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Estradiol patches 2nd line to tablets. No preferred patch recommendation has been made due to current stock shortages (Estraderm, Estradot, Evorel, FemSeven).

NOTE - discontinuation of the Progynova TS weekly patch by Dec 2025. FemSeven weekly patch remains available or twice-weekly Evoral / Estraderm patches.

Prescribe generically

https://www.gov.uk/drug-safety-update/tibolone-benefit-risk-balance

(2nd line) as a treatment option in a HRT regime for women that do not tolerate the side effects of micronised progesterone.

For moderate to severe vasomotor symptoms associated with menopause where hormone replacement therapy is not suitable.

For people with a history of breast cancer or other oestrogen-dependent cancers who have completed treatment, the use of fezolinetant (off-label) should be considered following an individualised risk assessment. Clinicians may seek advice from oncology and/or menopause specialists where appropriate.

Off-label use.

Levonorgestrel recommended for replacement every 5 years (off-label use) as per BMS: https://thebms.org.uk/wp-content/uploads/2023/04/14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf

• Mirena - licensed for endometrial protection but only for a duration of 4 years. Agreed to use for a duration of 5 years before replacement (off-label).

Off-label use.

Off-label use.

Pregnancy risks - https://www.gov.uk/drug-safety-update/antiepileptic-drugs-in-pregnancy-updated-advice-following-comprehensive-safety-review

https://www.gov.uk/drug-safety-update/pregabalin-lyrica-findings-of-safety-study-on-risks-during-pregnancy

Respiratory risks - https://www.gov.uk/drug-safety-update/pregabalin-lyrica-reports-of-severe-respiratory-depression

Off-label use

Progesterone pessaries have not been agreed for use as endometrial protection.

Off-label use.