Kliofem

How to order Kliofem

1. Find the drug you need on our site.
2. Pick a clinic. See the price.
3. Fill in a short health form.
4. A doctor reads your form.
5. If it is safe for you, they say yes.
6. Your order ships fast to your door.
7. It comes in a plain, sealed box.

Why use us? We compare UK clinics. We show you the price and how fast they ship. We do not sell drugs. We just help you find the best one for you.

Is it safe? Yes. All our clinics are UK-based. A real doctor reads each form. They will not sell to you if it is not safe for you.

Kliofem on Prescriptsy

Kliofem is described on Prescriptsy as independent product information.

Here you can understand how online consultation works, what medical checks partner clinics carry out, and which factors matter when comparing providers.

We do not sell medicines directly, but help users compare licensed healthcare partners on price, delivery speed, service quality, and overall trustworthiness.

Kliofem is a prescription-only continuous combined hormone replacement therapy (HRT) tablet used to relieve the symptoms of menopause and to help prevent postmenopausal osteoporosis.

Each tablet contains estradiol 2 mg (a natural oestrogen identical to the hormone produced by the human ovary) and norethisterone acetate 1 mg (a synthetic progestogen that provides endometrial protection).

Kliofem is manufactured by Novo Nordisk and is taken once daily without a break.

As a continuous combined preparation, it is designed to be period-free after an initial settling-in phase of up to 6 months.

It is suitable for postmenopausal women who have not had a natural period for at least 12 months.

The menopause is a natural biological event that occurs when the ovaries cease producing eggs and levels of oestrogen and progesterone decline significantly.

In the United Kingdom, the average age of natural menopause is 51, although it can occur at any age from the early 40s to the late 50s.

Premature menopause (before 40) affects approximately 1 in 100 women, and early menopause (between 40 and 45) affects approximately 5 in 100 women.

Menopausal symptoms result from oestrogen deficiency and include hot flushes, night sweats, vaginal dryness, reduced libido, mood changes, sleep disturbance, joint aches, difficulty concentrating, and urinary symptoms.

These can significantly impair quality of life.

HRT is the most effective treatment for menopausal symptoms and, when started at the appropriate time, also offers protection against postmenopausal osteoporosis.

This page provides a comprehensive clinical overview of Kliofem, covering its mechanism of action, clinical evidence, dosage guidance, side effects, important safety information, and how to obtain a prescription in the United Kingdom.

Important safety information about Kliofem

Before reading further, note these essential safety points about Kliofem and combined HRT.

• Kliofem is a prescription-only medicine requiring a clinical assessment before prescribing.
• It is suitable only for postmenopausal women who are at least 12 months past their last natural period.
• Combined HRT carries a small increased risk of breast cancer, venous thromboembolism, and stroke.
• Women with a uterus must use combined HRT, not oestrogen-only HRT, to protect the endometrium.
• Use the lowest effective dose for the shortest duration needed. Review treatment at least annually.
• Report unexpected vaginal bleeding persisting beyond 6 months to your GP.

Understanding the menopause and HRT

The menopause is confirmed retrospectively after 12 consecutive months without a menstrual period in the absence of other causes.

The perimenopause is the transitional phase during which hormone levels fluctuate and symptoms often begin. The postmenopause is the period after the final menstrual period.

Together these stages constitute the menopausal transition. Oestrogen has wide-ranging effects on the cardiovascular system, bones, brain, urogenital tract, skin, and metabolic function.

As oestrogen levels decline, women may experience vasomotor symptoms (hot flushes and night sweats), urogenital atrophy (vaginal dryness, dyspareunia, urinary frequency, recurrent urinary tract infections), psychological symptoms (low mood, anxiety, irritability, poor concentration), musculoskeletal symptoms (joint stiffness and pain), and accelerated bone loss leading to osteoporosis and increased fracture risk.

HRT addresses the root cause of menopausal symptoms by restoring circulating oestrogen levels.

NICE guideline NG23 states that HRT is the most effective treatment for vasomotor symptoms and should be offered after an individualised discussion of benefits and risks.

The British Menopause Society (BMS) provides additional clinical guidance emphasising the importance of personalised care and shared decision-making.

How Kliofem works: mechanism of action

Kliofem contains two hormones that work together to relieve menopausal symptoms while protecting the uterine lining.

Estradiol (17-beta estradiol) is the principal oestrogen naturally produced by the ovary during the reproductive years.

In Kliofem, estradiol binds to oestrogen receptors throughout the body, restoring the hormonal signals that decline during menopause.

