CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Menopause - Management
Which dose should I use?
- The lowest effective dose of hormone replacement therapy should be used for the shortest time possible.
- Oestrogen dose for symptom control:
- Older women may be less tolerant of oestrogen and need to start (and are usually maintained) on a lower dose (e.g. oral estradiol 1 mg, or transdermal estradiol 25–50 micrograms). Younger women may require higher doses (e.g. 2–4 mg estradiol, or transdermal estradiol 100 micrograms) to remain symptom-free. The dose should be tailored to the symptoms since the ingested or applied dose may not be well absorbed.
- Oestrogen dose for osteoporosis:
- The 'standard' bone-conserving doses of oestrogen are considered to be estradiol 2 mg, conjugated equine oestrogens 0.625 mg, or transdermal 50 microgram patch. However, it is now evident that lower doses also conserve bone mass.
- Progestogens for endometrial protection: several different progestogens used in combined hormone replacement therapy provide adequate endometrial protection. See Table 1 for more information.
- Tibolone: the standard dose is 2.5 mg daily.
Clarification / Additional information
Table 1. Accepted doses of progestogen for endometrial protection.
Progestogen type and route | Accepted endometrial protection dosage |
|---|
Cyclical preparations |
Norethisterone oral | 1 mg for last 12–14 days of 28-day cycle |
Norethisterone patch | 170–250 micrograms for last 14 days of a 28-day cycle |
Levonorgestrel oral | 75–250 micrograms for last 12 days of 28-day cycle |
Levonorgestrel patch | 10 micrograms for last 14 days of 28-day cycle |
Norgestrel oral | 150–500 micrograms for last 12 days of 28-day cycle |
Medroxyprogesterone acetate oral | 10 mg for last 14 days of 28-day cycle 20 mg for last 14 days of 3-month cycle |
Dydrogesterone oral | 10–20 mg for last 14 days of 28-day cycle |
Continuous regimens |
Norethisterone oral | 0.5–1 mg |
Norethisterone patch | 170 micrograms |
Levonorgestrel patch | 7 micrograms |
Medroxyprogesterone acetate oral | 2.5–5 mg |
Dydrogesterone | 5 mg |
|
Basis for recommendation
© NHS Institute for Innovation and Improvement