6.4. Sex hormones
6.4.1. Female sex hormones
6.4.1.1. Oestrogens and HRT
Prescribing Notes:
Transdermal patch containing estradiol. Available in 25, 50, 75 and 100 micrograms/24hour strengths.
Prescribing Notes:
Transdermal patch containing estradiol 50mcg /24 hours and norethisterone acetate 170mcg / 24 hours.
Prescribing Notes:
Combination of Evorel® 50 patches (containing estradiol) and Evorel® Conti patches (estradiol and norethisterone acetate).
Prescribing Notes:
Available as 1mg/10mg and 2mg/10mg strengths. Contains estradiol and dydrogesterone.
Prescribing Notes:
Available as 0.5mg/2.5mg and 1mg/5mg strengths. Contains estradiol and dydrogesterone.
Prescribing Notes:
Used for the short-term treatment of symptoms of oestrogen deficiency. Unsuitable for use in the premenopause (unless being treated with gonadotrophin-releasing hormone analogue) and as (or with) an oral contraceptive. Also unsuitable for use within 12 months of last menstrual period (may cause irregular bleeding).
If transferring from cyclical HRT, start at end of regimen; if transferring from continuous-combined HRT, start at any time.
Prescribing Notes:
Transdermal patch containing estradiol. Available in 25, 37.5, 50, 75 and 100 micrograms/24hour strengths.
Restrictions:
Restricted to patients who fail to tolerate oral or patch preparations.
Prescribing Notes:
Strength: 0.06%
6.4.1.2. Progestogens
Prescribing Notes:
Mirena is the preferred levonorgestrel intra-uterine system for prevention of endometrial hyperplasia during oestrogen replacement therapy.
Prescribe by brand name. Intra-uterine device which releases levonorgestrel (52mg). It is licensed for use for up to 4 years for this indication; please also see Royal College of Obstetricians & Gynaecologists (RCOG) guidance.
For other indications, see section 7.3.2.3.
Prescribing Notes:
The use of medroxyprogesterone tablets for postponing menstruation is off-label, and only for use in patients at higher risk of VTE or where norethisterone is unsuitable. Further guidance is available from the Specialist Pharmacy Service.
Prescribing Notes:
Norethisterone should be avoided in patients at risk of venous thromboembolism.
Prescribing Notes:
As an adjunctive use with oestrogen in post-menopausal women with an intact uterus, as hormone replacement therapy (HRT).
Restrictions:
Use of Lubion® injection is restricted to women who are unable to use or tolerate vaginal preparations.
Prescribing Notes:
Use for luteal support as part of an assisted reproductive technology (ART) treatment program for infertile women is restricted to specialist use only in line with national guidance.
6.4.2. Male sex hormones and antagonists
Restrictions:
All testosterone preparations are restricted to specialist initiation. In addition, testosterone transdermal gel is restricted to use on the recommendation of consultant endocrinologists, urologists and oncologists for patients requiring a transdermal delivery system.