Femoston

What is Femoston?

Femoston is a range of hormone replacement therapy (HRT) tablets used to treat oestrogen deficiency symptoms in postmenopausal women. Each medicine in the range contains two active ingredients: oestradiol, a form of the hormone oestrogen, and dydrogesterone, a synthetic progestogen. Both of these hormones work together to relieve menopausal symptoms while protecting the lining of the womb in women who still have their uterus. It is a prescription-only medicine (POM).

Femoston 1/10 contains 1mg oestradiol and 10mg dydrogesterone. It is typically the recommended starting dose, suited to women in the early postmenopausal period. Meanwhile, Femoston 2/10 contains 2 mg oestradiol and 10mg dydrogesterone. It may be prescribed when a higher oestrogen dose is needed to adequately control symptoms. Both Femoston 1/10 and 2/10 are cyclical (sequential) regimens in which the two hormones are taken in separate phases over a 28-day cycle, resulting in a predictable monthly withdrawal bleed for most women. 

At Prescription Doctor, we also stock Femoston Conti, a continuous combined HRT that is available in two strengths. 

How Does Femoston Work?

Femoston contains two hormonally active ingredients that work together to address the bodily changes that occur during and after menopause.

Oestradiol

As the ovaries produce less oestrogen during menopause, falling hormone levels drive many common symptoms. The most common ones are hot flushes, night sweats, vaginal dryness, sleep disturbance and mood changes. In Femoston, the exact oestradiol is synthetic 17β-oestradiol. This is both chemically and biologically identical to the oestradiol naturally produced by the ovaries. By boosting these falling levels, Femoston helps to relieve menopausal symptoms effectively. Oestrogen also plays a key role in maintaining bone density, and restoring oestrogen levels helps slow the faster rate of bone loss that follows menopause, reducing the risk of osteoporosis, a condition that weakens bones.

Dydrogesterone

In women who still have a womb (uterus), taking oestrogen without a progestogen causes the womb lining (endometrium) to thicken over time, increasing the risk of endometrial (womb) cancer.

Dydrogesterone is an orally active synthetic progestogen that works much like natural progesterone. By opposing oestrogen's effect on the endometrium, it shifts the lining from the growing phase to the secretory phase, stabilising and protecting it throughout the treatment cycle.

In the cyclical regimens (Femoston 1/10 and 2/10), dydrogesterone is taken during the second phase of the cycle alongside oestradiol, triggering a withdrawal bleed at the end of each cycle for most women. This differs from Femoston Conti, in which both hormones are taken continuously, typically eliminating the monthly bleed.

How Long Does Femoston Take to Work?

The time it takes for HRT to take effect can vary from person to person. Many people begin to notice improved symptoms within a few weeks. For sequential forms of HRT ( such as Femoston 1/10 and Femoston 2/10), it can take up to 3 months to reach its full effect. This is broadly the same for all forms of oral HRT products. 

Does Femoston Work for HRT?

Femoston has been studied extensively in clinical trials involving thousands of postmenopausal women, with robust evidence establishing its effectiveness for relieving oestrogen deficiency symptoms. NICE guidance recognises HRT as an effective treatment available for menopausal symptoms, and Femoston's oestradiol component addresses the hormonal deficiency driving them.

Symptom relief typically occurs within the first few weeks of treatment. A Cochrane systematic review (recognised as high-quality clinical research) of randomised, double-blind, placebo-controlled trials found that taking HRT reduced hot flush frequency by approximately 75% and significantly reduced its severity compared with placebo.

The Femoston summary of product characteristics (SmPC) confirms that, in clinical trials, menopausal symptom relief was achieved within the first few weeks in both sequential regimens (Femoston 1/10 and Femoston 2/10).

Responses will vary from person to person, and Femoston works best alongside lifestyle measures such as regular exercise, a balanced diet, and reduced alcohol intake. Femoston is also licensed for the prevention of osteoporosis in postmenopausal women at high risk who cannot tolerate other approved treatments.

How to Take Femoston 1/10 and 2/10 Tablets

Detailed instructions for taking Femoston are included in the Patient Information Leaflet that comes with the medication. Take one tablet a day without interruption between packs. Swallow whole with water. You can take Femoston with or without food. Your prescriber will aim to give you the lowest possible dose for the shortest time that adequately treats your symptoms.  

Each 28-day strip/cycle contains 28 tablets, divided into two phases. For the first 14 days, take one white tablet daily for Femoston 1/10, or one red tablet daily for Femoston 2/10. For the following 14 days, take one grey tablet daily for Femoston 1/10 or one yellow tablet daily for Femoston 2/10. After completing the 28-day cycle, begin the next strip immediately without a break. A withdrawal bleed typically occurs during or shortly after the grey/yellow tablet phase and is expected with this regimen. 

Femoston Dosage Information

Femoston 1/10 is generally the recommended starting dose for most postmenopausal women. If symptoms (such as hot flushes, night sweats or vaginal dryness) are not adequately controlled after a trial period, your prescriber may increase this to Femoston 2/10 for a stronger oestrogen effect.

Use the lowest effective dose for the shortest necessary duration. Your prescriber should review whether continuing HRT is still appropriate for your circumstances at least once a year.

If You Forget to Take Femoston Tablets

What to do if you forget to take Femoston tablets depends on how long it has been since you should have taken your dose. If it’s less than 12 hours, take a pill and then wait until your next scheduled dose. If more than 12 hours have passed, skip the missed dose and take the next one at your usual time. Do not try to double up and make up for a missed dose. Bleeding or spotting may occur if you miss a dose of HRT. 

