The drugs listed here are those most commonly prescribed in the UK, there may be other types that are available in other areas of the world.
If you are taking a drug that you think other women would like to know about please email the association. All Hormone Replacement Therapy (HRT) for women who have had a hysterectomy consists of oestrogen only although you may also receive additional treatment to replace testosterone.
When you begin taking HRT some side effects may occur, these include possible weight gain, breast tenderness, and headaches – the symptoms are very similar to those you may have experienced prior to your period every month. The usual method of administering HRT is to start with the lowest dose and gradually increase it until the menopausal symptoms are relieved. However, this may not provide enough oestrogen to protect the bones and heart.
Women who have their hysterectomies before the age of 40 will need more oestrogen as they will have been producing more before their operation. Not all types of HRT will suit all women and it is important to work with your GP to find the most suitable form of treatment for your own particular circumstances.
Tablets
The most common way to administer HRT is by using tablets which must be taken every day. With tablets, the amount of oestrogen is increased as they will pass through the liver before being absorbed into the bloodstream, the liver then inactivates 35 – 50% of the absorbed oestrogen, this is known as the first-pass effect. It is also common for the blood oestrogen levels to fluctuate during the day, the levels of oestrogen being at their highest about 4 – 8 hours after taking the drug.
| Trisequens Novo Nordisk | 12 Blue Tablets, 10 White and 8 Red Tablets | Combination of E2 and E3 | Natural |
| Premarin | Tablets | Conjugated Equine Oestrogens | Semi-natural |
| Harmogen | Tablets | Piperazine oestrone (E1) sulphate | Natural |
| Hormonin | Tablets | E3 – 0.27mg, E2 – 0.2mg, E1 – 1.4mg (E1) | Natural |
| Climaval | Tablets | E2V – 1mg or 2mg | Natural |
| Zumenon | Tablets | micronised E2 2mg(E1) | Natural |
Patches
To ensure that the maximum effect is obtained from patches and to ensure that they do not fall off, they should be applied to clean, dry skin and they should have pressure applied by the palm of the hand for at least 30 seconds so that the heat can help the adhesive to work. Most are re-applied every three to four days, although there is one product – FemSeven, produced by Merck, that is designed to be replaced on a weekly basis. As the oestrogen is not passing through the liver, much smaller doses can be used that achieve the same hormonal effects.
| Estraderm | Transdermal patches | E2 – 25mg, 50mg, 100mg per 24 hours | Natural |
| FemSeven | Transdermal patches | Estradiol Hemihydrate – 1.5mg, 2.25mg, 3.0mg per 24 hours | Natural |
Implants
An implant of oestrogen is placed underneath the skin in the area of the abdomen. The implant is small, about the size of an apple pip and it is inserted under local anaesthetic. This implant can last for up to six months and you will know when you need to have another one because you will begin to experience some menopausal symptoms, such as hot flushes and night sweats. The implant has advantages over other forms of administration as it avoids the liver and does not cause skin irritation as patches can. Because the oestrogen is not passing through the liver, the amount of oestrogen in the implant can be reduced.
However, the implant is not without its own possible side effects. Approximately 3% of implant users experience a syndrome called tachyphylaxis caused by a rapidly decreasing response to a drug following the initial dose, in effect this means that over time, the dosage needs to be increased to obtain the same effect even though the levels of blood oestrogen are high enough. This usually happens when a new implant is inserted before the last one has finished completely. This side effect has led to claims that HRT is addictive, which is not strictly the case and by careful monitoring, a GP can allow patients to continue to use other forms of HRT to allow the body to settle down.
| Oestradiol Implants | Fused Implant | E2 – 25mg, 50mg, 100mg | Natural |
| Ortho-Dienoestrol | Cream | Dienostrol 0.1%, 78gms | Natural |
| Orthogynest | Cream | Natural | |
| Orthogynest | Pessary | Oestriol 0.1% | Natural |
| Premarin Cream | Non-liquifying Cream | Conjugated Equine Oestrogens | Semi-Natural |
| Vagifem | Pessary | Oestrodiol – 25mcg | Natural |
| Ovestin | Cream | Oestriol 0.1% | Natural |