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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.

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*


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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