Femoston

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Femoston on Prescriptsy

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Femoston is a prescription-only hormone replacement therapy (HRT) used to relieve menopausal symptoms in women who have not had a hysterectomy.

It contains two active ingredients: estradiol (a natural oestrogen) and dydrogesterone (a progestogen similar to the body's own progesterone).

Femoston is a sequential combined HRT, meaning oestrogen is taken every day while dydrogesterone is added for the second half of each 28-day cycle.

This produces a predictable monthly withdrawal bleed. Femoston is manufactured by Viatris and is available in three strengths: 1/10, 2/10, and 2/20.

The menopause is a natural stage of life that occurs when the ovaries stop producing oestrogen and periods cease permanently.

In the UK, the average age of menopause is 51, but symptoms can begin several years earlier during the perimenopause.

Menopausal symptoms affect approximately 80% of women and can include hot flushes, night sweats, difficulty sleeping, vaginal dryness, low mood, anxiety, difficulty concentrating, joint aches, and reduced libido.

For many women, these symptoms are mild and manageable with lifestyle measures. For others, symptoms are severe enough to significantly affect quality of life, work, and relationships.

HRT is the most effective treatment for menopausal vasomotor symptoms (hot flushes and night sweats) and is recommended by NICE guideline NG23 as the first-line treatment for women with bothersome symptoms.

This page provides a comprehensive clinical guide to Femoston, including how it works, who should take it, how to use it, potential risks, and how to access it in the UK.

Important safety information about Femoston

Before reading further, note these key safety points about Femoston and HRT in general.

• Femoston is a prescription-only medicine and should only be started after a clinical assessment by a qualified prescriber.
• Combined HRT is associated with a small increase in the risk of breast cancer, which increases with duration of use beyond 3 to 5 years.
• Oral HRT carries a small increased risk of venous thromboembolism (blood clots in the legs or lungs), particularly in the first year of use.
• Femoston does not provide contraception. Women who may still be fertile should use effective contraception alongside HRT.
• HRT should be used at the lowest effective dose for the shortest duration needed, with regular reviews (at least annually).
• Report any unexpected vaginal bleeding, breast changes, or new symptoms promptly to your GP.

Understanding the menopause and HRT

Oestrogen plays a central role in many body systems, not just the reproductive organs. It affects the brain, bones, cardiovascular system, urinary tract, skin, and joints.

When oestrogen levels fall during the menopause, the consequences can be wide-ranging.

Vasomotor symptoms (hot flushes and night sweats) affect up to 75% of menopausal women and are caused by altered thermoregulation in the hypothalamus due to oestrogen withdrawal.

Urogenital atrophy (vaginal dryness, discomfort during intercourse, recurrent urinary infections) results from thinning of the vaginal and urethral epithelium.

Mood changes, cognitive difficulties, and sleep disturbance are also linked to declining oestrogen.

HRT replaces the oestrogen that the ovaries no longer produce, relieving vasomotor symptoms, improving urogenital health, and protecting against osteoporosis.

For women who still have a uterus, a progestogen must be added to oestrogen to prevent the endometrial stimulation that would otherwise increase the risk of endometrial hyperplasia and cancer.

This is why Femoston contains both estradiol and dydrogesterone.

NICE guideline NG23 on menopause recommends that healthcare professionals discuss the benefits and risks of HRT with all women experiencing troublesome menopausal symptoms.

The guideline emphasises that for most women under 60 or within 10 years of menopause, the benefits of HRT outweigh the risks, and that women should be supported to make informed decisions about their treatment.

How Femoston works: mechanism of action

Estradiol is the most potent naturally occurring oestrogen in humans.

When taken orally, it is absorbed from the gastrointestinal tract and partially converted to oestrone (a weaker oestrogen) during first-pass metabolism in the liver.

Despite this, oral estradiol provides effective oestrogen replacement.

It acts on oestrogen receptors throughout the body to restore the physiological effects of oestrogen: stabilising the hypothalamic thermoregulatory centre (relieving hot flushes), maintaining the health and thickness of the vaginal and urethral epithelium, supporting bone mineral density, and improving mood and cognitive function through effects on neurotransmitter systems.

Dydrogesterone is a retroprogesterone that is structurally very similar to natural progesterone. It binds selectively to progesterone receptors and has minimal androgenic, oestrogenic, or glucocorticoid activity.

