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Menopause - Management
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Advice about HRT

What issues should I discuss with a woman before starting HRT?

  • The risks and benefits of hormone replacement therapy.
  • The expected duration of treatment:
    • For vasomotor symptoms, most women require 2–3 years of treatment, but some women may need longer. This judgement should be made on a case-by-case basis with regular attempts to discontinue. Symptoms may recur for a short time after stopping HRT.
    • Topical (vaginal) oestrogen may be required long term as symptoms recur once treatment has stopped.
  • Any possible adverse effects such as breast tenderness or enlargement, nausea, headaches.

What advice should I give about the benefits of HRT?

  • Hormone replacement therapy (HRT) is effective for:
    • Treating vasomotor symptoms (e.g. hot flushes and night sweats).
    • Treating urogenital symptoms (e.g. vaginal dryness, dyspareunia as a result of vaginal dryness, recurrent urinary tract infections, and urinary frequency and urgency).
    • Sleep or mood disturbances caused by hot flushes and night sweats.
    • Preventing osteoporosis. HRT is not normally used as a first-line treatment (as the risks outweigh the benefits) except in women with premature ovarian failure.
    • Reducing the risk of colorectal cancer (but HRT is currently not recommended for this use).

In depth

What advice should I give about the possible risks of HRT?

  • There is a small increase in risk for:
    • Ovarian cancer: long-term use of oestrogen-only Hormone replacement therapy (HRT) may slightly increase the risk. Risk decreases after stopping HRT.
    • Venous thromboembolism (deep vein thrombosis or pulmonary embolism): the absolute risk is small and may be lower with transdermal than oral oestrogen.
    • Stroke and dementia: this is mainly found in women over the age of 65 years.

Prescribing HRT

How should I manage women who have had a hysterectomy with HRT?

  • Offer lifestyle advice.
  • Advise the woman about the risks and benefits of oestrogen-based hormone replacement therapy (HRT) and record in the notes.
  • For urogenital symptoms (e.g. vaginal dryness, dyspareunia) offer low-dose vaginal oestrogen (cream, pessary, tablet, or ring) or systemic (oral or transdermal) oestrogen replacement therapy:
    • Vaginal oestrogen may be preferred if the woman does not wish to take, or cannot tolerate systemic oestrogen.
  • For vasomotor symptoms (e.g. hot flushes, night sweats), with or without urogenital symptoms, offer systemic (oral, or transdermal) unopposed oestrogen replacement therapy.
  • Decreased libido: seek specialist advice if considering testosterone patches or implants.

In depth

Are there any specific issues I should consider in a woman who has had a subtotal hysterectomy?

  • A remnant of endometrial tissue may be present in women who have had a subtotal hysterectomy (in which the main part of the uterus is removed but the cervix is retained).
  • To test for the presence of endometrial tissue, prescribe a 3-month course of cyclical hormone replacement therapy (HRT):
    • If withdrawal bleeding occurs, endometrial tissue is present, and combined HRT should be started.
    • If the woman does not have withdrawal bleeding, endometrial tissue is unlikely to be present, and oestrogen-only HRT may be started.

In depth

What follow up is required?

  • Review 3 months after starting hormone replacement therapy (HRT) and once each year thereafter.
  • At 3-months:
    • Check blood pressure, body weight, and assess the effectiveness of treatment; adjust HRT to achieve symptom control.
    • Enquire about any adverse effects and manage appropriately.
  • Once each year:
    • Check blood pressure, effectiveness of treatment and adjust to achieve symptom control.
    • Enquire about adverse effects and manage appropriately.
    • Re-assess the need for continuing HRT.
    • Discuss the risks and benefits of HRT. Explain that some of the risks (e.g. ovarian cancer) associated with oestrogen-only HRT increase with longer duration of HRT. The risk decreases after stopping HRT.
    • Perform a breast examination if indicated by personal or family history.
    • Encourage breast awareness and participation in the national breast screening programme as appropriate for their age.

