high risk of fractures, and cannot take other medicines for preventing osteoporosis
• have had menopause caused by surgery to remove your ovaries
• are taking medicines called gonadorelin analogues for endometriosis

Who may not be able to take tibolone

Tibolone is not suitable for everyone. To make sure it's safe for you, tell your doctor if you:

• have ever had an allergic reaction to tibolone or any other medicine
• have ever had breast cancer, are having tests for breast cancer, or are considered high risk due to family history
• have a type of cancer that is sensitive to oestrogens, such as cancer of the womb lining (endometrium), or if you're having tests for this
• have any unexplained vaginal bleeding
• have too much thickening of the womb lining (endometrial hyperplasia) that is not being treated
• have ever had a blood clot in a vein (thrombosis), such as in your legs (deep vein thrombosis) or your lungs (pulmonary embolism)
• have a condition that affects how your blood clots, such as protein C, protein S, or antithrombin deficiency
• have or recently had a condition caused by blood clots in the arteries, such as a heart attack, stroke or angina
• have ever had liver disease and your liver function tests are not back to normal
• have a rare inherited condition called porphyria
• have a rare inherited problem of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption
• are pregnant or breastfeeding

Dosage

The usual dose of tibolone is one 2.5mg tablet, taken once a day.

How to take it

Swallow your tablet whole with a drink of water. Do not chew or crush it.

It's best to take it at the same time each day.

You can take it before or after food.

How long to take it for

How long you take tibolone for depends on your symptoms. It's common to take it for 2 to 5 years to treat menopause symptoms, but sometimes you may need to take it for longer.

How long you take HRT for depends on the benefits and risks to you. Ask your doctor for advice.

If you forget to take it

If you forget to take your tibolone, take it as soon as you remember, unless it's more than 12 hours since your dose was due. In this case, skip the missed dose and take your next dose at the usual time.

Do not take 2 doses to make up for a missed dose.

Missing your dose can sometimes cause vaginal bleeding or spotting.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicines.

If you take too much

Taking an extra dose of tibolone is unlikely to harm you. If you're worried, talk to a doctor or pharmacist for advice.

Stopping tibolone

Talk to your doctor if you're thinking of stopping taking tibolone. They may suggest that you reduce your dose gradually, to help prevent your menopause symptoms coming back.

If you're having problems with side effects, your doctor might suggest changing your dose, or switching to another type of HRT.

Common side effects

These common side effects of tibolone happen in more than 1 in 100 people. There are things you can do to help cope with them:

Speak to a pharmacist or doctor if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Call a doctor or call 111 straight away if any of these rare but serious side effects happen to you:

• the whites of your eyes turn yellow, or your skin turns yellow, although this may be less obvious on brown or black skin – this could be a sign of liver problems
• you suddenly have a migraine-type headache or severe headache
• you get pain, redness or swelling in one of your legs, usually in your calf – this could be a sign of a blood clot or deep vein thrombosis (DVT)

Speak to a GP if:

• you have a lump or changes in your breasts, especially dimpling of the skin, changes in the nipple or any lumps you can see or feel – this could be a sign of breast cancer
• you get continued vaginal bleeding or any changes in vaginal bleeding after you've been taking tibolone for more than 6 months – this could be a sign of womb cancer

It's important to attend your breast screening (mammogram) appointments while you're taking HRT.

• you have pain in your chest and breathlessness – this could be a sign of a blood clot in your lungs (pulmonary embolism) or heart problems
• you have difficulty speaking or moving your arm or leg, or your face has dropped on one side – this could be a sign of a stroke

Meds - serious side effects A&E safety messaging

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to tibolone.

Meds New IA (H4) - serious allergic reaction

These are not all the side effects of tibolone. For a full list see the leaflet inside your medicines packet.

Tibolone and pregnancy

Tibolone should not be taken during pregnancy.

If you're pregnant, then your levels of oestrogen and progesterone will be high and you will not need to take tibolone.

Although it is not thought that tibolone will harm your baby, there is very little information available on the safety of this medicine in pregnancy.

If you get pregnant while taking tibolone, stop taking the medicine and speak to your doctor or midwife.

Tibolone and breastfeeding

Tibolone should not be taken while breastfeeding.

There is no information about whether taking tibolone while breastfeeding can affect your baby or how much milk you produce. Until we know more, it's best not to take it.

If you do need a medicine, talk to your doctor. They may be able to recommend other medicines to manage your symptoms that are more suitable to take while breastfeeding.

Tibolone and fertility

Tibolone does not act as contraception.

Even if you think that you have gone through the menopause, there's a small chance that you could still get pregnant.

