Femoston

Femoston is a hormone replacement therapy (HRT) containing estradiol and dydrogesterone, available in both sequential and continuous combined formulations.

It is prescribed for the relief of menopausal symptoms and for the prevention of postmenopausal osteoporosis in women at risk of fracture when other treatments are not suitable.

Estradiol, the oestrogen component, replaces the natural hormone lost after the menopause, relieving symptoms such as hot flushes, night sweats, vaginal dryness, and mood changes.

Dydrogesterone is a progestogen that protects the endometrium from the proliferative effect of unopposed oestrogen, reducing the risk of endometrial hyperplasia and carcinoma.

Sequential vs Continuous Combined

Femoston 1/10 and 2/10 are sequential preparations: oestrogen is taken daily, with dydrogesterone added for the last 14 days of each 28-day cycle.

A withdrawal bleed typically occurs during the oestrogen-only phase. These are appropriate for perimenopausal women or those in early menopause.

Femoston Conti (1/5 or 0.5/2.5) provides both hormones daily without a break and is designed for women who are at least 12 months postmenopausal and wish to avoid monthly bleeds.

How to Take Femoston

Take one tablet daily at the same time, with or without food. Swallow whole with water.

Sequential Formulations (1/10, 2/10)

Take the oestrogen-only tablets (white or red) for the first 14 days, then the combined tablets (grey or yellow) for the next 14 days. Start the next pack immediately without a break.

A withdrawal bleed may occur during the first half of each cycle.

Continuous Combined Formulation (Conti)

Take one combined tablet every day without interruption. No withdrawal bleed is expected, though some irregular spotting may occur in the first months.

Missed Dose

Take the missed tablet as soon as you remember. If more than 12 hours have passed, skip it and resume the next day. Missing tablets may cause breakthrough bleeding.

Sequential (Perimenopausal Women)

• Femoston 1/10: estradiol 1 mg daily + dydrogesterone 10 mg for days 15-28
• Femoston 2/10: estradiol 2 mg daily + dydrogesterone 10 mg for days 15-28

Continuous Combined (Postmenopausal Women)

• Femoston Conti 1/5: estradiol 1 mg + dydrogesterone 5 mg daily
• Femoston Conti 0.5/2.5: estradiol 0.5 mg + dydrogesterone 2.5 mg daily

General Principles

• Use the lowest effective dose for the shortest duration
• Review at least annually
• No specific dose adjustment for renal impairment; contraindicated in active liver disease

Common (up to 1 in 10 women)

• Headache or migraine
• Breast tenderness or pain
• Abdominal pain, nausea, or bloating
• Back pain
• Irregular bleeding or spotting

Uncommon (up to 1 in 100 women)

• Depression or mood swings
• Weight gain
• Vaginal discharge
• Dizziness

Rare (up to 1 in 1,000 women)

• Venous thromboembolism (DVT, PE)
• Gallbladder disease
• Liver function disturbance

Very Rare (fewer than 1 in 10,000 women)

• Arterial thromboembolism (stroke, MI)
• Breast cancer (risk increases with duration of use beyond 5 years)

Breakthrough bleeding that persists beyond the first 6 months on continuous combined Femoston should be investigated.

Thromboembolism

HRT is associated with a small increase in the risk of venous thromboembolism. Risk factors include obesity, immobility, personal or family history of VTE, and thrombophilia.

Discontinue and seek urgent medical help if you develop sudden leg swelling, chest pain, or breathlessness.

Breast Cancer

Combined HRT is associated with a modestly increased risk of breast cancer, rising with duration of use. Attend all routine mammography appointments and report new breast lumps or changes promptly.

Endometrial Monitoring

Unexpected vaginal bleeding during continuous combined therapy or at times other than the expected withdrawal bleed on sequential therapy should be investigated.

Annual Review

The benefits and risks of continued HRT should be reassessed at least once a year. Use the lowest effective dose for the shortest necessary duration.

Do not take Femoston if you have:

• Known or suspected breast cancer (current or past)
• Known or suspected oestrogen-dependent malignancy
• Undiagnosed abnormal vaginal bleeding
• Untreated endometrial hyperplasia
• Active or recent venous or arterial thromboembolism
• Active liver disease or where liver function tests remain abnormal
• Known thrombophilic disorders (e.g., protein C, protein S, or antithrombin deficiency)
• Porphyria
• Hypersensitivity to estradiol, dydrogesterone, or any excipient