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 *

AMS 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

Can be given daily if adherence is an issue
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).

AMS Empowering Menopausal Women

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Content Updated October 2023