In the sequential Femoston regimen, dydrogesterone is taken for 14 days per cycle.

During these 14 days, it transforms the oestrogen-stimulated proliferative endometrium into a secretory endometrium, which is then shed as a withdrawal bleed.

This cyclical progestogenic opposition effectively prevents endometrial hyperplasia.

The sequential regimen (oestrogen daily plus progestogen for 14 days per cycle) is appropriate for perimenopausal women and women in early postmenopause who may still benefit from a regular withdrawal bleed.

For women who are at least 12 months past their last natural period and wish to avoid monthly bleeding, a continuous combined regimen such as Femoston Conti may be more suitable.

Clinical evidence and UK prescribing guidance

The use of HRT for menopausal symptom relief is supported by a large body of clinical evidence spanning several decades.

Randomised controlled trials, including the Women's Health Initiative and the Danish Osteoporosis Prevention Study (DOPS), have established that HRT is highly effective for vasomotor symptoms, with the majority of women experiencing significant improvement within 4 weeks and maximal benefit by 3 months.

NICE NG23 recommends oral or transdermal HRT as first-line treatment for vasomotor symptoms and notes that HRT also benefits sleep disturbance, mood, and musculoskeletal symptoms in many women.

The guideline recommends against the routine use of HRT solely for prevention of chronic conditions such as cardiovascular disease or dementia, but acknowledges the bone-protective effects and the favourable cardiovascular profile of HRT when started in women under 60 or within 10 years of menopause (the "timing hypothesis" or "window of opportunity").

The BNF lists Femoston as a sequential combined HRT preparation.

The choice between Femoston and other HRT products depends on the woman's preferences (oral versus transdermal), symptom severity, risk factors (particularly VTE risk), and whether a sequential or continuous regimen is appropriate.

Types of Femoston and how to choose

Femoston 1/10 contains estradiol 1 mg for all 28 days and dydrogesterone 10 mg for the last 14 days.

This is the recommended starting strength for most women beginning HRT. It provides effective symptom relief for many women with a lower oestrogen dose.

Femoston 2/10 contains estradiol 2 mg for all 28 days and dydrogesterone 10 mg for the last 14 days. This may be used if symptoms are not adequately controlled on the 1/10 strength after 2 to 3 months.

Femoston 2/20 contains estradiol 2 mg for all 28 days and dydrogesterone 20 mg for the last 14 days. The higher progestogen dose may be used when additional endometrial protection is needed.

Your prescriber will select the lowest effective strength and adjust after reviewing your symptom response. The goal is adequate symptom control with the minimum necessary dose.

Femoston compared with other HRT options

Numerous HRT products are available in the UK, including oral tablets, transdermal patches, gels, and combinations with different progestogens.

Femoston's key advantages include the use of body-identical estradiol (micronised 17-beta estradiol, identical to the hormone produced by the ovaries) and dydrogesterone (a progestogen with a favourable side effect profile and evidence of effective endometrial protection).

Some women prefer Femoston because dydrogesterone tends to cause fewer progestogenic side effects (such as mood changes, bloating, and breast tenderness) compared with older synthetic progestogens like norethisterone or medroxyprogesterone acetate.

Transdermal HRT (oestrogen patches or gel combined with oral progestogen or the Mirena coil) may be preferable for women with an elevated VTE risk, BMI over 30, migraine, or gastrointestinal absorption issues.

Transdermal oestrogen bypasses first-pass liver metabolism and does not increase VTE risk to the same extent as oral preparations.

The Mirena intrauterine system (levonorgestrel 52 mg) is licensed for endometrial protection as part of an HRT regimen and avoids the need for oral progestogen entirely.

This option may suit women who wish to avoid the progestogenic side effects of oral preparations.

Dosage and administration

Take one Femoston tablet daily at approximately the same time, with or without food. Each 28-day pack is divided into two phases.

During days 1 to 14, take the oestrogen-only tablet. During days 15 to 28, take the combined oestrogen/progestogen tablet.

Start the next pack immediately after finishing the previous one, without a gap.

A withdrawal bleed usually occurs during the second half of the cycle or shortly after the end of the pack. This is normal.

Irregular bleeding may occur during the first 3 to 6 months of treatment. Persistent or unexpected bleeding beyond this period should be investigated.