In depth

When should I refer women who have started HRT?

  • Refer to secondary care if there is multiple treatment failure (e.g. three or more regimens have been tried).

In depth

Prescriptions

Oestrogen only tablets (low dose)

Age from 40 years onwards
Climaval tablets (estradiol 1mg)
Climaval 1mg tablets
Take one tablet once a day.
Supply 84 tablets.
Age: from 40 years onwards
NHS cost: £9.19
Licensed use: yes
Elleste Solo tablets (estradiol 1mg)
Elleste Solo 1mg tablets
Take one tablet once a day.
Supply 84 tablets.
Age: from 40 years onwards
NHS cost: £5.34
Licensed use: yes
Hormonin tablets (estradiol + estriol + estrone)
Hormonin tablets
Take one tablet once a day.
Supply 84 tablets.
Age: from 40 years onwards
NHS cost: £6.61
Licensed use: yes
Premarin tablets (conjugated oestrogen 625 micrograms)
Premarin 625microgram tablets
Take one tablet daily.
Supply 84 tablets.
Age: from 40 years onwards
NHS cost: £9.72
Licensed use: yes
Progynova tablets (estradiol 1mg)
Progynova 1mg tablets
Take one tablet once a day.
Supply 84 tablets.
Age: from 40 years onwards
NHS cost: £6.56
Licensed use: yes
Zumenon tablets (estradiol 1mg)
Zumenon 1mg tablets
Take one tablet once a day.
Supply 84 tablets.
Age: from 40 years onwards
NHS cost: £6.89
Licensed use: yes

Oestrogen only tablets (high dose)

Age from 40 years onwards
Bedol tablets (estradiol 2mg)
Bedol 2mg tablets
Take one tablet daily.
Supply 84 tablets.
Age: from 40 years onwards
NHS cost: £5.07
Licensed use: yes
Climaval tablets (estradiol 2mg)
Climaval 2mg tablets
Take one tablet once a day.
Supply 84 tablets.
Age: from 40 years onwards
NHS cost: £9.19
Licensed use: yes
Elleste Solo tablets (estradiol 2mg)
Elleste Solo 2mg tablets
Take one tablet once a day.
Supply 84 tablets.
Age: from 40 years onwards
NHS cost: £5.34
Licensed use: yes
Hormonin tablets (estradiol + estriol + estrone)
Hormonin tablets
Take two tablets once a day.
Supply 180 tablets.
Age: from 40 years onwards
NHS cost: £13.22
Licensed use: yes
Premarin tablets (conjugated oestrogen 1.25mg)
Premarin 1.25mg tablets
Take one tablet once a day.
Supply 84 tablets.
Age: from 40 years onwards
NHS cost: £13.19
Licensed use: yes
Progynova tablets (estradiol 2mg)
Progynova 2mg tablets
Take one tablet once a day.
Supply 84 tablets.
Age: from 40 years onwards
NHS cost: £7.72
Licensed use: yes
Zumenon tablets (estradiol 2mg)
Zumenon 2mg tablets
Take one tablet once a day.
Supply 84 tablets.
Age: from 40 years onwards
NHS cost: £6.89
Licensed use: yes

Oestrogen only patches (start doses)

Age from 40 years onwards
Elleste Solo MX 40 patch (estradiol 40mcg): apply twice a week
Elleste Solo MX 40 transdermal patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patches.
Age: from 40 years onwards
NHS cost: £15.57
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Estraderm MX 50 patch (estradiol 50mcg): apply twice a week
Estraderm MX 50 patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patches.
Age: from 40 years onwards
NHS cost: £17.22
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Estradot patch (estradiol 50mcg): apply twice a week
Estradot 50micrograms/24hours patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patch.
Age: from 40 years onwards
NHS cost: £15.66
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Evorel 50 patch (estradiol 50mcg): apply twice a week
Evorel 50 patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patches.
Age: from 40 years onwards
NHS cost: £9.72
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Fematrix 40 patch (estradiol 40mcg): apply twice a week
Fematrix 40 patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patches.
Age: from 40 years onwards
NHS cost: £14.85
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
FemSeven 50 patch (estradiol 50mcg): apply once a week
FemSeven 50 patches
Apply one patch once a week to the trunk, below the waistline.
Supply 12 patches.
Age: from 40 years onwards
NHS cost: £18.07
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed once a week, on the same day each week. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Progynova 50 patch (estradiol 50mcg): apply once a week
Progynova TS 50 patches
Apply one patch once a week to the trunk, below the waistline.
Supply 12 patches.
Age: from 40 years onwards
NHS cost: £16.71
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed once a week, on the same day each week. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.

