Combined HRT (oestrogen + progestogen) Pregnancy: §4.6: not indicated during pregnancy. If pregnancy occurs during treatment, withdraw immediately. Most epidemiological studies relevant to inadvertent foetal exposure to combinations of oestrogens and progestogens indicate no teratogenic or foetotoxic effect; there are no adequate data on oestradiol/dydrogesterone in pregnant women. Not indicated during lactation.

Estradiol with dydrogesterone

Brand names: Femoston

A combined hormone replacement therapy pairing estradiol with the progestogen dydrogesterone, used for menopausal symptoms in women who have a uterus.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One tablet daily on a 28-day cycle: an oestradiol-only tablet for the first 14 days, then an oestradiol + dydrogesterone tablet for the following 14 days (Femoston 1/10 mg)

Route: Oral — may be taken with or without food

Frequency: Once daily, continuously — a new 28-day cycle begins on day 29 with no break between packs

SOURCE PRODUCT: Femoston 1/10 mg film-coated tablets — a continuous sequential HRT. In general treatment should start with Femoston 1/10; depending on clinical response the dosage can afterwards be adjusted to individual need, and if complaints linked to oestrogen deficiency are not ameliorated the dosage can be increased by using Femoston 2/10. For initiation and continuation of treatment of postmenopausal symptoms the lowest effective dose for the shortest duration should be used. STARTING: in women not taking HRT who are amenorrhoeic, or women switching from a continuous combined HRT, treatment may be started on any convenient day; in women transferring from a cyclic or continuous sequential HRT regimen, treatment should begin the day following completion of the prior regimen. The days of the week are printed on the back of the blister strips — take the tablets from the part marked with arrow 1 first, then all the tablets from the part marked with arrow 2. MISSED DOSE: take as soon as possible; if more than 12 hours have elapsed, continue with the next dose without taking the forgotten tablet — the likelihood of breakthrough bleeding or spotting may be increased. PAEDIATRIC: there is no relevant indication for use in the paediatric population.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Known, past or suspected breast cancer
Known or suspected oestrogen-dependent malignant tumours (e.g. endometrial cancer)
Known or suspected progestogen-dependent neoplasms
Undiagnosed genital bleeding
Untreated endometrial hyperplasia
Previous idiopathic or current venous thromboembolism (deep vein thrombosis, pulmonary embolism)
Known thrombophilic disorders (e.g. protein C, protein S or antithrombin deficiency)
Active or recent arterial thromboembolic disease (e.g. angina, myocardial infarction)
Acute liver disease or a history of liver disease as long as liver function tests have failed to return to normal
Porphyria
Known hypersensitivity to the active substances or to any excipient
Meningioma or history of meningioma

Side effects

Headache (very common); migraine and dizziness (common)
Breast pain/tenderness (very common); breast enlargement and premenstrual syndrome (uncommon)
Abdominal pain (very common); nausea, vomiting, flatulence (common)
Back pain (very common)
Menstrual disorders including postmenopausal spotting, metrorrhagia, menorrhagia, oligo-/amenorrhoea, irregular menstruation and dysmenorrhoea; pelvic pain; cervical discharge (common)
Venous thromboembolism, hypertension, peripheral vascular disease and varicose vein (uncommon); myocardial infarction (rare). Up to a 2-fold increased risk of breast cancer diagnosis with combined oestrogen-progestogen therapy for more than 5 years. Meningioma has been reported (see §4.3/§4.4)

Clinical monograph

How it works

Estradiol replaces endogenous oestrogen to relieve menopausal symptoms while dydrogesterone provides endometrial protection by opposing oestrogen-driven endometrial proliferation.

Prescribing in practice

The progestogen component is included specifically to prevent endometrial hyperplasia and carcinoma from unopposed oestrogen, so the combined product should not be split.
Assess thrombotic, stroke and breast cancer risk before starting and review the balance of benefits and risks at least annually.
Avoid in active or past thromboembolic disease, oestrogen-dependent cancers and undiagnosed vaginal bleeding.

Monitoring

Review symptoms, blood pressure and bleeding pattern periodically, and investigate persistent or unscheduled bleeding.

Counselling the patient

Report unexpected vaginal bleeding, breast lumps, or clot symptoms such as calf swelling or breathlessness.
Take the combined preparation as directed without omitting the progestogen part.
Keep up with breast and cervical screening invitations.

Evidence & guidelines

Combined oestrogen-progestogen hormone replacement therapy is supported by NICE menopause guidance for women with an intact uterus.

Reference: NICE NG23; British Menopause Society; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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