II. Indications
- See Continuous Estrogen Replacement for Estrogen only preparations (status post Hysterectomy)
-
Combination Estrogen Replacement in Late post-Menopause with intact Uterus
- Continuous Estrogen Replacement is preferred instead (lower Endometrial Hyperplasia risk)
- Jaakkola (2009) Obstet Gynecol 114(6): 1197-1204 [PubMed]
III. Protocol
IV. Medications: Estrogen and Progestin Sequential Combinations
- Premphase (Conjugated Estrogens 0.625 + Medroxyprogesterone 5.0)
- Days 1-14: Estrogen alone
- Days 15-28: Estrogen with Progesterone
-
Prefest (Estradiol 1.0 and Norgestimate 0.09)
- Repeated 6 day cycles (Estrogen alone for 3 days, Estrogen/Progesterone for 3 days)
V. Medications: Estrogen Options (choose one to accompany a Progesterone)
- Estrogen must be taken with Progesterone if Uterus is intact (Endometrial Hyperplasia risk)
- Conjugated Estrogen (Premarin, Enjuvia) 0.625 mg orally daily (or 0.3, 0.45, 0.9, 1.25 mg)
- Estropipate (Ogen) 0.625 mg orally daily
- Esterified Estrogen (Estratab, Menest) 0.625 mg orally daily (or 0.3, 1.25, 2.5 mg)
- Estradiol (Estrace) 0.5 mg orally daily (or 1.0 or 2.0 mg)
- Transdermal Estrogen (must be an Estrogen only product if used sequentially)
VI. Medications: Progestin Options (choose one to accompany an Estrogen if intact Uterus)
- First line:
- Provera 5 mg orally daily for 2 weeks of each month
- Second line (refractory to Provera)
- Norethindrone orally daily for 2 weeks of each month
- Micronized Progesterone 200 ug orally daily for 2 weeks of each month
VII. Adverse Effects
- Cyclic withdrawal bleed in 80-90% within 6 months