Bijuve

What is Bijuve?

Bijuve is a modern form of HRT that combines two key hormones in a single, daily capsule. Each soft capsule contains 1 mg of estradiol (as estradiol hemihydrate) and 100 mg of micronised progesterone. It is suitable for postmenopausal women who had their last period more than 12 months ago and still have their womb intact.

What makes Bijuve special is that it's the first body-identical HRT to combine these hormones in one oral capsule. There are similar body identical HRT methods available, such as Utrogestan, but this only contains micronised progesterone, you will need to use a separate oestrogen HRT. With Bijuve, you only need to take one daily pill.

Bijuve contains estradiol and progesterone, which are chemically identical to hormones naturally produced by the body. Some evidence suggests micronised progesterone may have a more favourable risk or tolerability profile than some synthetic progestogens, but individual response and risks vary.

Although Bijuve contains a combination of oestrogen and progesterone, it is not a method of contraception and will not stop you from getting pregnant. If you are looking for contraception, we can provide the following:

• Combined pill
• Mini pill
• Contraceptive ring
• Combined patch
• Morning-after pill 

Who is Bijuve For?

Bijuve is a continuous combined hormone replacement therapy for postmenopausal women who still have a womb (an intact uterus) and have not had a natural period for at least 12 months. Bijuve can treat moderate to severe menopausal symptoms that are affecting your quality of life, such as hot flushes and night sweats.

Bijuve is also suitable for anyone who doesn’t want to use separate oestrogen and progesterone HRT, as each capsule contains both estradiol and micronised progesterone. These are also body-identical hormones, meaning they are derived from plants and have molecular structures that match those of the naturally produced hormones in the body. 

How Do Bijuve HRT Capsules Work?

During menopause, your body's natural production of oestrogen and progesterone decreases dramatically. This change is responsible for many of the symptoms associated with menopause. Bijuve works by supplementing your body's declining oestrogen levels with estradiol (a form of oestrogen used in HRT) to help reduce these symptoms.

For women who still have a womb, Bijuve capsules contain both progesterone and oestrogen, so they remove the need to take a separate progesterone-only HRT alongside oestrogen-only HRT.

The importance of this is that the progesterone in Bijuve helps counteract the impact oestrogen can have on the womb lining, thereby reducing the increased risk of endometrial cancer and endometrial hyperplasia that’s associated with taking oestrogen-only HRT. In one large study of continuous combined oestrogen plus progestogen HRT, the incidence of endometrial cancer was reduced by 35%. 

How Long Do Bijuve Capsules Take to Work?

The time it takes to feel the benefits of Bijuve can vary from person to person. Evidence shows that the frequency and severity of hot flushes reduced as early as 4 weeks after starting treatment. However, it can take up to 3 months to feel the full effects of Bijuve and for the body to adjust to the treatment.

It's important to be patient and consistent with your treatment. If you don't notice improvements after three months, consult with your healthcare provider to discuss your options.

How Effective Are Bijuve 1mg/100mg Capsules?

Bijuve 1mg/100 mg capsules have been shown to reduce the frequency and severity of moderate-to-severe hot flushes in postmenopausal women. A phase 3 clinical trial, which included Bijuve 1mg/100 mg, found that 43-56% of people had no severe hot flushes at week 12, compared with 26% in the placebo group.

Another trial found that after 52 weeks, there was one case of simple endometrial hyperplasia without atypia and no cases of endometrial cancer, supporting Bijuve’s endometrial safety profile.

How to Take Bijuve

The usual dose of Bijuve is 1 capsule daily, taken with a meal. Taking your medication with a meal will help to improve absorption. It should be taken at the same time every day, which is why many people choose to take it with their evening meal. However, there is no specific time of day to take it; just choose a time that suits you. Take one capsule every day without breaks. This continuous dosing helps maintain stable hormone levels and consistent symptom relief.

A clinician will always prescribe the lowest HRT dose to treat your symptoms for the shortest time necessary. You should only take Bijuve exactly as a clinician has told you to. If you think your Bijuve dose is too strong or too weak. Speak to a clinician for advice. 

What if I Take More Bijuve Capsules Than Necessary?

If you take more Bijuve than you should, you may experience drowsiness, dizziness, sleepiness, or tiredness. You should talk to a doctor or go to the hospital if it is an emergency. If you take too much Bijuve, take the medication pack with you.

What if I Miss a Dose of Bijuve?

If you forget to take Bijuve, take it as soon as you remember. However, if it has been more than 12 hours since you should have taken the missed dose, skip it, and take your next capsule at the usual time. Do not take a double dose to make up for a missed one.

