Conjugated oestrogens

How it works

They bind oestrogen receptors to replace declining endogenous oestrogen, relieving vasomotor and urogenital symptoms of oestrogen deficiency.

Prescribing in practice

• In women with an intact uterus, oestrogen must be combined with a progestogen to oppose endometrial proliferation and reduce the risk of endometrial hyperplasia and carcinoma.
• Hormone replacement therapy is associated with increased risks of venous thromboembolism, stroke, and certain cancers that vary with age and regimen, and treatment should be reviewed regularly at the lowest effective dose.
• It is contraindicated in oestrogen-dependent cancers, undiagnosed vaginal bleeding, active thromboembolic disease, and active liver disease.

Monitoring

Review symptoms, blood pressure, breast awareness, and any abnormal bleeding periodically, and reassess the benefit-risk balance of continuing therapy.

Counselling the patient

• Report any unexpected or unscheduled vaginal bleeding.
• Seek urgent advice for symptoms of a clot, such as leg swelling, chest pain, or sudden breathlessness.
• Attend routine breast screening and report any new breast changes.

Evidence & guidelines

NICE menopause guidance supports hormone replacement therapy for menopausal symptoms with an individualised discussion of its benefits and risks.