Femoston Conti

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Femoston Conti on Prescriptsy

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Femoston Conti is a continuous combined hormone replacement therapy (HRT) used to relieve menopausal symptoms in postmenopausal women who have not had a hysterectomy.

Each tablet contains estradiol (a natural oestrogen) and dydrogesterone (a progestogen), taken daily without a break.

Unlike sequential HRT, which produces a monthly withdrawal bleed, continuous combined HRT is designed to provide symptom relief without regular bleeding.

Femoston Conti is manufactured by Viatris and is available in two strengths: 0.5/2.5 and 1/5. It is a prescription-only medicine (POM) in the United Kingdom.

For women who are well past the menopause and experiencing ongoing symptoms such as hot flushes, night sweats, sleep disturbance, vaginal dryness, and mood changes, the prospect of continuing monthly bleeds on sequential HRT can be unwelcome.

Continuous combined HRT addresses this by delivering both oestrogen and progestogen every day, maintaining a thin, atrophic endometrium and avoiding the cyclical hormonal fluctuations that cause withdrawal bleeding.

This regimen is suitable only for women who are at least 12 months past their last natural period.

For women who are still perimenopausal or recently postmenopausal, sequential HRT (such as standard Femoston) is more appropriate, as starting continuous combined HRT too early often causes unpredictable and troublesome bleeding.

This page provides a detailed clinical guide to Femoston Conti, covering how it works, who should use it, dosing, potential risks and side effects, and how to obtain it in the UK.

Important safety information about Femoston Conti

Before reading further, note these essential safety points.

• Femoston Conti is a prescription-only medicine and requires a clinical assessment before use.
• It is intended only for women who are at least 12 months past their last natural period.
• Combined HRT carries a small increased risk of breast cancer, which rises with duration of use beyond 3 to 5 years.
• Oral HRT carries a small increased risk of venous thromboembolism, particularly in the first year.
• HRT should be used at the lowest effective dose for the shortest time needed, with regular annual reviews.
• Any unexpected vaginal bleeding after the first 6 months, or new bleeding after a bleed-free interval, should be reported to your GP promptly.

Understanding continuous combined HRT

HRT for women with a uterus must include a progestogen to protect the endometrium from the stimulatory effects of oestrogen.

There are two main approaches: sequential combined HRT (oestrogen daily with progestogen added cyclically for 10 to 14 days per month, producing a monthly bleed) and continuous combined HRT (both hormones taken daily without interruption, aiming for no bleeding).

Sequential HRT is generally recommended for women who are still having periods or have recently stopped, as their endometrium is still accustomed to cyclical hormonal stimulation.

Continuous combined HRT is recommended for women who are clearly postmenopausal (at least 12 months since the last natural period), as the endometrium has had time to become thin and quiescent.

Starting continuous combined HRT in these women produces amenorrhoea (no bleeding) in the majority after an initial adjustment period.

NICE guideline NG23 recommends that the type of HRT (sequential versus continuous combined) should be chosen based on the woman's menopausal status and preference.

The guideline also states that women should be informed about the expected adjustment period with continuous combined HRT and reassured that initial irregular bleeding is normal and usually resolves within 3 to 6 months.

How Femoston Conti works: mechanism of action

Femoston Conti contains estradiol, the principal human oestrogen produced by the ovaries, and dydrogesterone, a progestogen closely related to natural progesterone. Both hormones are present in every tablet, providing constant daily hormone levels.

Estradiol acts on oestrogen receptors throughout the body to replace the oestrogen that the ovaries no longer produce.

It stabilises the hypothalamic thermoregulatory centre to relieve hot flushes and night sweats, restores the thickness and moisture of the vaginal and urethral epithelium, supports bone mineral density, and has beneficial effects on mood, sleep, and cognitive function.

Dydrogesterone provides continuous progestogenic opposition to the endometrium.

By maintaining a constant progestogenic effect, the endometrium remains thin, atrophic, and inactive, which eliminates the cyclical build-up and shedding that causes monthly withdrawal bleeds.

Dydrogesterone has a favourable safety profile compared with some older progestogens: it has minimal androgenic activity, does not adversely affect lipid profiles, and is generally well tolerated with fewer progestogenic side effects such as bloating and mood disturbance.