If you forget to take Bijuve, there is an increased chance of breakthrough bleeding or spotting. If you are concerned, contact your doctor for more advice. 

What if I Want to Stop Taking Bijuve?

If you would like to stop taking Bijuve, you must speak to a doctor first. They will monitor you as you come off of the treatment, usually over a 3 to 6 month period, to allow your body to adjust to the lower hormone levels and help you avoid a sudden and severe return of menopausal symptoms. 

Bijuve HRT Side Effects and Cautions

Bijuve is used to treat severe hot flushes and other menopause symptoms in postmenopausal women with a uterus. Although it is body-identical, which offers several benefits, it can also cause side effects that you should be aware of before starting Bijuve. 

Side Effects of Bijuve Capsules

Although clinical trials have reported side effects from taking Bijuve HRT, not everyone will experience them. These adverse effects are often mild and tend to improve as your body adjusts to the treatment.

Potential Bijuve HRT side effects include:

This is not a complete list of side effects. You can find a full list of potential adverse effects of Bijuve in the patient information leaflet supplied with the medication.

If you experience any Bijuve side effects, including those not listed here or in the patient leaflet, you should report them to a clinician or to the Yellow Card Scheme. This will help to provide more information about the safety of Bijuve.

Bijuve and Endometrial Hyperplasia

Endometrial hyperplasia is where the lining of the womb (endometrium) becomes abnormally thick. It is not cancer, but if it is not treated, it can increase the risk of endometrial cancer. It is often caused by a hormonal imbalance where there is too much oestrogen and not enough progesterone.

Bijuve contains both oestrogen and progesterone to prevent the womb lining from becoming too thick. The micronised progesterone counteracts oestradiol and encourages the womb lining to shed, reducing the risk of endometrial hyperplasia and protecting you against the increased risk of endometrial cancer associated with oestrogen-only HRT. In the REPLENISH trial, which involved 1,835 women and investigated the efficacy and safety of a combined oral HRT containing oestradiol and natural progesterone, similar to Bijuve, there was just 1 case of simple endometrial hyperplasia without atypia.

Bijuve HRT and Cancer

Because Bijuve contains oestradiol (oestrogen) and micronised progesterone, the latter helps protect you against the increased risk of endometrial cancer associated with oestrogen.

Micronised progesterone is associated with a lower risk of breast cancer compared to that noted with some other oral progestogens. However, the Bijuve patient information leaflet states that oestrogen-progestogen HRT can increase the risk of breast cancer, and that the extra risk depends on how long you use it for. The table below states the increased risk of breast cancer after 5 and 10 years in people who do not take HRT, take oestrogen-only HRT, or combined oestrogen and progesterone HRT.

You should regularly check your breasts while taking Bijuve and see a doctor if you notice any changes, such as:

• changes in the appearance of the nipple
• dimpling of the skin on or around the breast
• any lumps you can see or feel

You should also attend any mammography screening sessions you are offered. Tell the nurse or clinician conducting the screening that you are taking HRT, as this can affect your results.

There is also a slightly raised risk of ovarian cancer in people who take oestrogen-only or oestrogen-progesterone HRT, but the risk can vary with age. For example, in people aged 50 to 54:

• Who are not taking HRT, around 2 in 2000 will be diagnosed with ovarian cancer over a 5-year period
• Who have been taking HRT for 5 years, 3 in 2000 people will be diagnosed

If you have any concerns about the risk of cancer while taking Bijuve, you should discuss them with a clinician during your consultation.

Bijuve Capsules and Blood Clot Risk

It is thought that HRT users are 1.3 to 3 times more likely to get a blood clot in their veins than non-users, especially during the first year of use.

For women in their 50s who are not taking HRT, an average of 4 to 7 in 1000 would be expected to develop a blood clot in a vein over a 5-year period. This is compared to 9 to 12 people in 1000 who have been taking a combined oestrogen and progesterone form of HRT for over 5 years.

Evidence from other studies suggests that micronised progesterone (also known as ‘body identical’ progesterone), like that used in Bijuve, is unlikely to increase the risk of venous thrombosis (blood clots in the veins).

Blood clots are dangerous and can cause medical emergencies, such as heart attacks or strokes. You are more likely to get a blood clot if you:

• Are unable to walk for a while because of major surgery, an illness, or an injury
• Are seriously overweight (a body mass index (BMI) above 30)
• Have a blood-clotting problem that requires long-term medication
• Have close relatives who have ever had a blood clot in the leg, lung, or other organ
• Have systemic lupus erythematosus
• Have cancer

If you are worried about the link between Bijuve and blood clots, speak to a clinician for more advice.

