This Information Sheet has been developed as a guideline only to approximately equivalent doses of the different TGA registered MHT/HRT products available in Australia in May 2020. 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-PBS script products are marked with an * .
AMS Guide to Equivalent MHT/HRT Doses Australia115.69 KB
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) 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/1mg norethisterone |
| Femoston | tablet | 2mg oestradiol/10mg dydrogesterone |
| Estalis sequi 50/140) | transdermal patch | 50mcg 17 B oestradiol/140mcg norethisterone acetate (twice weekly application) |
| Estalis sequi 50/250 (same oestrogen, more progestogen than Estalis sequi 50/140) |
transdermal patch | 50mcg 17 B oestradiol/250mcg norethisterone acetate (twice weekly application) |
| 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
| LOW DOSE | ||
| PRODUCT | PRESENTATION | COMPOSITION |
| Angeliq1/2* | tablet | 1mg oestradiol/2mg drospirenone |
| Femoston-conti | tablet | 1mg oestradiol/5mg dydrogesterone |
| Kliovance* | tablet | 1mg oestradiol/0.5mg norethistrone |
| Estrogel Pro* | Combination pack of oestradiol transdermal gel, with micronised progesterone capsules. | 1 pump (0.75mg oestradiol) 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* (oestrogen/SERM combination) | tablet | 0.45mg conjugated equine oestrogens / 20mg bazedoxifene |
| MEDIUM DOSE | ||
| Kliogest* | tablet | 2mg oestradiol/1mg norethistrone |
| Estalis continuous 50/140 | transdermal patch | 50mcg 17 B oestradiol/140mcg norethisterone acetate (twice weekly application) |
| Estalis continuous 50/250 (same oestrogen, more progestogen than Estalis continuous 50/140) |
transdermal patch | 50mcg 17 B oestradiol/250mcg norethisterone acetate (twice weekly application) |
| Estrogel Pro* | Combination pack of oestradiol transdermal gel, with micronised progesterone capsules. | 2 pumps (1.5mg oestradiol) 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 17 B oestradiol |
| Progynova | tablet | 1mg oestradiol valerate |
| Premarin* | tablet | 0.3mg conjugated equine oestrogen |
| Climara 25 | transdermal patch | 25mcg/24hrs 17 B oestradiol (weekly application) |
| Estradot 25 or 37.5 | transdermal patch | 25 or 37.5mcg/24hrs 17B oestradiol (twice weekly application) |
| Estraderm 25 MX | transdermal patch | 25mcg/24hrs 17B oestradiol (twice weekly application) |
| Estrogel* | gel | 0.75mg oestradiol = 1 pump |
| MEDIUM DOSE | ||
| Estrofem*, Zumenon | tablet | 2mg 17B oestradiol |
| Progynova | tablet | 2mg oestradiol valerate |
| Premarin* | tablet | 0.625mg conjugated equine oestrogens |
| Climara 50 | transdermal patch | 50mcg/24hours 17B oestradiol (weekly application) |
| Estradot 50, Estraderm 50 MX |
transdermal patch | 50mcg/24 hours 17B oestradiol (twice weekly application) |
| Sandrena | gel | 1mg oestradiol (daily application) |
| Estrogel* | gel | 1.5mg oestradiol = 2 pumps |
| HIGH DOSE | ||
| Climara 75 | transdermal patch | 75mcg/24hours oestradiol (weekly application) |
| Estradot 75, Estradot 100 | transdermal patch | 75 or 100mcg/24 hours (twice weekly application) |
| Climara 100 | transdermal patch | 100mcg/24hours oestradiol (weekly application) |
| Estraderm 100 MX | transdermal patch | 100mcg/24hours 17B oestradiol (twice weekly application) |
| Estrogel* | gel | 2.25mg oestradiol = 3 pumps or 3.0mg oestradiol = 4 pumps |
| OESTROGEN ONLY VAGINAL THERAPY If prescribing vaginal oestrogen rather than systemic hormone therapy, a progestogen is not required. |
||
| PRODUCT | PRESENTATION | COMPOSITION |
| Ovestin | cream | 1mg/g oestriol |
| Ovestin | pessary | 0.5mg oestriol |
| Vagifem Low | pessary | 10mcg oestradiol |
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 cycle^ or 200mg orally daily for 12 days out of a 28-day cycle |
| Mirena* | device (5 years) | 20mcg/24hrs levonorgestrel |
| (PBS indication for contraception/menorrhagia) |
||
Low dose progestogen-only contraceptive pills (Microlut (30mcg levonorgestrel), and Noriday (350mcg norethisterone) are used by some clinicians in various doses but there is limited data for dosages of these pills required for endometrial protection. 1 mg norethisterone was considered the minimum dose (cyclical or continuous) for adequate endometrial protection in the Cochrane Review (Cochrane Database Syst Rev. 2009 Apr 15;(2):CS000402).
| MEDIUM DOSE for use with medium dose oestrogen | ||
| 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* | device (5 years) | 20mcg/24hrs levonorgestrel |
| (PBS indication for contraception/menorrhagia) |
||
| HIGHER DOSE (for use in cyclical therapy or continuous therapy with high dose oestrogen) | ||
| Primolut N (1/2 5mg tablet) | tablet | 2.5mg norethisterone |
| Provera, Ralovera | tablet | 10mg medroxyprogesterone acetate |
| Prometrium* | capsule | 200mg orally daily for 12 days out of a 28-day cycle. Safe continuous dose unknown due to insufficient data |
^Can be given daily if compliance is an issue
Low dose progestogen-only contraceptive pills (Microlut (30mcg levonorgestrel), and Noriday (350mcg norethisterone) are used by some clinicians in various doses but there is limited data for dosages of these pills required for endometrial protection. 1 mg norethisterone was considered the minimum dose (cyclical or continuous) for adequate endometrial protection in the Cochrane Review (Cochrane Database Syst Rev. 2009 Apr 15;(2):CS000402).
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:2020-02-13
Content Updated May 2020
