Systemic Hormone Therapies
- 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:
- Estrogen + Progestogen therapies
- Products that do not require an additional Progestogen
- TSEC: Tissue Selective Estrogen Complex – contains Estrogen + SERM
- 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
- Estrogen alone (ET): used for women without a uterus who require MHT
- 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* |
Oral | |
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 | Doses |
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* |
Oral | |
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 | Doses |
Oral | |
Medroxyprogesterone (ProveraⓇ, generic) | 2.5 mg daily (continuous) |
Micronized progesterone (PrometriumⓇ, generic) | 100 mg daily (continuous) |
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.