Clinical evidence for Femoston Conti

The efficacy and safety of estradiol/dydrogesterone continuous combined HRT have been established in multiple clinical trials.

Studies have demonstrated significant reductions in hot flush frequency and severity within 4 to 8 weeks of starting treatment, with amenorrhoea rates of 80 to 90% by 12 months.

Bone mineral density is maintained or improved, reducing the risk of osteoporotic fractures. Quality-of-life measures consistently show improvement in domains including vasomotor symptoms, sleep, mood, and sexual function.

The combination of body-identical estradiol with dydrogesterone has attracted particular attention in recent years.

Retrospective data from a large Finnish registry study and the EPAT (Estrogen in the Prevention of Atherosclerosis Trial) suggest that dydrogesterone may confer a more favourable cardiovascular and breast cancer risk profile compared with some synthetic progestogens, though prospective randomised data are still needed to confirm this.

The British Menopause Society has endorsed the use of body-identical hormones and notes the emerging evidence favouring dydrogesterone-containing HRT preparations.

Femoston Conti is listed in the BNF and prescribed within the framework of NICE NG23 and FSRH guidance on contraception and menopause. It is one of several continuous combined HRT options available in the UK.

Femoston Conti compared with other continuous combined HRT

Other continuous combined oral HRT products available in the UK include Kliovance (estradiol 1 mg / norethisterone acetate 0.5 mg), Kliofem (estradiol 2 mg / norethisterone acetate 1 mg), and Elleste Duet Conti (estradiol 2 mg / norethisterone acetate 1 mg).

Femoston Conti differs in its use of dydrogesterone rather than norethisterone acetate as the progestogenic component.

Dydrogesterone is structurally closer to natural progesterone and may cause fewer androgenic and metabolic side effects.

Some women who experience mood changes, bloating, or acne on norethisterone-containing HRT find these symptoms improve when switching to a dydrogesterone-containing product.

Transdermal continuous combined HRT (such as Evorel Conti patches) may be preferable for women with elevated VTE risk, BMI over 30, or conditions that affect gastrointestinal absorption.

Transdermal oestrogen does not undergo first-pass hepatic metabolism and is associated with a lower VTE risk than oral HRT.

The choice of HRT product should be individualised based on symptom severity, risk factors, previous HRT experience, and patient preference. Your prescriber can help you navigate the available options.

Who should use Femoston Conti

Femoston Conti is suitable for postmenopausal women who are at least 12 months past their last natural period, have not had a hysterectomy, and wish to relieve menopausal symptoms without monthly withdrawal bleeds.

It may be started de novo in women who have not previously used HRT, or it may be used as a step-down from sequential Femoston when a woman becomes clearly postmenopausal and no longer wishes to have regular bleeds.

Women who experience premature ovarian insufficiency (menopause before age 40) or early menopause (before age 45) are generally advised to take HRT at least until the average age of natural menopause (51) to reduce the risk of cardiovascular disease, osteoporosis, and cognitive decline associated with premature oestrogen deficiency.

The choice between sequential and continuous regimen in these women depends on individual circumstances and should be guided by a specialist.

Dosage and administration

Take one Femoston Conti tablet daily at approximately the same time, with or without food. Continue without a break between packs.

The recommended starting strength for most women is 0.5/2.5. If symptom relief is insufficient after 2 to 3 months, your prescriber may increase to the 1/5 strength.

Women switching from sequential HRT should complete the current pack (including the progestogen phase) before starting Femoston Conti the following day.

Some irregular bleeding or spotting is expected during the first 3 to 6 months. This is a normal adjustment response and usually resolves.

If bleeding persists beyond 6 months, or if new bleeding occurs after a period of amenorrhoea, report this to your GP for investigation.

Side effects of Femoston Conti

Common side effects

The most frequently reported effects include headache, breast tenderness, abdominal pain or bloating, back pain, and irregular vaginal spotting (especially in the first 3 to 6 months).

Mood changes (low mood, irritability), nausea, dizziness, and weight fluctuation have also been reported. These effects tend to be mild and improve with continued use.

Bleeding patterns

Irregular bleeding or spotting is the most common reason women discontinue continuous combined HRT in the early months.

