Conjugated oestrogens with medroxyprogesterone

How it works

The oestrogen component replaces declining endogenous oestrogen to control vasomotor symptoms, while the progestogen opposes oestrogenic endometrial stimulation to reduce the risk of endometrial hyperplasia and cancer.

Prescribing in practice

• Combined HRT increases the risk of venous thromboembolism, stroke, and breast cancer with duration of use, so prescribe the lowest effective dose for symptom control and reassess periodically.
• It is contraindicated in oestrogen-dependent cancers, undiagnosed vaginal bleeding, active or previous venous thromboembolism, and active arterial thromboembolic disease.
• Investigate any unscheduled or persistent vaginal bleeding promptly.

Monitoring

Review at least annually, reassessing symptom control, blood pressure, and the individual balance of benefits and risks.

Counselling the patient

• Report any unexpected vaginal bleeding, breast changes, or new lump.
• Seek urgent help for calf swelling, chest pain, breathlessness, or sudden weakness suggesting clot or stroke.
• HRT is not a contraceptive.

Evidence & guidelines

Risk estimates for breast cancer, venous thromboembolism, and stroke with combined HRT derive from the Women's Health Initiative and the Million Women Study and underpin NICE menopause guidance.