If you miss a dose and it is within 12 hours, take it as soon as you remember. If more than 12 hours late, skip the missed dose and continue as normal. Do not double up.

Side effects of Femoston

Common side effects

The most frequently reported side effects include headache, breast tenderness or pain, abdominal pain or bloating, nausea, back pain, and mood changes (including depressed mood).

Withdrawal bleeding may be irregular during the first few months. These effects are usually mild and tend to improve with continued treatment.

Uncommon and rare side effects

Uncommon effects include migraine, dizziness, leg cramps, gallbladder disease, changes in liver function, and allergic skin reactions. Rare effects include venous thromboembolism, arterial thromboembolism, and changes in glucose tolerance.

Breast cancer risk

The most discussed risk associated with combined HRT is breast cancer.

Current evidence from the WHI study and observational data indicates that the risk increases with duration of use, becoming statistically significant after approximately 3 to 5 years.

For women starting combined HRT at age 50, the estimated additional risk is approximately 8 cases per 10,000 women per year.

This must be weighed against the benefits of symptom relief and improved quality of life. The risk returns to baseline within approximately 5 years of stopping.

Attend routine NHS breast screening and report any breast changes promptly.

VTE and cardiovascular risk

Oral combined HRT increases VTE risk by approximately 1.3 to 3-fold, with the highest risk in the first year of use.

The absolute risk is approximately 1 to 2 additional cases per 1,000 women per year.

Women with existing VTE risk factors (obesity, thrombophilia, previous VTE, recent surgery) should discuss transdermal HRT, which is not associated with increased VTE risk, with their prescriber.

Stroke risk is slightly elevated with oral HRT, though the absolute increase is small in women under 60.

Coronary heart disease risk is not increased when HRT is started within 10 years of menopause (the "window of opportunity"); some data suggest a protective effect in this timing window.

When to seek medical advice

Contact your GP or NHS 111 for unusual vaginal bleeding, persistent breast tenderness, new breast lumps, persistent headache, or mood changes that concern you.

Call 999 or attend A&E for sudden chest pain, breathlessness, calf swelling or pain, sudden severe headache, visual disturbance, facial drooping, arm weakness, or speech difficulty.

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

Warnings and precautions

Regular reviews

HRT should be reviewed at least annually.

At each review, your prescriber should reassess your symptoms, risk factors, and whether the benefits of continuing treatment still outweigh the risks.

There is no arbitrary upper limit on HRT duration; the decision to continue should be individualised.

Endometrial monitoring

Any unexpected or persistent vaginal bleeding during HRT should be investigated, typically with a pelvic ultrasound and potentially an endometrial biopsy. While the progestogen in Femoston protects against endometrial hyperplasia, vigilance is still required.

Bone health

HRT is effective at preventing and treating postmenopausal osteoporosis. NICE NG23 notes that HRT should be considered for women at risk of fragility fractures, particularly those under 60.

However, HRT is not usually recommended solely for osteoporosis prevention in the absence of menopausal symptoms, as other treatments (bisphosphonates, denosumab) are available.

Contraception

Femoston is not a contraceptive.

Perimenopausal women should continue effective contraception until 2 years after the last natural period if under 50, or 1 year after the last period if over 50.

The Mirena coil can provide both endometrial protection for HRT and contraception.

How to get Femoston in the UK

Femoston is available on NHS prescription from your GP, a menopause specialist, or an authorised online prescriber.

A clinical assessment including symptom review, personal and family history, blood pressure check, and any necessary investigations (such as mammography) should be completed before prescribing.

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

NHS England has announced that from April 2025, women in England can access HRT prescriptions through a prepayment certificate that covers 12 months of HRT items for a single annual charge.

This may reduce costs for women using multiple HRT products.

Living with the menopause: practical advice

Alongside HRT, lifestyle measures can help manage menopausal symptoms.

Regular exercise, maintaining a healthy weight, reducing caffeine and alcohol, using layered clothing to manage hot flushes, practising relaxation techniques or cognitive behavioural therapy (CBT), and using vaginal moisturisers for dryness can all contribute to improved wellbeing.

The NHS website and organisations such as the British Menopause Society and the Daisy Network provide reliable information and support for women going through the menopause.

Sources

• Femoston 2/10, 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