Oestrogen only patches (high dose)

Age from 40 years onwards
Estraderm MX 75 patch (estradiol 75mcg): apply twice a week
Estraderm MX 75 patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patches.
Age: from 40 years onwards
NHS cost: £18.25
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Estradot patch (estradiol 75mcg): apply twice a week
Estradot 75micrograms/24hours patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patch.
Age: from 40 years onwards
NHS cost: £18.09
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Evorel 75 patch (estradiol 75mcg): apply twice a week
Evorel 75 patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patches.
Age: from 40 years onwards
NHS cost: £11.10
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
FemSeven 75 patch (estradiol 75mcg): apply once a week
FemSeven 75 patches
Apply one patch once a week to the trunk, below the waistline.
Supply 12 patches.
Age: from 40 years onwards
NHS cost: £17.46
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed once a week, on the same day each week. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Elleste Solo MX 80 patch (estradiol 80mcg): apply twice a week
Elleste Solo MX 80 transdermal patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patches.
Age: from 40 years onwards
NHS cost: £17.97
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Fematrix 80 patch (estradiol 80mcg): apply twice a week
Fematrix 80 patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patches.
Age: from 40 years onwards
NHS cost: £18.00
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Estraderm MX 100 patch (estradiol 100mcg): apply twice a week
Estraderm MX 100 patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patches.
Age: from 40 years onwards
NHS cost: £18.94
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Estradot patch (estradiol 100mcg): apply twice a week
Estradot 100micrograms/24hours patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patch.
Age: from 40 years onwards
NHS cost: £18.93
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Evorel 100 patch (estradiol 100mcg):apply twice a week
Evorel 100 patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patches.
Age: from 40 years onwards
NHS cost: £11.52
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
FemSeven 100 patch (estradiol 100mcg): apply twice a week
FemSeven 100 patches
Apply one patch once a week to the trunk, below the waistline.
Supply 12 patches.
Age: from 40 years onwards
NHS cost: £18.21
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed once a week, on the same day each week. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Progynova TS 100 patch (estradiol 100mcg): apply once a week
Progynova TS 100 patches
Apply one patch once a week to the trunk, below the waistline.
Supply 12 patches.
Age: from 40 years onwards
NHS cost: £19.68
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed once a week, on the same day each week. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.

Oestrogen only patches (low dose)

Age from 40 years onwards
Estraderm MX 25 patch (estradiol 25mcg): apply twice a week
Estraderm MX 25 patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patches.
Age: from 40 years onwards
NHS cost: £17.15
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Estraderm TTS 25 patch (estradiol 25mcg): apply twice a week
Estraderm TTS 25 patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patches.
Age: from 40 years onwards
NHS cost: £22.36
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Estradot patch (estradiol 25mcg): apply twice a week
Estradot 25micrograms/24hours patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patch.
Age: from 40 years onwards
NHS cost: £15.60
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Evorel 25 patch (estradiol 25mcg): apply twice a week
Evorel 25 patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patches.
Age: from 40 years onwards
NHS cost: £8.58
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.
Estradot patch (estradiol 37.5mcg): apply twice a week
Estradot 37.5micrograms/24hours patches
Apply one patch twice a week to the trunk, below the waistline.
Supply 24 patch.
Age: from 40 years onwards
NHS cost: £15.60
Licensed use: yes
Patient information: Stick one patch onto a clean, dry, hairless area of skin below the waist. The buttocks are often the best place to stick patches. Patches can also be stuck on the lower back, hip, abdomen or upper thigh. Never put a patch on or near the breasts. The patch needs to be changed twice a week. It is usually easier to change your patch on the same days each week e.g. Monday and Thursday. When you change your patch, always put the new patch on a fresh area of skin. For full instructions on how to use these patches, please read the package insert.

