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:
Combination of Evorel® 50 patches (containing estradiol) and Evorel® Conti patches (estradiol and norethisterone acetate).
Prescribing Notes:
Available as 1/10 and 2/10 strengths. Contains estradiol and dydrogesterone.
Prescribing Notes:
Used for the short-term treatment of symptoms of oestrogen deficiency, tibolone is not suitable for use in the pre-menopausal stage or within 12 months of the last menstrual period (unless being treated with gonadotrophin releasing hormone analogues).
Restrictions:
Restricted to patients who fail to tolerate oral or patch preparations.
Prescribing Notes:
Strength: 0.06%
Restrictions:
Restricted to specialist initiation. Restricted to use in patients for whom bisphosphonates are contraindicated or not appropriate.
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 up to 4 years for this indication, please also see Faculty of Sexual and Reproductive Healthcare (FSRH) guidance.
For other indications, see section 7.3.2.3.
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.