AMS Guide to Equivalent MHT/HRT Doses Australia only

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 * .

pdfAMS 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).

AMS Empowering Menopausal Women

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Content Updated May 2020

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