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Systemic Hormone Therapies

  1. Combined hormone therapies: used for women who require MHT and who require endometrial protection (as unopposed estrogen can cause endometrial hyperplasia or cancer). These include:
    1. Estrogen + Progestogen therapies
    2. Products that do not require an additional Progestogen
      1. TSEC: Tissue Selective Estrogen Complex – contains Estrogen + SERM
      2. STEAR: Selective Tissue Estrogenic Activity Regular – sex steroid with hormonal activity*

*while the STEAR (Tibolone) only contains a single compound (ie. Tibolone), it acts like a combined hormone therapy

  1. Estrogen alone (ET): used for women without a uterus who require MHT
  2. Progestogen: a progestogen without estrogen is sometimes used for perimenopausal women for cycle control. Progestogens may have a small direct benefit for vasomotor symptoms but are much less effective than estrogen-based therapies.

Combined Continuous Products

Estrogen and progestogen products may be combined to create a cyclic OR continuous EPT regimen or you may choose existing daily products which provide for continuous therapy.

Type of Continuous Combined Product

Starting doses*


17β-estradiol + NETA oral (ActivelleⓇ, Activelle LDⓇ)

1 mg E2/0.5 mg NETA daily

0.5 mg E2/0.1 mg NETA daily (LD)

One tablet daily

17β-estradiol + drospirenone oral (AngeliqⓇ)

1 mg E2/1 mg DRSP

One tablet daily

Transdermal Patch

17β-estradiol + NETA patches (EstalisⓇ 140/50; 250/50)

140 mg NETA /50 mg E2

250 mg  NETA/50 mg E2

One patch twice weekly

Custom Combined Regimen

Combine an estrogen (oral or transdermal) from Table A with a progestogen from Table B to create EPT (see tables below)

Estrogen + Progestogen daily, or

Estrogen daily + LNG-IUS (off-label)

Continuous MHT Options: no additional Progestogen


Selective Tissue Estrogenic Activity Regulator (STEAR)

Tibolone (TibellaⓇ)

2.5 mg tablet

One tablet daily

Tissue Selective Estrogen Complex (TSEC)

Conjugated estrogen (0.45 mg) + bazedoxifene (DuaviveⓇ)

0.45 mg CEE + 20 mg BZA

One tablet daily

[A] EstrogenS

Type of Estrogen

Starting dose*


Conjugated estrogen (PremarinⓇ)

0.3 – 0.625 mg daily

17β-estradiol (EstraceⓇ)

0.5 – 1 mg daily

Transdermal Patch

17β-estradiol (EstradotⓇ, OesclimⓇ, generic)

25 – 50 mcg twice weekly

17β-estradiol (ClimaraⓇ)

25 – 50 mcg once weekly

Transdermal Gel

17β-estradiol (EstrogelⓇ)

1 pump = 0.75 mg 17β-estradiol 

1 – 2 pumps daily

17β-estradiol (DivigelⓇ)

0.5 – 1 mg sachet daily

*Starting doses may be higher when treating premature ovarian insufficiency (POI).

[B] ProgestogenS

Type of Progestogen



Medroxyprogesterone (ProveraⓇ, generic)

2.5 mg daily (continuous)
5 mg daily x 12 – 14 days (cyclic)

Micronized progesterone (PrometriumⓇ, generic)

100 mg daily (continuous)
200 mg daily x 12 – 14 days (cyclic)

Norethindrone (NorlutateⓇ)

5 mg daily

Intrauterine System

Levonorgestrel IUS* (MirenaⓇ)

LNG 52 mg releases 20 mcg/day

x 5 years (off-label for MHT)

For a full listing of hormonal products and non-hormonal medication options click here.

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