Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
6.4.1 Hormone Replacement Therapy (HRT)
Refer to the *NEW* website *Menopause and Hormone Replacement Therapy page* to see formulary options and detailed information on diagnosis, management and risks, and benefits of treatment options.

See NICE guidance [NG23] Menopause: diagnosis and management recommendations.
Unopposed
oestrogen
Elleste Solo®1mg tablets: £5.06 (84)
2mg tablets: £5.06* (84)
Bedol®2mg tablets: £5.07* (84)
Transdermal patches
as Evorel®
25mcg patch: £3.42 (8)
50mcg patch: £3.88* (8)
75mcg patch: £4.12* (8)
100mcg patch:£4.28* (8)
Evorel® is recommended where a patch formulation is required, due to lower cost, range of doses available and patient acceptability of matrix patches.
Transdermal spray
as Lenzetto®
1.53mg per metered dose transdermal spray, £6.90 per 8.1ml (56 actuations).
Cyclical combinedElleste Duet®1mg tablets: £9.20 (84)
2mg tablets: £9.20* (84)
Elleste Duet® tablets are first line on cost grounds.
January 2020 - A temporary replacement whilst Elleste Duet 1mg is out of stock is Novofem® 1mg tablets.
Cyclo-progynova®2mg tablets: £3.11* (21)
Transdermal patches
as Evorel Sequi®
Transdermal patch: £11.09* (8)
Continuous combined:Kliofem®Tablets: £11.43* (84)Continuous combined products should not be used until 12 months after the menopause. Irregular bleeding patterns may occur for the first few months and may persist for some women, requiring a move back to cyclical preparations and/or investigation.
Kliofem® has identical composition to Elleste Duet Conti®, but at a lower cost
Kliovance®Tablets: £13.20* (84)
Premique Low Dose®Tablets: £6.52 (84)
Transdermal patches
as Evorel Conti®
Transdermal patches: £13.00* (8)
Tibolone is now non-formulary. It is expensive and benefits over HRT have not been demonstrated for menopausal symptoms. The MHRA have advised of increased risk of stroke in older women (LIFT study) and in February 2009 noted the increased risk of recurrent breast cancer when tibolone was used for vaso-motor symptoms in women with a history of breast cancer (LIBERATE trial).
ProgestogensMicronised progesterone as Utrogestran®100mg capsules: £5.13 (30)200 mg once daily on days 15–26 of each 28-day oestrogen HRT cycle, alternatively 100 mg once daily on days 1–25 of each 28-day oestrogen HRT cycle.
Micronised progesterone is also known as body identical and is less likely to cause side effects.
Medroxy-progesterone2.5mg tablets: £1.84 (30)
5mg tablets: £1.23 (10)
10mg tablets: £22.16 (90)
Medroxyprogesterone may produce less androgenic adverse effects than Norethisterone.
Levonorgestrel 20mcg/24hours IUS
as Mirena®
IUS: £88 (1)Licensed for 4 years use for protection from endometrial hyperplasia during oestrogen replacement therapy
Testosterone for treatment of low libidohttps://www.somersetccg.nhs.uk/prescribing-and-medicines-management/prescribing-guidelines-by-clinical-area/menopause-and-hormone-replacement-therapy/
First line Testim tubes (1% testosterone gel)®30 x 5g tubes=£30.50Preferred choice as lid can be replaced between uses. 1/10th of a tube daily, replace screw lid between uses.

Apply a small pea sized amount once daily to lower abdomen, buttock, or outer thigh. Rotate site of application daily. Use at the same time each day. Replace lid between uses. One tube should last for 10 days.
Second line Testogel sachets (1% testosterone gel)®30 x 5g sachets=£31.11Do not prescribe the pump version of Testogel. 1/10th of a sachet daily, seal with a clip between uses.

Apply a small pea sized amount once daily to lower abdomen, buttock, or outer thigh. Rotate site of application daily. Use at the same time each day. Seal sachet with a clip between uses. One sachet should last for 10 days.
Third lineTostran pump (2% testosterone gel) – (metered dose) ®60g pump=£28.63Apply one metered dose three times a week or on alternate days to lower abdomen, buttock, or outer thigh. Rotate site of application daily. Use at the same time each day. 60g pump container delivers 120 metered doses, each cannister should last 240 days.