This Information Sheet has been developed as a guideline only to the different MHT/HRT products available in New Zealand in October 2023. 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 Pharmac subsidised script products are marked with an *.
AMS Guide to MHT/HRT Doses NZ148.44 KB
Progestogen
Suggested alternative doses for use with the oestrogen preparations above where fixed dose therapy is not suitable
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Low dose for use with low dose oestrogen |
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Product |
Presentation |
Composition |
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Provera (½ of 5mg tablet) |
tablet |
2.5mg medroxyprogesterone acetate |
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Provera 2.5mg tablet* |
tablet |
2.5mg medroxyprogesterone acetate |
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Primolut N (¼ of 5mg tablet) |
tablet |
1.25 mg norethisterone |
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Utrogestan* |
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* (Pharmac indication for menorrhagia/anaemia) |
intrauterine system | 52 mg Levonorgestrel (approx 20mcg daily over 5 years) |
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Medium dose for use with medium dose oestrogen2 |
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Primolut N (¼ of 5mg tablet) |
tablet |
1.25 mg norethisterone |
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Provera |
tablet |
5mg medroxyprogesterone acetate |
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Utrogestan* |
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 |
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Mirena* (Pharmac indication for menorrhagia/anaemia) |
intrauterine system |
52 mg Levonorgestrel (approx 20mcg daily over 5 years) |
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Higher dose (for use in cyclic therapy or continuous therapy with high dose oestrogen)2 |
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Primolut N (1/2 5mg tablet) |
tablet |
2.5mg norethisterone |
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Provera |
tablet |
10mg medroxyprogesterone acetate |
| Utrogestan* | 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 |
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Mirena* (Pharmac indication for menorrhagia/anaemia) |
intrauterine system |
52 mg Levonorgestrel (approx 20mcg daily over 5 years) |
- 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).
Oestrogen only therapy:
Only use these if patient has had a hysterectomy or in combination with a progestogen or Mirena if intact uterus
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Low dose |
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Product |
Presentation |
Composition |
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Estrofem* |
tablet |
1mg oestradiol hemihydrate |
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Progynova |
tablet |
1mg oestradiol valerate |
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Premarin* |
tablet |
0.3mg conjugated equine oestrogen |
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Estradot 25 |
transdermal patch |
25 /24hrs oestradiol (twice weekly application) |
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Climara 25* |
transdermal patch |
25mcg/24hrs oestradiol (weekly application) |
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Estrogel*^ |
gel |
0.75mg oestradiol hemihydrate= 1 pump |
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Medium dose |
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Progynova |
tablet |
2mg oestradiol valerate |
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Estradot 50 |
transdermal patch |
50mcg/24 hours oestradiol (twice weekly application) |
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Premarin* |
tablet |
0.625mg conjugated equine oestrogens |
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Sandrena*# |
gel |
1mg oestradiol (daily application) |
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Climara 50* |
transdermal patch |
50mcg/24hours oestradiol (weekly application) |
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Estrogel*^ |
gel |
1.5mg oestradiol hemihydrate = 2 pumps |
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High dose |
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Estradot 75 Estradot 100 |
transdermal patch |
75 or 100mcg/24 hours (twice weekly application) |
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Climara 75* |
transdermal patch |
75mcg/24hours oestradiol (weekly application) |
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Climara 100* |
transdermal patch |
100mcg/24hours oestradiol (weekly application) |
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Estrogel*^ |
gel |
2.25mg oestradiol hemihydrate = 3 pumps or |
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Oestradiol implants - No longer available |
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Oestrogen only vaginal therapy If prescribing vaginal oestrogen rather than systemic hormone therapy, a progestogen is not required. |
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Product |
Presentation |
Composition |
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Ovestin Ovestin |
cream pessary |
1mg/g oestriol 0.5mg oestriol |
# Note Sandrena is only available under Section 29 at online pharmacies.
^Note Estrogel is only available under Section 29 direct from supplier Pharmaco.
Cyclical oestrogen and progestogen combination MHT
Use cyclical oestrogen and progestogen combinations at peri-menopause or if less than 12 months amenorrhoea
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Medium dose |
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Trisequens* |
tablet |
1 and 2mg oestradiol hemihydrate/1mg norethisterone acetate |
Continuous oestrogen and progestogen combinations
Should be used if 12 months since LMP or after 12 months cyclical MHT
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Low dose |
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Product |
Presentation |
Composition |
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Kliovance* |
tablet |
1mg oestradiol hemihydrate/0.5mg norethistrone acetate |
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Other Low dose hormonal options |
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Livial*, Xyvion* |
tablet |
2.5mg tibolone |
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Duavive* |
tablet |
0.45mg conjugated equine oestrogens / 20mg bazedoxifene acetate |
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Medium dose |
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Kliogest* |
tablet |
2mg oestradiol/1mg norethistrone acetate |
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 may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society. ID:2023-10-20
Content Updated October 2023
