Estradiol with dydrogesterone

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.