Does medi cal cover hormone replacement therapy

What is this medication for?

Hormone replacement therapy (HRT) is used to describe preparations that contain the two female hormones, estrogen and progestogen, that are given together to relieve bothersome symptoms of menopause. 

Symptoms of menopause include hot face, neck and chest (“hot flushes”), night sweats, vaginal dryness and low mood. The decrease in estrogen may also lead to a condition called osteoporosis, where the bones become thinner ,weaker and easier to break. Using estrogen alone may cause abnormal thickening of the uterus (womb) lining – hence those with an intact uterus require an additional female hormone, progestogen, to prevent this. 

Progestogen may be combined together with estrogen in one tablet. It may also be prescribed separately for a specific duration each month.

How should I take/use this medication?

• Do not stop taking your medication without checking with your healthcare professional.
• You should take this medication after food.

The regimen depends on the HRT that you have been prescribed. Some brands have different coloured tablets to take on certain days.

The following are some commonly used HRT regimens:  

• Estrogen only HRT e.g.  Premarin® / Estrofem® / Progynova®

You should take one tablet daily without break, preferably at the same time every day.

If you have an intact uterus and are still menstruating, your doctor would prescribe a separate progestogen hormone as well to take for a specific duration (usually 10 – 14 days) each month. In this case, you will experience a withdrawal bleed after finishing the progestogen tablets. 

• Continuous combined therapy e.g. Activelle®, Femoston® Conti 1/5 

You should take one tablet daily without break, preferably at the same time every day.

• Continuous Estrogen and Cyclic Progestogen Therapy e.g. Femoston® 1/10 and Femoston® 2/10
• Usually contains 14 tablets containing estrogen only, and 14 tablets containing estrogen and progestogen, in one pack. 
• You should take one tablet daily without break, preferably at the same time every day.
• When a pack is finished, the next pack should be started without any break.
  
• You will experience a withdrawal bleed once a month after completion of each pack. 
  

• Triphasic therapy e.g. Trisequens® 
• Contains estrogen tablets and combined estrogen and progestogen tablets in varying doses, in one pack.
• You should take one tablet daily without break, preferably at the same time every day.
• When a pack is finished, the next pack should be started without any break.
• You will experience a withdrawal bleed once a month. 
  

• Cyclic Estrogen and Progestogen e.g. Progyluton® 
  
• Contains estrogen tablets and combined estrogen and progestogen tablets, in one pack.
• You should take one tablet daily for 21 consecutive days, preferably at the same time every day. Then, stop for 7 days – during which time a withdrawal bleed usually occurs.
• Subsequent pack is to be started after the 7 tablet-free days are over, even if you still have bleeding 

Related: Medication, Dispensing & Counselling

What should I do if I forget to take/use this medication?

• Take the missed dose as soon as you remember. Then take your next dose at the usual time. Do not take two doses to make up for the missed dose.
• You may have vaginal bleeding or spotting if you forget to take more than 1 tablet. Please ask your doctor for advice.
  

What precautions should I take?

This medication is NOT meant to be as a birth control method and would not prevent you from getting pregnant.

Inform your healthcare professional if: 

• You are allergic to this medication or any of the other ingredients of this medication
• You are pregnant, planning to become pregnant, or breastfeeding 
• You are taking any other medications, including supplements, traditional medications and herbal remedies.
• You have a history of or current medical conditions such as liver problems, stroke, heart disease, blood clots, migraine headaches, epilepsy, diabetes mellitus or cancer
• You are going for a surgery. You may need to stop taking HRT for a couple of weeks before the surgery.
  

What are some common side-effects of this medication?

• Breakthrough bleeding and spotting
• May occur during the first few months of treatment or if doses are missed. If they persist, seek medical advice.
• Mood changes 
• Take medication at the same time every day to avoid huge changes in the hormone levels in your body, which can lead to mood changes.
• Breast tenderness, slight bloating or fluid retention 
• Nausea and vomiting
• Take the medication after food to reduce these side effects
• Headache
• You may take Paracetamol to manage headaches. Do make sure that you are drinking enough water. 

Consult your doctor about any symptoms that becomes bothersome.

What are some rare but serious side-effects that I need to seek medical advice immediately?

Taking HRT increases a woman’s risk of developing blood clots and breast cancer. However, these are rare and the doctor would have evaluated and weighed its benefits over risks before making the recommendation. Please discuss with your doctor if you have any concerns.

• The symptoms of blood clot include one or more of the following: 
• Any unusual sudden cough, breathlessness or difficulty in breathing
• Severe pain in the chest which may reach the left arm
• Severe pain in legs or swelling in either of your legs
• Weakness or numbness in any part of your body
• Change in your speech, including slurring of words
• Change in your senses of hearing, smell or taste
• Vision changes such as loss of vision/ blurred vision

It is also advisable to regularly check your breasts while you are on HRT.  If you notice any unusual changes, please see your doctor immediately. 

Other rare but serious side effects that you may or may not experience.

• Have unexpected, heavy or longer than usual menstrual bleeding
• Experience dark urine or light coloured stools, nausea, vomiting, loss of appetite, stomach pain, yellowing of your eyes or skin
• Experience bothersome mood changes
• Exhibit signs of a drug allergy
• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body
  

If you experience any of these side effects/ symptoms, you should stop your medication and see your healthcare professional immediately.

What food or medication should I avoid when I take this medication?

Some medications including antibiotics, antifungals and St John’s wort may affect how HRT works or be affected by HRT. Please inform other healthcare professionals about the HRT you are taking if you are seeing them for other medical conditions.

Related: Know Your Medication

How should I store this medication?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children. 

How should I throw away this medication safely?

Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin. 

Disclaimers

If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

Last reviewed on July 2019

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