First line drugs | Second line drugs | Specialist drugs | Secondary care drugs |
Link to British Menopause Society Tools for Clinicians
Link to Menopause Matters Decision Tree
BNSSG Menopause Guidelines and HRT Prescribing Pathway
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
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1st line oral
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Alternatives
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Patches (only use if oral not tolerated)
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Transdermal Gel / Spray |
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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. |
Recommended:
(estradiol & norethisterone)
(estradiol & norethisterone)
(estradiol & norethisterone)
(estradiol & dydrogesterone)
(estradiol & dydrogesterone)
(estradiol & norethisterone)
(estradiol & levonorgestrel)
(estradiol & norethisterone)
(estradiol / micronised progesterone) - second line treatment option and alternative to Femoston-Conti where first line options have not been tolerated / are not suitable.
Recommended:
(estradiol)
(estradiol 25, 50, 75 & 100mcg/24 hrs)
(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.
(estradiol 50, 75 & 100mcg /24hrs)
(estradiol)
(estradiol)
(estradiol)
Gepretix® is the preferred brand (most cost effective option)
Specific indication:
Specific indication:
Information about testosterone replacement therapy for male patients with hypogonadism is available on the Endocrine System Guidelines page
For licensed indications - men only
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%
See Nebido Shared Care Protocol
See Sustanon Shared Care Protocol
N.B. Amber for prostate cancer
For patients who are intolerant of finasteride. Alone or in combination with Tamsulosin
For information: Charing Cross information Hormonal treatment for Trans men
None
GMC guidance for doctors treating trans patients
Tavistock and Portman Clinical Information and guidance for hormone therapy
West of England Specialist Gender Identity Service: For GPs and professionals
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