It is important to understand that this is an expected adjustment phenomenon. Approximately 80 to 90% of women on continuous combined HRT achieve amenorrhoea by 12 months.

Persistent or heavy bleeding requires medical assessment.

Serious risks

The serious risk profile of Femoston Conti is comparable to other combined HRT products. Breast cancer risk increases with use beyond 3 to 5 years.

VTE risk is elevated, particularly in the first year and in women with predisposing factors. Stroke risk is slightly increased with oral HRT.

Endometrial cancer risk is minimised by the continuous progestogen component but is not entirely eliminated; any unexpected bleeding should be investigated.

Ovarian cancer risk may be very slightly increased with long-term HRT use, though the absolute risk is small.

When to seek help

Contact your GP or NHS 111 if you experience persistent or new vaginal bleeding after the first 6 months, breast changes, persistent headache, or mood changes.

Call 999 or attend A&E for signs of DVT (painful swollen leg), PE (sudden breathlessness, chest pain), stroke (facial drooping, arm weakness, speech difficulty), heart attack (chest pressure, arm pain, sweating), or severe allergic reaction.

Report reactions to the MHRA at yellowcard.mhra.gov.uk .

Warnings and precautions

Contraindications

Femoston Conti must not be used in women with known or suspected breast cancer, other oestrogen-dependent malignancies, untreated endometrial hyperplasia, undiagnosed vaginal bleeding, current or previous VTE or arterial thromboembolism, active liver disease, porphyria, known thrombophilia, or hypersensitivity to any ingredient.

Women who are not yet 12 months past their last period should use sequential HRT instead.

VTE and cardiovascular considerations

Oral HRT increases VTE risk approximately 1.3 to 3-fold compared with non-use.

Women with additional risk factors (obesity, previous VTE, thrombophilia, recent surgery, prolonged immobilisation) should discuss transdermal HRT, which does not carry the same elevated risk.

If major surgery is planned, discuss temporarily stopping HRT with your prescriber and arrange thromboprophylaxis as appropriate.

The cardiovascular risk profile of HRT is most favourable when started within 10 years of menopause or before age 60.

Initiating HRT in older women or those many years past menopause may carry a different risk-benefit balance and should involve specialist assessment.

Breast cancer awareness

Women taking any combined HRT should be breast-aware and attend all routine NHS breast screening appointments. Report any new breast lump, skin change, nipple discharge, or persistent breast pain to your GP without delay.

Drug interactions

Enzyme-inducing medicines (carbamazepine, phenytoin, rifampicin, St John's wort, and some HIV antivirals) may reduce the efficacy of HRT by increasing oestrogen metabolism. Inform your prescriber and pharmacist of all medications before starting or changing HRT.

How to get Femoston Conti in the UK

Femoston Conti is a prescription-only medicine available on the NHS.

Your GP, a menopause specialist, or an authorised online prescriber can issue a prescription following a clinical assessment that includes symptom review, blood pressure check, personal and family history, and any necessary investigations.

The NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

For women in England taking multiple prescription items, an NHS prescription prepayment certificate can significantly reduce annual costs.

From April 2025, a dedicated HRT prescription prepayment certificate is also available, covering 12 months of HRT items for a single annual fee.

Practical advice for postmenopausal women

Alongside HRT, maintaining a healthy lifestyle supports overall wellbeing during the postmenopausal years. Weight-bearing exercise (walking, dancing, resistance training) helps maintain bone density and cardiovascular health.

A calcium-rich diet, adequate vitamin D (consider supplementation during UK winters), limiting alcohol, and not smoking all contribute to long-term health.

Vaginal moisturisers and lubricants can be used alongside systemic HRT for persistent vaginal dryness. Cognitive behavioural therapy (CBT) has evidence for managing menopausal mood symptoms and sleep disturbance.

The British Menopause Society, the NHS website, and organisations such as Menopause Matters provide reliable support and information.

Sources

• Femoston Conti 1/5, Summary of Product Characteristics (EMC)
• Estradiol with dydrogesterone, British National Formulary (BNF)
• NICE NG23: Menopause: diagnosis and management
• Menopause, NHS
• British Menopause Society
• MHRA Yellow Card Scheme