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.
Cyclic MHT Products
There are no manufactured cyclic MHT options available in Canada. To create a cyclic regimen, consider prescribing the following:
Cyclic MHT Regimens | |
Type of Hormone | Dosing Options |
An Estrogen (from Table A below) | Oral = daily Patch = 1-2 x a week (depends on product) Gel = daily |
+ | |
A Progestogen (from Table B below) | Daily: One tablet daily days 1 to 12-14 of the calendar month Progestogen containing IUS |
[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.