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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 October 2023. 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 *

pdfAMS Guide to MHT/HRT Doses Australia

Cyclic Menopausal Hormone Therapy (MHT)

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

Low Dose

   

Product

Presentation

Composition

Femoston

tablet

1mg oestradiol/10mg dydrogesterone

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

Medium dose

   

Trisequens*

tablet

1 and 2mg oestradiol hemihydrate/1mg norethisterone

Femoston

tablet

2mg oestradiol/10mg dydrogesterone

Estalis sequi 50/140)

transdermal patch

50mcg 17β oestradiol/140mcg norethisterone acetate (twice weekly application)

Estalis sequi 50/250
(same oestrogen, more progestogen than Estalis sequi 50/140)

transdermal patch

50mcg 17β oestradiol/250mcg norethisterone acetate (twice weekly application)

Estrogel Pro*

Combination pack of oestradiol transdermal gel, with micronised progesterone capsules.

2 pumps (1.5mg oestradiol hemihydrate) 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

Low dose

   

Product

Presentation

Composition

Angeliq1/2*

tablet

1mg oestradiol hemihydrate/2mg drospirenone

Femoston-conti

tablet

1mg oestradiol/5mg dydrogesterone

Kliovance*

tablet

1mg oestradiol hemihydrate/0.5mg norethistrone

Bijuva*

capsule

1mg oestradiol/100mg micronised progesterone

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^

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 hemihydrate/1mg norethistrone

Estalis continuous 50/140

transdermal patch

50mcg 17β oestradiol/140mcg norethisterone acetate (twice weekly application)

Estalis continuous 50/250 (same oestrogen, more progestogen than Estalis continuous 50/140)

transdermal patch

50mcg 17β oestradiol/250mcg norethisterone acetate (twice weekly application)

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^

^Can be given daily if adherence is an issue 

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 oestrogens

Climara 25

transdermal patch

25mcg oestradiol (weekly application)

Estradot 25 or 37.5

transdermal patch

25 or 37.5mcg oestradiol (twice weekly application)

Estraderm 25 MX

transdermal patch

25mcg oestradiol (twice weekly application)

Estrogel*

gel

0.75mg oestradiol hemihydrate= 1 pump daily

Medium dose

   

Estrofem*, Zumenon

tablet

2mg oestradiol hemihydrate

Progynova

tablet

2mg oestradiol

Premarin*

tablet

0.625mg conjugated equine oestrogens

Climara 50

transdermal patch

50mcg oestradiol (weekly application)

Estradot 50, Estraderm 50 MX

transdermal patch

50mcg oestradiol (twice weekly application)

Sandrena

gel

1mg oestradiol daily

Estrogel*

gel

1.5mg oestradiol hemihydrate = 2 pumps daily

High dose

   

Climara 75

transdermal patch

75mcg oestradiol (weekly application)

Estradot 75, Estradot 100

transdermal patch

75 or 100mcg oestradiol (twice weekly application)

Climara 100

transdermal patch

100mcg oestradiol (weekly application)

Estraderm 100 MX

transdermal patch

100mcg oestradiol hemihydrate (twice weekly application)

Estrogel*

gel

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

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

0.5mg oestriol = 1 application

0.5mg oestriol

Vagifem Low

pessary

10mcg oestradiol hemihydrate

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 (1/2 of 5mg tablet)

tablet

2.5mg medroxyprogesterone acetate

Provera 2.5mg tablet*

tablet

2.5mg medroxyprogesterone acetate

Primolut N (1/4 of 5mg tablet)

tablet

1.25 mg norethisterone

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

Mirena*(PBS indication for contraception/menorrhagia)

Intrauterine system

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

Medium dose for use with medium dose oestrogen 2

Product

Presentation

Dose

Primolut N (1/4 of 5mg tablet)

tablet

1.25 mg norethisterone

Provera, Ralovera

tablet

5mg medroxyprogesterone acetate

Prometrium*

capsule

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

Mirena*(PBS indication for  contraception/menorrhagia)

Intrauterine system

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

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

Primolut N (1/2 5mg tablet)

tablet

2.5mg norethisterone

Provera, Ralovera

tablet

10mg medroxyprogesterone acetate

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

Mirena*(PBS indication for contraception/menorrhagia)

Intrauterine system

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

Notes

  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).

 

© Australasian Menopause Society Ltd

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 contains copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. No other reproduction or transmission is permitted in any form or by any information storage and retrieval systems except as permitted under the Copyright Act 1968 or with prior written permission from the copyright owner. ID:ID:2023-10-10

Content Updated October 2023