Other non-oral oestrogens

Age from 40 years onwards
Estradiol 0.06% gel: apply once a day
Oestrogel Pump-Pack 0.06% gel
Apply two measures once a day to the arms, shoulders or inner thighs as directed.
Supply 240 grams.
Age: from 40 years onwards
NHS cost: £7.39
Licensed use: yes
Patient information: Apply the gel to a clean, dry, unbroken area of skin using the template provided The area covered should be twice the size of the template. Apply one measure (half the dose) to each arm, shoulder or thigh. Do not apply the gel on or near the breasts or the vulval region. Let the gel dry for 5 minutes before covering with clothing. Avoid skin contact with another person (especially men), and avoid using other skin products or washing the area for an hour after application. The dose may be increased if necessary (after at least 1 months trial) to 3 or 4 measures once a day.
Estradiol 0.1% gel sachets: apply once a day
Sandrena 1mg gel sachets
Apply the contents of one sachet once a day to the lower trunk or thighs as directed.
Supply 84 1mg sachets.
Age: from 40 years onwards
NHS cost: £18.24
Licensed use: yes
Patient information: Apply the gel to intact areas of skin such as the lower trunk or thighs, using the right and left sides on alternate days. Wash hands after application. Not to be applied on the breasts or face and avoid contact with eyes. Allow area of application to dry for 5 minutes and do not wash area for at least 1 hour. After 2 to 3 months, the dose can be reduced or increased if necessary.
Estradiol 25mg implant
Estradiol 25mg implant
For subcutaneous implantation.
Supply 1 implant.
Age: from 40 years onwards
NHS cost: £9.59
Licensed use: yes
Patient information: This implant will be put in by the doctor or the nurse.
Estradiol 50mg implant
Estradiol 50mg implant
For subcutaneous implantation.
Supply 1 implant.
Age: from 40 years onwards
NHS cost: £19.16
Licensed use: yes
Patient information: This implant will be put in by the doctor or the nurse.

Vaginal oestrogens

Age from 40 years onwards
Estriol 0.1% cream (500mcg estriol per application)
Ovestin 0.1% cream
Insert one applicatorful into the vagina each evening until improvement occurs. Then reduce to one applicatorful twice a week.
Supply 15 grams.
Age: from 40 years onwards
NHS cost: £4.63
Licensed use: yes
Patient information: This product may damage latex condoms and diaphragms.
Estriol 500microgram pessaries
Ortho-Gynest 500microgram pessaries
Insert one pessary into the vagina each evening, until improvement occurs. Then reduce to one pessary twice a week.
Supply 30 pessaries.
Age: from 40 years onwards
NHS cost: £9.84
Licensed use: yes
Patient information: This product damages latex condoms and diaphragms.
Estradiol 25microgram m/r pessaries
Vagifem 25microgram vaginal tablets
Insert one pessary into the vagina each evening for 2 weeks, then reduce to one pessary twice a week.
Supply 30 pessaries.
Age: from 40 years onwards
NHS cost: £17.60
Licensed use: yes
Estradiol 2mg vaginal ring (7.5mcg estradiol/24 hours)
Estring 2mg vaginal ring
Insert one ring high into the vagina and wear continuously for 3 months.
Supply 1 vaginal ring.
Age: from 40 years onwards
NHS cost: £31.42
Licensed use: yes
Patient information: This ring must be replaced every 3 months.

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