If you're under 50 years old, you're advised to use contraception for at least 2 years after your last period. If you're over 50 years old, you're advised to use contraception for at least 1 year. Discuss this with your doctor or family planning practitioner.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

There are some medicines that may affect how tibolone works.

Tell your doctor or pharmacist if you're taking any of these medicines before you start taking tibolone:

• medicines that help to prevent blood clots, such as warfarin
• medicines for epilepsy, such as phenytoin or carbamazepine
• medicines for tuberculosis, such as rifampicin

Mixing tibolone with herbal remedies and supplements

There are several different herbal products sold to help relieve menopause symptoms. These include evening primrose oil, soya, red clover, black cohosh, ginseng and St John's wort.

St John's wort may stop tibolone from working as well.

It's not possible to say that other herbal remedies and supplements are safe to take with tibolone. They are not tested in the same way as pharmacy or prescription medicines. They're generally not tested for the effect they can have on other medicines.

All of these products might affect other medicines you're taking, so it's important to check with your doctor or pharmacist before starting to take them.

Meds New IA (H2) - Cautions with other medicines alert

Utrogestan (micronised progesterone) is a medicine that contains a hormone called progesterone. Progesterone is a type of progestogen that's identical to the hormone your body produces.

Your ovaries produce progesterone and oestrogen until the menopause, when your periods stop. Menopause usually affects women between the ages of 45 and 55, but it can happen earlier. It affects anyone who has periods.

Progesterone is produced during the second half of your menstrual cycle. As you reach menopause, the amount of progesterone and oestrogen that your body produces falls.

Utrogestan is taken along with oestrogen as part of hormone replacement therapy (HRT) to relieve the menopause symptoms you may have when your body produces less of these hormones. Taking progesterone with oestrogen is known as combined HRT.

Oestrogen-based HRT can thicken the womb lining. This slightly increases the risk of womb cancer. Taking progesterone together with oestrogen reduces this risk.

Progesterone stops the womb lining from getting too thick, and when you stop taking it (usually for a few days each month) this causes the womb lining to be shed, like a period, which helps to protect you from womb cancer.

You'll need to take combined HRT if you still have a womb.

Utrogestan is only available on prescription. It comes as capsules that you swallow.

Utrogestan also comes as vaginal capsules but these are only used as part of fertility treatment (IVF).

Currently there are supply shortages of some types of HRT. If the medicine you've been prescribed is not available, a pharmacist or doctor will be able to advise you about using a different brand or type of HRT that is suitable for you.

Who can take Utrogestan

You can usually can take Utrogestan if you're taking oestrogen and still have a womb.

It's not suitable if you've had a hysterectomy to remove your womb.

Who may not be able to take Utrogestan

Utrogestan is not suitable for everyone. To make sure it's safe for you, tell your doctor before taking it if you:

• have ever had an allergic reaction to Utrogestan or any other medicine
• are allergic (hypersensitive) to soya, peanut, or any of the other ingredients in the capsules
• have ever had breast cancer, are having tests for breast cancer, or are considered high risk due to family history
• have a type of cancer that is sensitive to oestrogens, such as cancer of the womb lining (endometrium), or if you're having tests for this
• have any unexplained vaginal bleeding
• have ever had a blood clot in a vein (thrombosis), such as in the legs (deep vein thrombosis) or the lungs (pulmonary embolism)
• have a condition that affects how your blood clots, such as protein C, protein S, or antithrombin deficiency
• have or recently had a condition caused by blood clots in the arteries, such as a heart attack, stroke or angina
• have ever had liver disease and your liver function tests are not back to normal
• have a rare inherited condition called porphyria
• have bleeding on the brain (cerebral haemorrhage)
• are pregnant or breastfeeding

If you get any of these conditions after you start taking Utrogestan, stop taking it and speak to your doctor.

Dosage

The usual dose of Utrogestan is 2 capsules (200mg) taken once a day, on days 15 to 26 of your 28-day HRT cycle.

You'll usually have vaginal bleeding for a few days each cycle after you stop taking Utrogestan. This is normal.

If you have not had a period for 6 to 12 months or more, your doctor may recommend that you take 1 capsule (100mg) once a day, on days 1 to 25 of your 28-day HRT cycle.

Sometimes, your doctor might advise you to take it every day, if they think it's OK for you not to have a period.

You may have less bleeding, or none at all, if you take Utrogestan on days 1 to 25 of your cycle. If you take it every day you will not usually have any bleeding once your body gets used to the medicine.

How to take it

Take Utrogestan at bedtime, at least 2 hours after food.

Swallow the capsules whole with a drink of water.

You'll also be prescribed an HRT medicine containing oestrogen.

How long to take it for

It's common to take HRT for 2 to 5 years to treat menopause symptoms, but sometimes you may need to take it for longer.

