Oestrogen-only tablets: what you need to know

Article

Understanding Premarin, Elleste Solo, Zumenon and Progynova for easing perimenopause and menopause symptoms

• Replacement estrogen can be given during perimenopause and menopause to improve symptoms and future health

• Estrogen-only tablets can be convenient and there are different types available

• Understand the benefits and side effects of estrogen-only tablets

During perimenopause and menopause, estradiol (estrogen) levels fluctuate and then decline, which can lead to symptoms. Estrogen-only HRT is prescribed to relieve these symptoms - it works by replacing the estradiol that is lost.

Estrogen can be given either through your skin, known as transdermal estradiol, or orally in the form of a tablet. Estrogen-only tablets are a type of systemic HRT, which means estrogen is absorbed into your body and travels in your bloodstream to improve symptoms. As well as reducing menopausal symptoms, taking HRT can reduce your future risk of diseases, including osteoporosis and cardiovascular disease.

What types of estrogen-only tablets are available?

Premarin/conjugated estrogens tablets

You may have heard of the brand name Premarin – it contains conjugated equine estrogen, which means a mixture of estrogens and other hormones, and they are derived from pregnant horses’ urine. This type of tablet is synthetic – its chemical structure is different to that of oestradiol, which is the beneficial type of hormone produced by your body before menopause.

Although Premarin tablets remain available, the supplier of Premarin has debranded this product, which means the name Premarin has been removed and it is now available and known under its generic name - conjugated estrogens tablets. This type of estrogen-only tablet is less commonly prescribed in the UK today but is prescribed more in some other countries, including the US.

It’s available in three strengths: 0.3mg, 0.625mg and 1.25mg.

Elleste Solo, Zumenon, Progynova

Elleste Solo and Zumenon are brands of tablet that contain estradiol, which is the body identical type of estrogen. Both are available in two strengths: 1mg and 2mg. You will usually begin on the 1mg dose, but like with Premarin, your doctor may recommend increasing this (to 2mg) if your symptoms don’t improve after the first three months.

Progynova contains estradiol valerate, which is a synthetic estrogen that is absorbed more slowly than estradiol and its effects last longer. It is available in two strengths: 1mg and 2mg.

What are the benefits of estrogen-only tablets?

Some people find that taking tablets is the simplest and most convenient way to take HRT.

What are the disadvantages of estrogen-only tablets?

For most people, the benefits of HRT outweigh any risks. However, there is thought to be a small increased risk of blood clot or stroke if you take HRT in tablet form, and this is more likely if you are obese, a smoker, or have had a clot in the past. However, the evidence for this is from synthetic types of estrogen so may not be relevant for body identical tablet estradiol.

Can I expect any side effects?

It often takes a few months for your body to adjust to taking any HRT, so you may notice some mild side effects. The most common are breast discomfort, leg cramps, and breakthrough bleeding or spotting. These usually settle over time, but talk to your doctor if side effects persist for longer than the first six months.

You may also experience a lower libido when you take HRT tablets. This is because taking tablet hormones can block the way testosterone works in your body. If this becomes an issue, talk to your doctor about alternative preparations that don’t have this effect. You can still take testosterone with tablet HRT but some women find it does not work as effectively compared to other forms of HRT.

RELATED: HRT doses explained

How do I take estrogen-only tablets

Estrogen-only tablets should be taken daily at a similar time of day, with or without food.

RELATED: HRT easy prescribing guide

What else do I need to know?

Measuring your estradiol levels through a blood test can sometimes be useful for monitoring how well your HRT is being absorbed. However, they are not that accurate if you take estradiol as a tablet, as the estradiol becomes metabolised into different types of estrogen when it is digested.

If you still have your womb, you’ll also need to take a form of progesterone or progestogen, which is usually given as a tablet or via the Mirena coil. This is because taking estrogen can thicken the cells in the lining of your womb but taking progesterone or progestogen protects the lining of the womb. Some women take progesterone if they have had a hysterectomy or have a Mirena coil as there are many benefits from taking progesterone – watch my video All About Progesterone.

Vaginal hormones, including estrogen and prasterone, can be taken – instead of or as well as – estrogen-only tablets and can help alleviate symptoms associated with Genitourinary Syndrome of the Menopause (GSM), including vaginal dryness, discomfort or pain during sex, irritation or burning of the vulva or vagina, needing to go to the toilet more often and feeling very desperate to go, and urinary tract infections such as cystitis.

Resources

NHS: Oestrogen tablets, patches, gel and spay

BNF: Estradiol: oral tablet

BNF: Conjugated oestrogens (equine)

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