If You Take Too Much Femoston

If you take too many Femoston tablets, you may experience symptoms such as nausea, vomiting, tender or painful breasts, dizziness, abdominal pain, drowsiness/tiredness, or withdrawal bleeding. However, you are unlikely to come to any harm. If you are at all worried, contact your clinician for advice. 

Femoston Side Effects and Cautions

Before using Femoston for the first time, you should review the following side effects and safety information. Carefully consider the risks vs benefits of using HRT. If you have any concerns about whether Femoston is suitable for you, contact one of our expert prescribers. 

Femoston 1/10 and 2/10 Side Effects

As with any medication, unwanted side effects from Femoston use can occur. Not everyone who uses Femoston will experience side effects. The table below includes a list of some of the reported side effects: 

Please note that the above is not an exhaustive list of possible Femoston side effects. Further side effects have been reported in all forms of HRT (including Femoston). More details can be found within the Patient Information Leaflet enclosed with the medication. You can also report any adverse reactions to your clinician or using the MHRA’s Yellow Card Scheme. 

Serious Side Effects of Femoston 1/10 and 2/10

Serious side effects can occur. If you notice any of the following, stop taking Femoston immediately and contact your doctor:

• Allergic reactions (swelling around the face, tongue, throat, and neck, or difficulty breathing) 
• Heart attack (chest pain) 
• Tumours that may be affected by levels of progestogens (e.g., meningioma) 
• Heavy, irregular, or painful genital bleeding
• A large rise in blood pressure (symptoms include headaches, tiredness, and dizziness) 
• Migraine headaches for the first time 
• Signs of a blood clot (painful swelling and redness of the legs, sudden chest pain, or difficulty breathing) 
• Yellowing of the skin or whites of the eyes (jaundice)

Femoston includes a progestogen component that protects the womb from the extra risk of womb cancer associated with unopposed oestrogen. However, you should still remain vigilant for abnormal bleeding. See your doctor as soon as possible if you experience irregular or unexpected bleeding or spotting that carries on after the first 6 months of treatment, starts after you have been taking Femoston for 6 months, or carries on after you have stopped taking it. The use of HRT has also been associated with an increased risk of breast and ovarian cancer. The Patient Information Leaflet contains more information about the risk breakdown.

The risk of blood clots in a vein is 1.3 to 3 times higher in women who use HRT. This risk increases with age. Your prescriber will assess your medical history to determine whether you have any risk factors that would increase your risk of blood clots. Women over 60 who use oestrogen-progestogen HRT are slightly more likely to develop heart disease. The risk of stroke is also 1.5 times higher in HRT users, and this risk increases with age.

There is some evidence that there is a higher risk of memory loss in women who start using HRT after the age of 65. 

Femoston Warnings and Interactions

Femoston is prescribed for postmenopausal women (at least six months since their last period) experiencing oestrogen deficiency symptoms. It is not suitable for women with:

• Breast cancer, either current, previous, or if you are suspected of having it
• An oestrogen-sensitive cancer, or you are suspected of having one
• A progestogen-sensitive tumour
• Current or previous meningioma
• Unexplained genital bleeding 
• Untreated endometrial hyperplasia 
• Liver disease and your liver tests have not returned to normal
• A current or a history of blood clots in a vein (such as in the lungs or legs) 
• A blood clotting disorder 
• A current or recent condition caused by blood clots in the arteries, such as heart attack, stroke, or angina
• Porphyria
• An allergy to oestradiol or dydrogesterone or any other ingredient in Femoston

If any of these conditions appear for the first time while taking Femoston, stop taking it and speak to your doctor immediately. 

Precautions Before Taking Femoston

Before you are prescribed Femoston for the first time, your prescriber will assess your medical history. Certain conditions may recur or worsen during HRT. Tell your prescriber if you have any of the following:

• Fibroids inside your womb
• Growth of womb lining outside your womb (endometriosis) or a history of excessive growth of the womb lining (endometrial hyperplasia)
• Increased risk of developing blood clots
• Increased risk of getting an oestrogen-sensitive cancer 
• High blood pressure
• A liver disorder
• Diabetes
• Gallstones
• Migraine or severe headaches
• A disease of the immune system that affects many organs of the body (systemic lupus erythematosus, SLE)
• Epilepsy
• Asthma
• A disease affecting the eardrum and hearing (otosclerosis)
• A very high level of fat in your blood
• Fluid retention due to cardiac or kidney problems
• Hereditary and acquired angioedema.

You should also tell your clinician if you are due to have planned surgery, as you may need to stop taking it around 4-6 weeks before the operation to reduce the risk of a blood clot. Advise your surgeon that you have been taking the treatment as well. Your clinician will let you know when to restart the medication.

Femoston and Other Medicines

Some medicines may interfere with the effect of Femoston and may cause irregular bleeding. This includes medicines used to treat epilepsy, tuberculosis, and HIV, as well as herbal remedies including St John’s Wort.

Tell your prescriber if you are taking or have recently taken any prescribed medicines, herbal remedies, supplements, or over-the-counter treatments. The following medicines may interact with Femoston:

• Lamotrigine
• Medicines for Hepatitis C 
• Tacrolimus and cyclosporin 
• Fentanyl 
• Theophylline

Your prescriber may advise you that Femoston is not suitable, or to seek advice from your general practitioner or specialist about your other medications.

Femoston is not a contraceptive and should only be used by post-menopausal women. However, if it has been less than 12 months since your last menstrual period or you are under the age of 50, you may still need to consider using contraception. Speak to your prescriber for advice. If you become pregnant while taking Femoston, stop using the medication and contact your doctor. 

Frequently Asked Questions About Femoston HRT