Indications: short-term treatment of symptoms of oestrogen deficiency (including women being treated with gonadotropin releasing hormone analogues); osteoporosis prophylaxis in women at risk of fractures (second-line)

Cautions: renal impairment, liver disease, epilepsy, migraine, diabetes mellitus, hypercholesterolaemia; withdraw the drug if signs of thromboembolic disease, abnormal liver function tests or cholestatic jaundice.

Contra-indications: hormone-dependent tumours, history of cardiovascular or cerebrovascular disease (e.g. thrombophlebitis, thromboembolism), uninvestigated vaginal bleeding, severe liver disease, pregnancy, breast- feeding.

Side Effects: abdominal pain, weight changes, leucorrhoea, facial hair, and rarely amnesia; gastro- intestinal disturbances, oedema, dizziness, headache, migraine, depression, breast cancer, arthralgia, myalgia, vaginal bleeding, visual disturbances, seborrhoeic dermatitis, cases with rash and pruritus had been reported.

Dose: 2.5mg daily

Unsuitable for use in the premenopause (unless being treated with gonadotropin-releasing hormone analogue) and as (or with) an oral contraceptive; also unsuitable for use within 12 months of last menstrual period (may cause irregular bleeding); induce withdrawal bleed with progestogen if transferring from another form of HRT.