This relieves vasomotor symptoms by stabilising thermoregulatory centres in the hypothalamus, improves vaginal and urethral health by promoting blood flow and epithelial maturation, helps maintain bone mineral density by inhibiting osteoclast-mediated bone resorption, and may improve mood, cognition, and sleep quality.

Norethisterone acetate is a prodrug converted to norethisterone in the body.

It acts on progesterone receptors in the endometrium, counteracting the proliferative effect of oestrogen on the uterine lining.

Without progestogen opposition, exogenous oestrogen stimulates endometrial growth, increasing the risk of endometrial hyperplasia and endometrial cancer.

The continuous administration of norethisterone acetate in Kliofem causes the endometrium to become thin and atrophic, providing endometrial protection and eliminating the need for monthly withdrawal bleeds.

The continuous combined regimen is specifically designed for postmenopausal women. Using it before menopause is confirmed (while some endogenous hormone production continues) often causes unpredictable bleeding.

Women who are perimenopausal should use sequential HRT, which provides the progestogen for 12 to 14 days per cycle, producing a predictable monthly bleed.

Clinical evidence and UK prescribing guidance

HRT has been the subject of extensive clinical research over several decades.

The Women's Health Initiative (WHI), published in 2002, initially raised significant concerns about the cardiovascular and cancer risks of combined HRT.

However, subsequent re-analyses and extended follow-up data have clarified that the balance of risks and benefits depends critically on the age at initiation and the time since menopause.

For women who start HRT within 10 years of menopause or before age 60, the benefits generally outweigh the risks, with effective symptom relief, bone protection, and possible cardiovascular benefit.

NICE guideline NG23 recommends HRT as first-line treatment for moderate to severe vasomotor symptoms after an individualised risk-benefit discussion.

It emphasises that the absolute risks of HRT are small and should be contextualised.

For example, the additional breast cancer risk from 5 years of combined HRT starting at age 50 is approximately 4 per 1,000 women, comparable to the risk associated with obesity, consuming 2 to 3 units of alcohol per day, or physical inactivity.

The BMS endorses an individualised approach and notes that there is no arbitrary time limit for HRT use.

The decision to continue treatment should be reviewed annually, balancing ongoing symptom relief and bone protection against the cumulative risks.

Many women use HRT for 5 to 10 years or longer under medical supervision.

For osteoporosis prevention, NICE technology appraisal TA160 recommends HRT as one option for postmenopausal women at risk of fragility fractures who cannot tolerate or have contraindications to bisphosphonates.

Estradiol at a dose of 2 mg (as in Kliofem) has demonstrated significant reductions in vertebral and hip fracture risk in clinical trials.

Kliofem compared with other HRT options

The UK HRT market offers a wide range of formulations.

Kliovance (estradiol 1 mg/norethisterone acetate 0.5 mg) is a lower-dose version of Kliofem made by the same manufacturer, providing the same hormones at half the dose.

It is often preferred when the lowest effective dose is sought. Indivina (estradiol valerate/medroxyprogesterone acetate) is another continuous combined oral option with different hormonal components.

Bijuve (estradiol/micronised progesterone) offers an alternative with body-identical progesterone rather than a synthetic progestogen; some emerging data suggest micronised progesterone may carry a lower breast cancer risk than synthetic progestogens, though long-term outcome data are still being gathered.

Transdermal HRT options include combination patches (such as Evorel Conti, which delivers estradiol and norethisterone acetate through the skin) and separate oestrogen patches or gel used with oral or intrauterine progestogens.

Transdermal delivery bypasses first-pass hepatic metabolism, which is associated with a lower VTE risk compared with oral HRT.

Women with additional VTE risk factors (BMI above 30, previous VTE, thrombophilia, age over 60) are recommended transdermal rather than oral preparations.

For women who have had a hysterectomy, oestrogen-only HRT is used because endometrial protection is not required.

Oestrogen-only HRT has a more favourable risk profile than combined HRT, with no increased breast cancer risk in the WHI data for up to 7 years of use.

Women with premature or early menopause (before age 45) are strongly advised to take HRT at least until the average age of natural menopause (51) to protect bone, cardiovascular, and cognitive health.

In this context, HRT represents physiological replacement rather than supplementation.

Dosage and administration

Take one Kliofem tablet at the same time each day, every day, without a break. Swallow the tablet whole with water, with or without food.

