AMS Guide to MHT/HRT Doses Australia only
This Information Sheet has been developed as a guideline only to MHT/HRT products available in Australia in November 2024. Hormone Replacement Therapy (HRT) is now referred to as Menopausal Hormone Therapy (MHT). The intention of this sheet is to help clinicians 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-PBS script products are marked with an *
AMS Guide to MHT/HRT Doses Australia- PDF currently being updated, Page content updated (16 Dec 2024)
CYCLIC MENOPAUSAL HORMONE THERAPY (MHT)
Use continuous oestrogen and cyclic progestogen combinations at perimenopause or if less than 12 months amenorrhoea
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LOW DOSE |
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PRODUCT |
PRESENTATION |
COMPOSITION |
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Femoston |
Tablet |
1mg oestradiol/10mg dydrogesterone |
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Estrogel Pro* |
Combination pack of oestradiol transdermal gel, with micronised progesterone capsules. |
1 pump (0.75mg oestradiol hemihydrate) daily, and 2 capsules (200mg) micronised progesterone orally for 12 days out of a 28-day cycle |
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Medium dose |
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Trisequens* |
Tablet |
1 and 2mg oestradiol hemihydrate/1mg norethisterone |
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Femoston |
Tablet |
2mg oestradiol/10mg dydrogesterone |
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Estalis sequi 50/140) |
Transdermal patch |
50mcg 17β oestradiol/140mcg norethisterone acetate (twice weekly application) |
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Estalis sequi 50/250 |
Transdermal patch |
50mcg 17β oestradiol/250mcg norethisterone acetate (twice weekly application) |
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Estrogel Pro* |
Combination pack of oestradiol transdermal gel, with micronised progesterone capsules. |
2 pumps (1.5mg oestradiol) daily, and 2 capsules (200mg) micronised progesterone orally for 12 days out of a 28-day cycle |
CONTINUOUS COMBINED MENOPAUSAL HORMONE THERAPY (MHT)
Should be used if 12 months since LMP or after 12 months cyclical MHT
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LOW DOSE |
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PRODUCT |
PRESENTATION |
COMPOSITION |
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Angeliq1/2* |
Tablet |
1mg oestradiol hemihydrate/2mg drospirenone |
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Femoston-conti* |
Tablet |
1mg oestradiol/5mg dydrogesterone |
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Kliovance* |
Tablet |
1mg oestradiol hemihydrate/0.5mg norethistrone |
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Bijuva* |
Capsule |
1mg oestradiol/100mg micronised progesterone |
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Estrogel Pro* |
Combination pack of oestradiol transdermal gel, with micronised progesterone capsules. |
1 pump (0.75mg oestradiol hemihydrate) daily, and 1 capsule (100mg) micronised progesterone orally for 25 days out of a 28-day cycle |
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OTHER LOW DOSE HORMONAL OPTIONS |
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Livial*, Xyvion* |
tablet |
2.5mg tibolone |
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Duavive* (oestrogen/ SERM combination) |
tablet |
0.45mg conjugated equine oestrogens / 20mg bazedoxifene acetate |
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MEDIUM DOSE |
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Kliogest* |
Tablet |
2mg oestradiol hemihydrate/1mg norethistrone |
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Estalis continuous 50/140 |
Transdermal patch |
50mcg 17β oestradiol/140mcg norethisterone acetate (twice weekly application) |
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Estalis continuous 50/250 (same oestrogen, more progestogen than Estalis continuous 50/140) |
Transdermal patch |
50mcg 17β oestradiol/250mcg norethisterone acetate (twice weekly application) |
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Estrogel Pro* |
Combination pack of oestradiol transdermal gel, with micronised progesterone capsules. |
2 pumps (1.5mg oestradiol hemihydrate) daily, and 1 capsule (100mg) micronised progesterone orally for 25 days out of a 28-day cycle |
OESTROGEN ONLY THERAPY:
Only use these if patient has had a hysterectomy or in combination with a progestogen or Mirena if intact uterus
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LOW DOSE |
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PRODUCT |
PRESENTATION |
COMPOSITION |
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Estrofem* |
Tablet |
1mg oestradiol hemihydrate |
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Progynova |
Tablet |
1mg oestradiol valerate |
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Premarin* |
Tablet |
0.3mg conjugated equine oestrogens |
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Estradot 25,37.5 |
Transdermal patch |
25mcg or 75 mcgoestradiol hemihydrate (twice weekly application) |
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Estraderm 25 MX |
Transdermal patch |
25mcg oestradiol hemihydrate (twice weekly application) |
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Estradot 37.5 |
Transdermal patch |
37.5mcg oestradiol hemihydrate (twice weekly application) |
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Estrogel* |
Gel |