Interactions and Warnings for Bijuve Capsules

While Bijuve can be highly effective, it's not suitable for everyone. Several medical conditions and medications can interfere with Bijuve, making it less effective or even dangerous. That’s why it is important to have a medical consultation before taking it. You should not use Bijuve if you:

• Are allergic to estradiol hemihydrate, progesterone, or any other listed ingredient
• Have current, past, or suspected breast cancer
• Have known or suspected oestrogen-dependent tumours or cancer, such as cancer of the womb lining (endometrium)
• Have any unexplained vaginal bleeding
• Have untreated excessive thickening of the womb lining (endometrial hyperplasia)
• Have a history of venous thromboembolism (blood clots in the veins)
• Have a blood-clotting disorder
• Have recently had a disease caused by blood clots in the arteries, such as a heart attack, stroke, or angina
• Have or have ever had liver disease, and your liver function tests are not yet back to normal
• Have a rare, inherited blood problem called porphyria
• Are pregnant or breastfeeding (although this is unlikely if you're menopausal)

Bijuve Interactions

Bijuve can affect the way some medicines work and vice versa, which can cause irregular bleeding or other side effects. It’s important that you tell a clinician about any prescribed, over-the-counter, or herbal medicines you are taking before starting Bijuve, especially medications to treat:

• Epilepsy
• Tuberculosis
• HIV infections
• Pituitary gland issues or Parkinson’s disease (bromocriptine)
• Fungal infections (ketoconazole, griseofulvin)
• Immune system suppression (ciclosporin)

Bijuve can affect the way the following work:

• Lamotrigine to treat epilepsy
• Hepatitis C medications (ombitasvir/paritaprevir/ritonavir and dasabuvir with or without ribavirin with glecaprevir/pibrentasvir or sofobuvir/velatasvir/voxilaprevir)

When to Take Special Care with Bijuve HRT

Extra care should be taken if you have any of the following medical conditions and are considering Bijuve as a method of HRT. Tell your doctor about any of the following because you may need more frequent check-ups:

• Fibroids in the womb
• Growth of the womb lining outside of the womb (endometriosis) or a history of excessive growth of the womb lining (endometrial hyperplasia)
• Increased risk of developing blood clots
• Increased risk of oestrogen-sensitive cancer
• High blood pressure
• A liver disorder, such as a benign liver tumour
• Diabetes
• Gallstones
• Migraine or severe headaches
• An immune system disease that affects many organs, such as systemic lupus erythematosus (SLE)
• Epilepsy
• Asthma
• A disease that affects the eardrum and hearing (otosclerosis)
• High blood fat levels (triglycerides)
• Fluid retention caused by heart or kidney problems
• Hereditary or acquired angioedema

Pregnancy and Breastfeeding

Bijuve is recommended for postmenopausal women, so although pregnancy is unlikely, if it occurs while taking this medication, you should stop taking it immediately and contact a clinician for advice.

Bijuve must not be used during breastfeeding. You must tell a clinician if you are breastfeeding before starting Bijuve.

Where Can I Buy Bijuve in the UK?

Bijuve is a prescription-only medication. That means you will need to have a brief consultation or complete a medical questionnaire for a clinician to review, so they can determine whether Bijuve is safe for you. It is usually available on the NHS and via a private prescription.

Do I Need a Prescription for Bijuve Capsules?

Yes, you do need a prescription for Bijuve, so you cannot buy it over the counter. 

Is Bijuve on the NHS?

Yes, Bijuve is widely available on the NHS in Scotland, but its availability is more limited in England. You should make an appointment with your GP if you are looking to get Bijuve on the NHS to find out if it is available in your area or to discuss alternative options. 

Can I Buy Bijuve Online?

Yes, you can buy Bijuve online from trusted pharmacies, such as Prescription Doctor. You must complete a short online consultation, including a medical questionnaire, so our clinician can determine whether Bijuve is right for you.

To buy Bijuve online from Prescription Doctor, you’ll need to:

• Complete our online consultation form. It's quick, confidential, and can be done at your convenience.
• Our UK-registered clinicians will review your information to ensure Bijuve is appropriate and safe for you.
• We will dispatch your medication in plain packaging to maintain discretion.
• If approved before 3pm on a weekday, your order will be eligible for next-day delivery, ensuring you get your medication quickly and conveniently.

There is no need for in-person GP appointments or trips to the pharmacy.

Frequently Asked Questions About Bijuve HRT