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AMS Guide to MHT/HRT Doses New Zealand only

This Information Sheet has been developed as a guideline only to the different MHT/HRT products available in New Zealand in October 2023. HRT is now referred to as Menopausal Hormone Therapy (MHT). The intention of this sheet is to help physicians change their patients to higher or lower approximate doses of MHT if needing to tailor therapy, or remain within the same approximate dose if needing to change brands of MHT. Private/non Pharmac subsidised script products are marked with an *.

pdfAMS Guide to MHT/HRT Doses NZ148.44 KB

Progestogen

Suggested alternative doses for use with the oestrogen preparations above where fixed dose therapy is not suitable

Low dose for use with low dose oestrogen  

Product

Presentation

Composition

Provera (½ of 5mg tablet)

tablet

2.5mg medroxyprogesterone acetate

Provera 2.5mg tablet*

tablet

2.5mg medroxyprogesterone acetate

Primolut N (¼ of 5mg tablet)

tablet

1.25 mg norethisterone

Utrogestan*

capsule

100mg micronised progesterone orally for 25 days out of a 28-day cycle1 or 200mg orally daily for 12 days out of a 28-day cycle

Mirena*   
(Pharmac indication for menorrhagia/anaemia)
 intrauterine system 52 mg Levonorgestrel (approx 20mcg daily over
5 years)

Medium dose for use with medium dose oestrogen2

Primolut N (¼ of 5mg tablet)

tablet

1.25 mg norethisterone

Provera

tablet

5mg medroxyprogesterone acetate

Utrogestan*

capsule

100mg micronised progesterone orally for 25 days out of a 28-day cycle1 or 200mg orally for 12 days out of a 28-day cycle

Mirena*

(Pharmac indication for menorrhagia/anaemia)

intrauterine system

52 mg Levonorgestrel (approx 20mcg daily over 5 years)

Higher dose (for use in cyclic therapy or continuous therapy with high dose oestrogen)2

Primolut N (1/2 5mg tablet)

tablet

2.5mg norethisterone

Provera

tablet

10mg medroxyprogesterone acetate

Utrogestan* capsule 100mg micronised progesterone orally for 25 days out of a 28-day cycle1 or 200mg orally for 12 days out of a 28-day cycle

Mirena*

(Pharmac indication for menorrhagia/anaemia)

intrauterine system

52 mg Levonorgestrel (approx 20mcg daily over 5 years)

  1. Can be given daily if adherence is an issue
  2. There are insufficient data for the need to increase the dose of micronised progesterone with higher oestrogen doses, or safety of higher doses. Therefore, the current recommendation is 200mg of progesterone for 12 days on a cyclical regimen or 100mg per day on a continuous regimen. This may not be enough in terms of unscheduled bleeding with higher doses of oestrogen.
    Patients commenced on continuous combined MHT should not bleed after the first 6 months of use. If they do bleed, they need investigating. Those using combined cyclic therapy should have a withdrawal bleed around the end of the progestogen phase and if they bleed out of cycle, too long or too heavily, they also need an ultrasound.
    If investigation of unscheduled or out of cycle bleeding discloses no endometrial abnormality, it may be appropriate to increase the dose of progestogen to 200mg daily for women using high dose oestrogen on a continuous regimen and to 300-400mg for 12 days per month for those using high dose oestrogen on a cyclic regimen.
    The use of oestrogen plus progestogen is intended to reduce the risk of endometrial cancer to the level seen in an untreated population and not to zero. Consequently, women and their doctors should be aware of the importance of investigating any postmenopausal bleeding (see AMS Information Sheet Bleeding – perimenopausal, postmenopausal and breakthrough bleeding on MHT/HRT).

Oestrogen only therapy: 

Only use these if patient has had a hysterectomy or in combination with a progestogen or Mirena if intact uterus

Low dose

   

Product

Presentation

Composition

Estrofem*

tablet

1mg oestradiol hemihydrate

Progynova

tablet

1mg oestradiol valerate

Premarin*

tablet

0.3mg conjugated equine oestrogen

Estradot 25

transdermal patch

25 /24hrs oestradiol (twice weekly application)

Climara 25*

transdermal patch

25mcg/24hrs oestradiol (weekly application)

Estrogel*^

gel

0.75mg oestradiol hemihydrate= 1 pump

Medium dose

   

Progynova

tablet

2mg oestradiol valerate

Estradot 50

transdermal patch

50mcg/24 hours oestradiol (twice weekly application)

Premarin*

tablet

0.625mg conjugated equine oestrogens

Sandrena*#

gel

1mg oestradiol (daily application)

Climara 50*

transdermal patch

50mcg/24hours oestradiol (weekly application)

Estrogel*^

gel

1.5mg oestradiol hemihydrate = 2 pumps

High dose

   

Estradot 75

Estradot 100

transdermal patch

75 or 100mcg/24 hours (twice weekly application)

Climara 75*

transdermal patch

75mcg/24hours oestradiol (weekly application)

Climara 100*

transdermal patch

100mcg/24hours oestradiol (weekly application)

Estrogel*^

gel

2.25mg oestradiol hemihydrate = 3 pumps or
3.0mg oestradiol hemihydrate = 4 pumps

Oestradiol implants - No longer available

Oestrogen only vaginal therapy

If prescribing vaginal oestrogen rather than systemic hormone therapy, a progestogen is not required.

Product

Presentation

Composition

Ovestin

Ovestin

cream

pessary

1mg/g oestriol

0.5mg oestriol

# Note Sandrena is only available under Section 29 at online pharmacies.

^Note Estrogel is only available under Section 29 direct from supplier Pharmaco.

Cyclical oestrogen and progestogen combination MHT

Use cyclical oestrogen and progestogen combinations at peri-menopause or if less than 12 months amenorrhoea

Medium dose

   

Trisequens*

tablet

1 and 2mg oestradiol hemihydrate/1mg norethisterone acetate

Continuous oestrogen and progestogen combinations

Should be used if 12 months since LMP or after 12 months cyclical MHT

Low dose

   

Product

Presentation

Composition

Kliovance*

tablet

1mg oestradiol hemihydrate/0.5mg norethistrone acetate

Other Low dose hormonal options

Livial*, Xyvion*

tablet

2.5mg tibolone

Duavive* 

tablet

0.45mg conjugated equine oestrogens / 20mg bazedoxifene acetate

Medium dose

   

Kliogest*

tablet

2mg oestradiol/1mg norethistrone acetate

 

AMS Empowering Menopausal Women

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society. ID:2023-10-20

Content Updated October 2023

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