Combined oestrogen and progestogen for HRT combination tablets, patches and capsules

About combined HRT

Most hormone replacement therapy (HRT) is a combination of two female hormones, an 'oestrogen' and a 'progestogen'. Oestrogens and progestogens are natural female hormones which are used to treat women's health problems, including menopausal symptoms. Different types of oestrogen and progestogen are used in HRT products.

The oestrogens used include conjugated oestrogens, estradiol, estriol and estrone. The progestogens used include progesterone, medroxyprogesterone, norgestrel, drospirenone, norethisterone, dydrogesterone, and levonorgestrel. You will find the names of the oestrogen and progestogen used in your HRT on the labelling of the package. HRT is available as tablets and as patches to be applied to your skin. There are several brands for each of these types of HRT - all deliver a set dose of oestrogen and progestogen into your bloodstream.

If you have had your uterus removed during surgery (a hysterectomy), then you will only need to take oestrogen HRT. Please see the separate leaflet called Oestrogen HRT for more information about this.

During the menopause, or 'change', your natural female hormone levels begin to fall. HRT replaces these hormones. The oestrogen helps to relieve some of the problems associated with the menopause, such as hot flushes, night sweats and vaginal dryness. The progestogen protects the lining of your womb (uterus). Depending on the preparation you are using, you may take the progestogen daily or for only part of the month.

HRT also protects against osteoporosis, although other treatments are often preferred for this. Osteoporosis weakens your bones, making breaks and fractures more likely.

Before taking HRT containing oestrogen and progestogen

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking HRT it is important that your doctor knows:

• If you have migraine-like headaches.
• If you have any unexplained vaginal bleeding.
• If you have had breast cancer or any lumps in your breast, or if a close family member has had breast cancer.
• If you or a close family member have ever had a blood clot in the legs or lungs.
• If you have a problem with your veins (such as thrombophlebitis).
• If you have too much sugar in your blood (diabetes mellitus), epilepsy, or asthma.
• If you have liver, kidney, or gallbladder problems.
• If you have ever had depression.
• If you have high blood pressure or a heart disorder.
• If you have chest pain (angina) or if you have had a heart attack.
• If during a pregnancy you have had problems such as severe itching and blistering of your skin, yellowing of your skin or the whites of your eyes (jaundice), or any involuntary jerky movements.
• If you have a rare inherited blood disorder known as porphyria.
• If you have ever had an allergic reaction to a medicine.
• If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

How to take combined HRT

• Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack. The leaflet will give you more information about the specific brand of HRT you have been given, and a full list of possible side-effects from taking it.
• If you have been prescribed tablets or capsules: follow the instructions on your pack - it is usual to take one dose every day:
• Some brands may have different coloured tablets to take on certain days; other brands may contain a second tablet for you to take on certain days of the month. If you are unsure what to do, ask your pharmacist for advice.
• Take the dose at the same time of day each day. If you forget to take a dose, read the advice on the manufacturer's leaflet and follow the instructions it gives. You can take the tablets before, during or after your meals.
• If you have been prescribed patches: some patches are applied and left on for a whole week (such as FemSeven®), whereas with others you apply two patches during a week (each is removed after 3-4 days). Make sure you are clear about how often to use the patches you have been prescribed - the instructions for how to use them will be on the label of the pack:
• Apply the patches to clean, dry, unbroken areas of your skin, preferably below your waist. You should not apply the patches near to your breasts. Each time you use a patch, apply it to a different area so that your skin doesn't become irritated.
• There are several different types of patches, so it is a good idea to check that you have the same patches each time you collect a prescription.
• With some patches, you will also be given tablets to take on certain days of the month. Read the instructions carefully and if you are not sure when to start taking the tablets, ask your pharmacist for advice.

Getting the most from your treatment

• Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress. Also, regularly check your breasts for any lumps and go for regular breast screening and cervical smear tests.
• If you are due to have an operation, tell the person carrying out the surgery that you are taking HRT, as you may be advised to stop the treatment for a while if you are likely to be on bed rest.
• There are some risks which are associated with HRT - your doctor will discuss the benefits and risks of the treatment with you before you start. The risks are reduced when small doses of HRT are used for short periods of time. If used for a long time the risk of breast cancer and other complications may increase. Because of this, the decision to continue HRT needs to be made individually and your progress should be reviewed at least once a year. If you have any concerns at any time, make an appointment to discuss them with your doctor.
• Travelling that involves long periods of immobility (more than three hours) can increase the risk of serious side-effects and, in rare cases, may lead to blood clots. Taking appropriate exercise during the journey and possibly wearing elastic hosiery can reduce this risk. If you would like more advice about this, speak with your doctor or pharmacist.
• HRT treatments are not suitable for preventing pregnancy. If you are having menstrual periods (and for 1-2 years afterwards) you could still become pregnant. You should not take the contraceptive pill while you are on HRT - you are advised to use other methods of contraception such as condoms or a cap. Do not use the rhythm method, as your usual menstrual cycle will become less regular during the menopause and make this method unreliable. If you suspect you might be pregnant, stop taking HRT and speak with your doctor as soon as possible.
• If you pay for your prescriptions and your pack contains more than one type of tablet or patch then you may need to pay two prescription charges.
• If you have diabetes you may need to test your blood more frequently, as the HRT may affect the levels of sugar in your blood. Your doctor will be able to advise you about this.
• Before buying any medicines, check with your pharmacist which medicines are safe for you to take alongside HRT.

Can combined HRT cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. These usually improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following side-effects continue or become troublesome.

Stop taking HRT and contact your doctor for advice straightaway if you develop any of the following symptoms:

• Sudden chest pain.
• Sudden breathlessness, or if you cough up blood.
• Swelling or pain in a leg.
• An unusually severe headache.
• Yellowing of your skin or the whites of your eyes (jaundice).

If you experience any other symptoms which you think may be due to this medicine, discuss them with your doctor or pharmacist.

How to store combined HRT

• Keep all medicines out of the reach and sight of children.
• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines