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BNSSG Adult Joint Formulary

6.8 Sex hormone responsive conditions

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First line drugs Second line drugs Specialist drugs Secondary care drugs

Sex hormones

Link to British Menopause Society Tools for Clinicians

Link to Menopause Matters Decision Tree

BNSSG Menopause Guidelines and HRT Prescribing Pathway

6.8.1 Female sex hormone responsive conditions

Norethynodrel Derivatives

Tibolone (TLS Green)

 

Oestrogens

Please note, choice of HRT product may be driven by current stock situation. Please contact your community pharmacist for the most up to date information regarding Out of Stocks.

HRT

 

1st line oral

 

Alternatives

 

Patches (only use if oral not tolerated)

 

Transdermal Gel / Spray

Women with a uterus Sequential preparations

Elleste Duet®

(estradiol & norethisterone)

£2.84

Femoston® 1/10, 2/10

(estradiol & dydrogesterone)

£4.17

Evorel® Sequi

(estradiol & norethisterone)

 

Continuous combined preparations

Kliofem®

(estradiol & norethisterone)

£3.52

Kliovance®

(estradiol & norethisterone)

£4.07

 

 

Femoston®- Conti

(estradiol & dydrogesterone)

£6.29

Bijuve® 

(estradiol & micronised progesterone)

£8.14

Evorel® Conti

(estradiol & norethisterone)

 

FemSeven® Conti

(estradiol & levonorgestrel)

£13.60

 

 

Women without a uterus

Elleste Solo®

(estradiol)

£1.78

 

Evorel®

(estradiol 25, 50, 75, 100micrograms/24 hours)

 

 

FemSeven®

(estradiol 50, 75 & 100micrograms /24hrs)

 

Estradot®

(estradiol 25, 37.5, 50, 75 & 100 micrograms/ 24 hrs)

Oestrogel® gel

(transdermal)

(estradiol)

 

Sandrena® gel

(transdermal)

(estradiol)

£24.80

 

Lenzetto® transdermal spray

(estradiol)

Reserved for patients where transdermal treatment is indicated (e.g. oral HRT contra-indicated, not tolerated or ineffective) and where transdermal patches are inappropriate.

 

Women with uterus

Recommended:

Elleste Duet® (oral) (TLS Green)

(estradiol & norethisterone)

Kliofem® (oral continuous) (TLS Green)

(estradiol & norethisterone)

Kliovance® (oral continuous) (TLS Green)

(estradiol & norethisterone)

Femoston® 1/10, 2/10 tablets (oral) (TLS Green)

(estradiol & dydrogesterone)

Femoston® - Conti (oral continuous) (TLS Green)

(estradiol & dydrogesterone)

Evorel® Conti patch (TLS Green)

(estradiol & norethisterone)

FemSeven® Conti patch (TLS Green)

(estradiol & levonorgestrel)

Evorel® Sequi patch (TLS Green)

(estradiol & norethisterone) 

Bijuve® (TLS Green)

(estradiol / micronised progesterone) - second line treatment option and alternative to Femoston-Conti where first line options have not been tolerated / are not suitable.

 

Women without uterus

Recommended:

Elleste Solo® (oral) (TLS Green)

(estradiol)

Evorel® patch (TLS Green)

(estradiol 25, 50, 75 & 100mcg/24 hrs)

Estradot® patch (TLS Blue)

(Estradiol 25, 37.5, 50, 75 & 100mcg/24 hrs) -second line brand option for patients where Evorel patch reported to lack adhesion, be poorly absorbed or where localised reactions to the glue are reported.

FemSeven® patch (TLS Green)

(estradiol 50, 75 & 100mcg /24hrs)

Sandrena® gel (transdermal) (TLS Green)

(estradiol)

Oestrogel® gel (transdermal) (TLS Green)

(estradiol)

Lenzetto® transdermal spray (TLS Green)

(estradiol)

  • Reserved for patients where transdermal treatment is indicated (e.g. oral HRT contra-indicated, not tolerated or ineffective) and where transdermal patches are inappropriate.

 

Ethinylestradiol

Ethinylestradiol (TLS Green)

 

Progestogens

Medroxyprogesterone (TLS Green)

Norethisterone (TLS Green)

Micronized Progesterone (oral) (TLS Green)

Gepretix® is the preferred brand (most cost effective option)

 

Selective oestrogen receptor modulators

Specific indication:

Raloxifene (TLS Blue)

  • For the treatment and prevention of postmenopausal osteoporosis i.e. where no effect on the endometrium and / or anti-oestrogenic effect on the breast is required

 

Nortestosterone derivatives

Dienogest tablets (TLS Amber Specialist Recommended)

  • For adult female patients with confirmed or suspected endometriosis

 

6.8.2 Anti-oestrogens

Ovulation stimulants

Specific indication:

Clomifene (TLS Blue)

  • Anovulatory infertility

Tamoxifen (TLS Blue)

  • Anovulatory infertility

 

6.8.3 Male sex hormone responsive conditions

Information about testosterone replacement therapy for male patients with hypogonadism is available on the Endocrine System Guidelines page

Testosterone gel (TLS Green)

  • For licensed indications - men only

Testosterone gel (Tostran® 2% gel / Testim® 50mg/5g gel tubes / Testogel® 40.5mg/2.5g gel sachets) (TLS Amber 3 months)

  • Restricted to use for treatment of low libido causing distress in women with optimised HRT and with either early menopause (age 45 and under) or surgical menopause only. Use of testosterone gel for women outside of this indication / cohort is non-formulary.

  • Please note the approved criteria for the initiation of testosterone gel are outlined in the shared care protocol and are as follows:

    • Low libido causing distress and

    • Ongoing symptoms despite optimised oestrogen and progesterone HRT and

    • Either early menopause (45 years and under) or surgical menopause (bilateral oophorectomy) and

    • Free Androgen Index (FAI) < 5%

Testosterone oily injection (Nebido®) (TLS Amber 3 months)

See Nebido Shared Care Protocol

Testosterone oily injection (Sustanon 250®) (TLS Amber 3 months)

See Sustanon Shared Care Protocol

Testosterone implant (TLS Red)

 

6.8.4 Male sex hormone anatagonism

Anti-Androgens

Cyproterone (TLS Red)

  • N.B. Amber for prostate cancer

Finasteride (TLS Green)

Dutasteride (TLS Blue)

  • For patients who are intolerant of finasteride. Alone or in combination with Tamsulosin

 

Anabolic steroids

None

 

6.8.5 Hormone Therapy for Gender Reassignment

Hormone therapy for gender reassignment

NHSE England Circular SSC 1620 Primary Care Responsibilities in Prescribing and Monitoring Hormone Therapy and Transgender and Non-Binary Adults (updated)

GMC guidance for doctors treating trans patients

Local Guidance

Guidance from Gender Identity Clinics (GIC) Clinics

 

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