The tablet contains estradiol 2 mg and norethisterone acetate 1 mg. If your prescriber considers a lower dose more appropriate, Kliovance (1 mg/0.5 mg) may be substituted.

When switching from sequential HRT, start Kliofem the day after completing the progestogen phase. When switching from another continuous combined product, start on any convenient day.

If you forget a dose, take it as soon as you remember unless more than 12 hours have passed, in which case skip it. Do not double up.

Side effects of Kliofem

Common side effects

Breast tenderness, headache, nausea, abdominal bloating, mood changes, fluid retention, weight fluctuations, and leg cramps are commonly reported.

Breakthrough bleeding or spotting is expected during the first 3 to 6 months as the endometrium atrophies. Changes in libido and minor skin changes may occur.

Serious risks

Combined HRT is associated with a small increased risk of VTE, breast cancer, and stroke, as detailed in the warnings section.

The risk of endometrial cancer is not increased because the progestogen component provides endometrial protection. Gallbladder disease risk is modestly elevated.

Cardiovascular risk is lowest when HRT is initiated within 10 years of menopause or before age 60.

When to seek urgent help

Contact your GP or call NHS 111 for persistent breast pain, unexplained bleeding after 6 months, severe headache, or troublesome mood changes.

Call 999 or attend A&E for signs of a blood clot (sudden leg swelling, chest pain, breathlessness), stroke (facial drooping, arm weakness, speech difficulty), or severe allergic reaction.

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

Warnings and precautions

Contraindications

Kliofem must not be used in women with known or suspected breast cancer, other oestrogen-dependent malignancy, undiagnosed abnormal vaginal bleeding, untreated endometrial hyperplasia, active or recent VTE or arterial thromboembolism, active liver disease, known thrombophilic disorders, or porphyria.

Assessment before prescribing

Your clinician should take a full medical history covering personal and family history of breast cancer, ovarian cancer, VTE, stroke, and heart disease. Blood pressure should be checked.

Mammography should be current. Women over 50 should participate in the NHS Breast Screening Programme.

VTE risk management

Risk factors include obesity, immobility, previous VTE, and strong family history. Temporarily stop Kliofem before planned surgery requiring prolonged bed rest and restart once fully mobile. If VTE occurs, stop immediately. Consider transdermal HRT for women at higher VTE risk.

Breast cancer

Risk increases with combined HRT duration and declines after stopping, reaching baseline approximately 5 years after cessation. Be breast-aware and report any new lumps, skin changes, or nipple discharge promptly.

Drug interactions

Enzyme-inducing medicines (carbamazepine, phenytoin, phenobarbital, rifampicin, St John's wort) may reduce HRT efficacy by increasing hepatic metabolism of both estradiol and norethisterone.

Contraception

Kliofem is not a contraceptive. Women who may still be fertile should use non-hormonal contraception alongside HRT. The FSRH advises continuing contraception for 2 years after the last period if under 50, or 1 year if over 50.

Pregnancy and breastfeeding

Kliofem must not be used during pregnancy or breastfeeding. It is indicated for postmenopausal women only.

How to get Kliofem in the UK

Kliofem is a prescription-only medicine. Your GP, menopause specialist, or an authorised online prescriber registered with the General Pharmaceutical Council (GPhC) can prescribe it after a clinical assessment.

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

Living well during and after the menopause

HRT is one component of a comprehensive approach to wellbeing during the menopausal transition. NICE recommends combining HRT with sustained lifestyle measures for optimal health.

Regular weight-bearing and resistance exercise (at least 150 minutes of moderate-intensity activity per week) supports bone health and cardiovascular fitness.

A balanced diet rich in calcium (dairy products, fortified plant milks, green leafy vegetables) and adequate vitamin D (from sunlight, diet, or supplements of 10 micrograms daily as recommended by Public Health England) help maintain bone strength.

Limit alcohol to no more than 14 units per week. Stop smoking, as smoking increases cardiovascular risk and accelerates bone loss. Manage stress and prioritise sleep hygiene.

Cognitive behavioural therapy (CBT) has evidence for managing vasomotor symptoms and low mood associated with the menopause, and NICE recommends it as an option alongside or instead of HRT.

Maintain regular health checks, including mammography, cervical screening, blood pressure monitoring, and cholesterol assessment.

Sources

• Kliofem, Summary of Product Characteristics (EMC)
• Norethisterone with estradiol, British National Formulary (BNF)
• NICE NG23: Menopause: diagnosis and management
• Menopause, NHS
• British Menopause Society
• MHRA Yellow Card Scheme