21 July 2023
This version of the AMS Guide to MHT/HRT Doses is currently under review. Please check back soon for the updated version.
This Information Sheet has been developed as a guideline only to approximately equivalent doses of the different MHT/HRT products available in New Zealand in March 2022. 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 Equivalent MHT/HRT Doses NZ109.55 KB
Cyclical oestrogen and progestogen combination MHT
Use cyclical oestrogen and progestogen combinations at peri-menopause or if less than 12 months amenorrhoea
| Medium dose | ||
| Product | Presentation | Composition |
| Trisequens* | tablet | 1 and 2mg oestradiol/1mg norethisterone |
Continuous oestrogen and progestogen combinations
Should be used if 12 months since LMP or after 12 months cyclical MHT
| Low dose | ||
| Product | Presentation | Composition |
| Kliovance* | tablet | 1mg oestradiol/0.5mg norethistrone |
| 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 |
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 |
| 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 contraception/menorrhagia) |
device (5 years) | 20mcg/24hrs levonorgestrel |
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 |
| Utrogestan* | capsule | 100mg micronized progesterone orally 25 days out of a 28-day cycle1 or 200mg daily for 12 days of a 28-day cycle |
| Mirena* (Pharmac indication for contraception/menorrhagia) |
device (5 years) | 20mcg/24hrs levonorgestrel |
| 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 |
| Utrogestan* | capsule | 200mg orally daily for 12 days out of a 28-day cycle1. Safe continuous dose unknown due to insufficient data. |
| Mirena* (Pharmac indication for menorrhagia/anaemia) |
device (5 years) |
20mcg/24hrs levonorgestrel |
1Can be used 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).
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 |
| Estradot 25 | transdermal patch | 25 or 37.5mcg/24hrs 17B oestradiol (twice weekly application) |
| Climara 25* | transdermal patch | 25mcg/24hrs 17Β oestradiol (weekly application) |
| Estrogel*^ | gel | 0.75mg oestradiol = 1 pump |
| Medium dose | ||
| Progynova | tablet | 2mg oestradiol valerate |
| Estradot 50 | transdermal patch | 50mcg/24 hours 17B oestradiol (twice weekly application) |
| Premarin* | tablet | 0.625mg conjugated equine oestrogens |
| Sandrena*# | gel | 1mg oestradiol (daily application) |
| Climara 50* | transdermal patch | 50mcg/24hrs 17Β oestradiol (weekly application) |
| Estrogel*^ | gel | 1.5mg oestradiol = 2 pumps |
| High dose | ||
| Estradot 75 Estradot 100 |
transdermal patch | 75 or 100mcg/24 hours (twice weekly application) |
| Climara 75* | transdermal patch | 75mcg/24hrs 17Β oestradiol (weekly application) |
| Climara 100* | transdermal patch | 100mcg/24hrs 17Β oestradiol (weekly application) |
| Estrogel*^ | gel | 2.25mg oestradiol = 3 pumps or 3.0mg oestradiol = 4 pumps |
| Oestradiol implants - No longer available | ||
|
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 |
1mg/g oestriol 0.5mg oestriol |
| Vagifem Low* | pessary | 10mcg oestradiol |
#Note Sandrena is only available under Section 29 at online pharmacies..
^Note Estrogel is only available under Section 29 direct from supplier Pharmaco.
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Content Updated March 2022
