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July 2024: HRT product recommendations in section 6.4.1
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July 2024: HRT product recommendations in section 6.4.1
Section 6.4.1 Female sex hormones and their modulators has been reviewed and includes the following updates and new HRT products (Devon-wide).
Introductory text includes:
- updated recommendations regarding the need for oestrogen plus progestogen to reflect guidance from the British Menopause Society (BMS) to consider progestogen for women who have had a subtotal hysterectomy (retaining the cervix).
- updated recommendations regarding patients for whom the transdermal route is clinically indicated.
- addition of tables from BMS / FSRH / RCOG joint guidance on the management of unscheduled bleeding on HRT, to support selection of appropriate doses of progestogen for adequate endometrial protection for different doses of oestrogen.
Drug changes:
- Evorel transdermal patches (estradiol), Evorel Conti transdermal patches (estradiol with norethisterone), and Evorel Sequi transdermal patches (estradiol with norethisterone) have been reclassified to green to reflect that they are first choice options when the transdermal route is clinically indicated.
- Estradot transdermal patches (estradiol) have been added as blue (second line transdermal) for use where the transdermal route is clinically indicated but Evorel patches are ineffective, not tolerated, or impractical.
- Oestrogel Pump-Pack 0.06% gel (estradiol) has been added as blue (second line transdermal) for use where the transdermal route is clinically indicated but Evorel patches are ineffective, not tolerated, or impractical.
- Lenzetto 1.53mg/dose transdermal spray (estradiol) has been added as blue (third line transdermal) for use where the transdermal route is clinically indicated but transdermal patches (Evorel or Estradot) and Oestrogel are ineffective, not tolerated, or impractical.
- FemSeven Conti transdermal patches (estradiol with levonorgestrel) have been added as blue (second line) for use where the transdermal route is clinically indicated but Evorel Conti patches are ineffective, not tolerated, or impractical.
- Gepretix 100mg oral capsules (micronised progesterone) have been added as green (first line) as an alternative to Mirena IUD for progestogenic opposition of transdermal oestrogen-only HRT.
- Branded prescribing as Gepretix is recommended as this is 30% cheaper than generic / Utrogestan brand prescribing.
- Medroxyprogesterone acetate 2.5mg, 5mg and 10mg tablets are now classified green (first line) for dysfunctional uterine bleeding, secondary amenorrhoea, and endometriosis, and blue (second line) for progestogenic opposition of HRT.
- Medroxyprogesterone acetate 100mg, 200mg, and 400mg tablets remain amber (specialist input) for use in cancer indications.
- Tibolone 2.5mg tablets are now classified green (first line) for short-term treatment of symptoms of oestrogen deficiency, and blue (second line) for osteoporosis prophylaxis in women at risk of fractures.
- Premarin tablets (conjugated equine oestrogens, CEE) and Premique Low Dose modified-release tablets (CEE with medroxyprogesterone) have been removed from the formulary on the basis of their significantly increased cost in comparison to alternatives.