0.75mg oestradiol hemihydrate= 1 pump daily |
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Sandrena |
Gel |
0.5mg oestradiol |
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MEDIUM DOSE |
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Estrofem*, Zumenon |
Tablet |
2mg oestradiol hemihydrate |
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Progynova |
Tablet |
2mg oestradiol |
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Premarin* |
Tablet |
0.625mg conjugated equine oestrogens |
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Estradot 50 |
Transdermal patch |
50mcg oestradiol (twice weekly application) |
| Estraderm 50 MX | Transdermal patch | 50mcg oestradiol hemihydrate (twice weekly application) |
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Sandrena |
Gel |
1mg oestradiol daily |
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Estrogel* |
Gel |
1.5mg oestradiol hemihydrate = 2 pumps daily |
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HIGH DOSE |
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Estradot 75, 100 |
Transdermal patch |
75 or 100mcg oestradiol hemihydrate (twice weekly application) |
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Estraderm 75, 100 MX |
Transdermal patch |
75 or 100mcg oestradiol hemihydrate (twice weekly application) |
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Estradot 100, Estraderm 100 MX |
Transdermal patch |
100mcg oestradiol hemihydrate (twice weekly application) |
| Sandrena | Gel | 1.5mg = 1mg + 0.5mg sachets daily |
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Estrogel* |
Gel |
2.25mg oestradiol hemihydrate = 3 pumps daily or 3.0mg oestradiol = 4 pumps daily |
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VAGINAL THERAPY |
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| If prescribing vaginal oestrogen rather than systemic hormone therapy, a progestogen is not required. | ||
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PRODUCT |
PRESENTATION |
COMPOSITION If prescribing vaginal oestrogen rather than systemic hormone therapy, a progestogen is not required. |
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Ovestin Ovestin |
Cream Pessary |
0.5mg oestriol = 1 application 0.5mg oestriol |
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Vagifem Low |
Pessary |
10mcg oestradiol hemihydrate |
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Intrarosa |
Pessary |
6.5 mg daily Dehydroepiandrosterone (DHEA) (Prasterone) |
PROGESTOGEN THERAPY
Suggested alternative doses for use with the oestrogen preparations above where fixed dose therapy is not suitable
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LOW DOSE FOR USE WITH LOW DOSE OESTROGEN |
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PRODUCT |
PRESENTATION |
COMPOSITION |
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Provera (1/2 of 5mg tablet) |
Tablet |
2.5mg medroxyprogesterone acetate |
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Provera 2.5mg tablet* |
Tablet |
2.5mg medroxyprogesterone acetate |
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Primolut N (1/4 of 5mg tablet) |
Tablet |
1.25 mg norethisterone |
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Prometrium* |
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 |
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Mirena*(PBS indication for contraception/menorrhagia) |
Intrauterine system |
Levonorgestrel 52mg (approx. 20mcg daily over 5 years) |
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MEDIUM DOSE FOR USE WITH MEDIUM DOSE OESTROGEN 2 |
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PRODUCT |
PRESENTATION |
DOSE |
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Primolut N (1/4 of 5mg tablet) |
Tablet |
1.25 mg norethisterone |
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Provera, Ralovera |
Tablet |
5mg medroxyprogesterone acetate |
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Prometrium* |
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 |
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Mirena* (PBS indication for contraception/menorrhagia) |
Intrauterine system |
Levonorgestrel 52mg (approx. 20mcg daily over 5 years) |
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HIGHER DOSE (FOR USE IN CYCLICAL THERAPY OR CONTINUOUS THERAPY WITH HIGH DOSE OESTROGEN)2 |
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Primolut N (1/2 5mg tablet) |
Tablet |
2.5mg norethisterone |
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Prometrium* |
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 |
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| Provera, Ralovera | Tablet | 10mg medroxyprogesterone acetate | |
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Mirena* (PBS indication for contraception/menorrhagia) |
Intrauterine system |
Levonorgestrel 52mg (approx. 20mcg daily over 5 years) |
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Notes
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Can be given daily if adherence is an issue
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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 investigating.
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).
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Safe continuous or cyclic dose of micronised progesterone for use with high dose oestrogen (75mcg patch or higher, or high dose oestrogel gels) is unknown due to insufficient data
© Australasian Menopause Society Ltd
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Content Updated 16 December 2024