[Skip to content]

Print this page
.

6.4 Sex hormones

Click here for warning on HRT from the MHRA

6.4.1.1 Oestrogens and HRT

Premarin tablets
Elleste-Solo tablets
Estradiol implants (unlicensed)
Evorel patches applied twice a week (second line preparation)
FemSeven patches applied once a week (second line preparation)
Raloxifene - specialist use only
Tibolone tablets

Note:

Raloxifene is supported by NICE for the treatment and prevention of vertebral fractures in women at increased risk of osteoporosis. It has no effect on menopausal vasomotor symptoms.

 

6.4.1.2 Progestogens

Norethisterone tablets
Medroxyprogesterone Tablets
Progesterone (Cyclogest) pessaries, Utrogestan capsules (unlicensed, used in IVF/ICSI treatment)

Note:

Progestogens may be used to treat dysmenorrhoea and endometriosis. Prophylactic vaginal progesterone is also recommended for women with a history of spontaneous preterm birth or mid‑trimester loss between 16+0 and 34+0 weeks of pregnancy and in whom a transvaginal ultrasound scan has been carried out between 16+0 and 24+0 weeks of pregnancy that reveals a cervical length of less than 25 mm (see nice guideline). Efficacy of progesterone in pre-menstrual syndrome is more controversial. They are relatively ineffective at reducing blood loss in menorrhagia or dysfunctional uterine bleeding (see DUB guidelines).

Progesterone receptor modulators
Ulipristal acetate tablets - GREEN after Consultant/Specialist initiation: for symptomatic fibroids, in accordance with local clinical guideline and an individualised management plan (link).
COMBINED PREPARATIONS
Sequential
Elleste-Duet tablets
Femoston tablets - alternative oral preparation for progesterone sensitive patients
Evorel Sequi patches - note: second line preparation

 

Continuous combined
Premique Low Dose tablets
Femoston Conti tablets - alternative oral preparation for progesterone sensitive patients
Kliofem tablets
Kliovance tablets - low dose
Evorel Conti

Notes:

1. CSM warning - October 1996 The relative risk of venous thromboembolism appears to be two-to-four fold in current users of HRT. There appears to be no evidence of important differences between types of preparations of HRT. The risks are likely to be greater in women with predisposing factors such as personal history of DVT or PE, severe varicose veins, obesity, surgery, trauma or prolonged bed rest. The advice is to review the need for treatment in women with these risk factors, as in some cases the risks of HRT may be expected to outweigh the benefits.

2. Continuous oestrogen alone is suitable for hysterectomised patients; non-hysterectomised women should be given combined oestrogen/progestogen treatment, with cyclical progestogen for 12 to 14 days of the cycle to protect the endometrium from hyperplasia and minimise the risk of endometrial carcinoma. Those given sequential combined oestrogen replacement are likely to experience a withdrawal bleed when starting the new pack. Premarin/Prempak-C should be viewed as first line products. 'Older' progestogens may produce better cycle control.

3. Oestrogen patches for hormone replacement have not been shown to provide a clear advantage in terms of cardiovascular disease or bone loss and are more expensive, but may be preferred by some patients.

4. Topical oestrogen is useful for the short-term treatment of urogenital symptoms, it improves the quality of the vaginal epithelium and increases resistance to infection. Note that it is suitable only for local problems, not for prevention of osteoporosis. The minimum effective amount should be used as systemic absorption occurs. A progestogen should be used if treatment is continued for more than a few weeks in non-hysterectomised women.

5. In younger women with intact uterus requiring oestrogen replacement, the combined oral contraceptive pill is equally effective, considerably cheaper, and has not been shown to be inferior in terms of possible side effects.

6. Vaginal Progesterone suppositories - may be inserted rectally or vaginally.

 

6.4.2 Male sex hormones and antagonists

Testosterone undecanoate (Nebido) injection
Testosterone propionate depot (Sustanon) injection
Testosterone Gel
Mesterolone tablets
Cyproterone acetate tablets
Finasteride tablets - see note
Dutasteride Capsules - see note
Combodart (tamsulosin + dutasteride)

 

Notes:

1. Alpha-blockers remain the drug of first choice for the medical management of benign prostatic hypertrophy (see 7.4.1).

2. Testosterone patches are not included, as the increased cost is not justified by any clinical benefit. Oral testerone preparations are often ineffective and parenteral preparations preferred.

3. Patients with existing meningioma or a history of meningioma must not be prescribed
high-dose (>25 mg per day) cyproterone acetate. This advice does not apply to low-dose
cyproterone acetate products such as co-cyprindiol (Dianette). See the MHRA Drug Safety Update for October 2009.

4. Finasteride has been associated with rare reports of depression and suicidal thoughts (Link to DSU)

5. Dutasteride is reserved for management of patients with severe symptoms related to benign prostate hyperplasia who do not respond to finasteride or intolerant of it.

 

For link to BNF section: 6.4 Sex hormones