Combined HRT (body-identical oestrogen + micronised progesterone) 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 the use of estradiol/progesterone in pregnant women. Not indicated during lactation, and not indicated in women of childbearing potential.

Estradiol with progesterone

Brand names: Bijuve

A combination of estradiol with body-identical micronised progesterone, available as a hormone replacement therapy preparation (including a combined capsule) for menopausal symptoms in women with 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 capsule each evening with food (Bijuve 1 mg/100 mg soft capsules — 1 mg estradiol with 100 mg progesterone)

Route: Oral

Frequency: Once daily every evening, every day without interruption

SOURCE PRODUCT: Bijuve 1 mg/100 mg soft capsules — a combined (continuous combined) HRT. For initiation and continuation of treatment of postmenopausal symptoms the lowest effective dose for the shortest duration should be used. STARTING: continuous combined treatment may be started depending on the time since menopause and the severity of symptoms; women experiencing a natural menopause should commence treatment 12 months after their last natural menstrual bleed, while for surgically induced menopause treatment may start immediately. Patients changing from a continuous sequential or cyclical preparation should complete the 28-day cycle and then change; patients changing from another continuous combined preparation may start therapy at any time. MISSED DOSE: take as soon as possible; if more than 12 hours have elapsed, continue with the next capsule without taking the forgotten one — the likelihood of breakthrough bleeding or spotting may be increased. PAEDIATRIC: not indicated in children.

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)
Undiagnosed genital bleeding
Untreated endometrial hyperplasia
Previous 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

Side effects

Breast tenderness — very common (10.4% in clinical trials); breast pain also reported
Headache (common, 3.4%) and dizziness
Vaginal haemorrhage (3.4%) and vaginal discharge (3.4%); pelvic pain (3.1%)
Nausea (2.2%), abdominal distension and abdominal pain (common)
Back pain and fatigue (common); weight increased
Uncommon: hypersensitivity, breast cancer, adnexa uteri cyst, visual impairment, vertigo, hirsutism, anaemia, abnormal liver function tests and prolonged prothrombin/activated partial thromboplastin time; rare: acute pancreatitis

Clinical monograph

How it works

Estradiol restores oestrogen levels to relieve menopausal symptoms, while micronised progesterone provides endometrial protection against oestrogen-induced hyperplasia.

Prescribing in practice

Micronised progesterone can cause drowsiness, so an oral combined capsule is generally taken at bedtime; warn about sedation, especially with concomitant CNS depressants.
As with all HRT, counsel on the small increased risks of VTE, stroke and breast cancer and use the lowest effective dose.
Endometrial protection requires the progesterone component in any woman with an intact uterus.

Monitoring

Review symptoms, bleeding pattern and benefit-risk annually, investigating any persistent unscheduled bleeding.

Counselling the patient

Take the combined capsule at bedtime as it may make you feel drowsy.
Report any unexpected vaginal bleeding.
Continue routine breast and cervical screening.

Evidence & guidelines

NICE NG23 supports menopause care, and body-identical micronised progesterone is recognised for endometrial protection in HRT.

Reference: NICE NG23; British Menopause Society; SmPC; 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.

Calculators

Pathways