If you have premature menopause (where your periods stop before the age of 40) or early menopause (where your periods stop before the age of 45), you'll usually be advised to take HRT at least until you're 51 years old, which is the average age of menopause.

How long you take HRT for depends on the benefits and risks to you. Ask your doctor for advice.

If you have a hysterectomy to remove your womb, you'll need to stop taking Utrogestan.

If you forget to take it

If you forget to take your Utrogestan, take it as soon as you remember, unless it's nearly time for your next dose. In this case, skip the missed dose and take the next dose at your usual time.

Do not take 2 doses to make up for a missed dose.

It may help to write on the packet or use a calendar to help you remember which days to take Utrogestan.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicines.

If you take too much

Taking an extra dose of Utrogestan is unlikely to harm you. You may feel drowsy, dizzy, sleepy or tired.

If you're worried, talk to a doctor or pharmacist for advice.

Stopping Utrogestan

Talk to your doctor if you're thinking of stopping taking HRT. They may suggest that you reduce your dose gradually, to help prevent your menopause symptoms coming back.

If you're having problems with side effects, your doctor might suggest changing your dose, or switching to another type of HRT.

It's important to keep taking Utrogestan or another type of progestogen if you're taking oestrogen. Taking oestrogen on its own could cause problems with the lining of your womb, such as womb cancer.

Common side effects

There are things you can do to help cope with these common side effects of Utrogestan:

Other possible side effects may include:

Speak to a pharmacist or doctor if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Serious side effects from Utrogestan are rare.

Call a doctor or call 111 for advice now if you have:

• pain, redness or swelling in one of your legs, usually in your calf – this could be a sign of deep vein thrombosis (DVT)
• yellowing of the whites of the eyes, or the skin although this may be less noticeable on brown or black skin – this could be a sign of liver problems

Speak to a GP if:

• you have a lump or changes in your breasts, especially dimpling of the skin, changes in the nipple or any lumps you can see or feel – this could be a sign of breast cancer
• you have any changes in vaginal bleeding after you have been taking Utrogestan for more than a few months – this could be a sign of womb cancer

It's important to attend your breast screening (mammogram) appointments while you're taking HRT.

• you have pain in your chest and breathlessness – this could be a sign of a blood clot in your lungs (pulmonary embolism) or heart problems
• you have difficulty speaking or moving your arm or leg, or your face has dropped on one side – this could be a sign of a stroke

Meds - serious side effects A&E safety messaging

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to Utrogestan.

Meds New IA (H4) - serious allergic reaction

These are not all the side effects of Utrogestan. For a full list see the leaflet inside your medicines packet.

Utrogestan and pregnancy

Utrogestan is not known to be harmful in pregnancy, but if you get pregnant or think you might be pregnant, stop taking it and speak to your doctor.

If you're pregnant, then your levels of oestrogen and progesterone will be high and you will not need to take HRT.

Utrogestan and breastfeeding

There is not much information on taking Utrogestan while breastfeeding. Most of the information comes from other forms of progestogen when used as a contraception.

Utrogestan is not usually prescribed if you're breastfeeding, unless a specialist recommends it.

Utrogestan and fertility

Taking Utrogestan as HRT is unlikely to affect your fertility.

Although Utrogestan contains progesterone it does not act as contraception.

Even if you think that you've gone through the menopause, there's a small chance that you could still get pregnant. You're advised to use contraception for at least 1 year from your last period if you're over 50 years old and for 2 years if you're under 50 years old. Discuss this with your doctor or family planning practitioner.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

There are some medicines that may affect how Utrogestan works.

Tell your doctor or pharmacist if you're taking any other medicines, including:

• epilepsy medicines such as phenytoin or carbamazepine
• ampicillins or tetracyclines, types of antibiotic
• medicines for HIV, such as ritonavir
• medicines for tuberculosis, such as rifampicin
• ciclosporin, an immunosuppressant
• antifungal medicines such as ketoconazole or terbinafine
• spironolactone, a medicine to make you pee more (diuretic)
• medicines for diabetes
• warfarin, a medicine to help prevent blood clots
• diazepam, a medicine for anxiety and seizures or fits
• tizanidine, a medicine for multiple sclerosis

Mixing Utrogestan with herbal remedies and supplements

There are several different herbal products sold to help relieve menopause symptoms. These include evening primrose oil, soya, red clover, black cohosh, ginseng and St John's wort.

St John's wort may stop Utrogestan from working as well.

It's not possible to say that other herbal remedies and supplements are safe to take with Utrogestan. They are not tested in the same way as pharmacy or prescription medicines. They're generally not tested for the effect they can have on other medicines.

All of these products might affect other medicines you're taking, so it's important to check with your doctor or pharmacist before starting to take them.

Meds New IA (H2) - Cautions with other medicines alert

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