Answered by Hema Love, a registered pharmacist in our Health at Hand team.
Premique is a medicine that alleviates symptoms of the menopause.
Between the ages of 45 and 55 years old, most women start the menopause. This is where you stop having your monthly menstrual periods – it is officially diagnosed once you have no menstrual periods for 12months if you are over 50. If you are under 50 you will be diagnosed as having the menopause if you have not had a period for 2 years.
During the menopause your body stops making regular amounts of oestrogen. The amount of oestrogen in the body reduces considerably, and you can start experiencing symptoms.
The symptoms of the menopause are different for every woman, but can include:
Premique provides oestrogen to replace the lack of natural oestrogen produced by the body. This is why it is known as a hormone replacement therapy (known as HRT).
Premique and Premique low dose also contain a progesterone component, called medroxyprogesterone acetate or MPA. If you have an intact uterus you will need progesterone to prevent the thickening of the womb (endometrium) lining. This thickening is known as endometrial hyperplasia. Endometrium hyperplasia can increase your risk of womb (endometrial) cancer, or cancer of the uterus.
If you are thinking about starting HRT – whether that is Premique low dose or any other product – you must discuss this with your doctor. When selecting an HRT a great deal depends on your own individual needs, beliefs and circumstances.
The manufacturer of Premique, Pfizer, had two Premique products: Premique (which contained 0.625mg conjugated oestrogen (a mixture of naturally occurring oestrogens) and 5mg of medroxyprogesterone (a type of progesterone) and Premique low dose.
As the names suggest, the difference between the two products was dosage. Premique low dose contains 0.3mg of conjugated oestrogen and 1.5mg of medroxyprogesterone.
In November 2016, Pfizer discontinued Premique 0.625mg/5mg and started only producing Premique low dose.
Currently there are no problems with stocks of Premique low dose.
The active ingredients in Premique low dose are conjugated estrogens 0.3mg and medroxyprogesterone acetate (MPA) 1.5 mg.
Premique low dose has a lower amount of oestrogen and progesterone than the previously available Premique 0.625mg/5mg. It is licensed to be taken as a one-a-day tablet.
Women who've previously taken by the higher strength Premique tablets may find that their symptoms are not adequately controlled by Premique low dose so they will have to find an alternative that suits them.
The closest alternative HRT to Premique is Premarin 0.625, which contains 0.625mg conjugated oestrogen, taken with 5mg of medroxyprogesterone (as a separate tablet).
Pfizer who used to make Premique and now make Premique low dose and Premarin have assured us that Premarin has the same conjugated oestrogens are those in Premique and Premique low dose.
Premique (i.e. the original 0.625mg version) combined both conjugated oestrogens and progesterone (medroxyprogesterone acetate) in one tablet.
This is a form of continuous combined HRT, prescribed for post-menopausal women who still have a uterus and have not had a period for more than one year. If this is the one you were previously taking and you would like – or need – to continue taking it, speak to you doctor to arrange a suitable alternative.
There are three main options open to you.
As discussed above, the closest alternative is to take the two ingredients in Premique – oestrogen and progesterone – as two different tablets. Premarin is a brand of conjugated oestrogens tablets, available in three strenght: 0.3mg, 0.625mg and 1.25mg. Currently there are no problems with stock availability.
If you wanted to have the exact amount as that in Premique you could take one tablet of Premarin 0.625mg and one medroxyprogesterone 5mg tablet.
Climanor and Provera are two brands of medroxyprogesterone 5mg tablets on the market.
Climanor is currently unavailable and the manufacture is not able to say when it will be in stock.
Provera 5mg tablets is currently freely available.
The second option is to take a combination of oestradiol and progesterone in various forms, including tablets, gels, patches and intrauterine devices (IUD or coil), depending on what works best for you.
Oestradiol can be be a synthetic or body identical form of oestrogen. Elleste Duet Conti, Kliofem, Femostin 2/10mg, Indivina 2+5, and Tridestra are alternatives to Premique. They are in tablet form and contain 2mg of oestradiol but various different types’ progesterone.
Of these, Indivina2+5 is the closest to Premique in terms of the progesterone content because it contains 5mg of medroxyprogesterone acetate (MPA). However, Indivina2+5 tablets are currently out of stock. The manufacturer informs us that more supplies are due in September 2019.
Nuvelle Continuous is another alternative HRT but this has been discontinued in the UK.
If you prefer to try an HRT patch, Evorel Conti is the first line of this type of treatment option. Patches are suitable commonly for those who suffer from migraine or those who are more prone to having a clot such as DVT.
Each Evorel Conti patch contains oestradiol 50micrograms and norethisterone 170micrograms. You change the patch twice a week.
There has been a shortage of Evorel Conti patches in the recent past. However, Jansen-Cilag who manufacture of Evorel Conti patches report they are back in stock. Anyone having difficulty getting them on prescription due to stock availability will need to ask their local pharmacist to directly contact Jansen-Cilag, who will ensure a small supply can be sent to that pharmacy via the wholesalers.
Femseven patches are no longer available in the UK.
Other alternatives include oestrogen only tablets, patches or gels, plus progesterone tablets or having the Mirena coil (an IUD) inserted. The Mirena coil releases continuous progesterone into the womb. It is licensed to be used as a contraceptive and as part of HRT.
The body identical micronised progesterone known as Utrogestan tablets is the latest form of progesterone available in the HRT armament. It is similar to the natural progesterone made by the body and it is derived from plants.
The third option is to switch to tibolone 2.5mg tablets, also known by its brand name Livial. Tibolone tablets contain a synthetic molecule with oestrogen, progestogen and androgenic (male hormone-like) properties.
All HRT treatment has side effects so check your patient information leaflet for these. Some risks associated with HRT that are of more concern include:
It is important to get your HRT dose absolutely right because the higher the amount of oestrogen the higher your risk of developing these – the lower amount of oestrogen, the lower the risk.
Recent evidence and the National Institute for Health and Care Excellence's (NICE) new guidelines say that the risks of HRT are small and are usually outweighed by the benefits.
We have more information about taking HRT for the menopause in a previous Ask the Expert response.
As you can see there are various different options open to you. We suggest you discuss this matter with your GP or specialist, who can help you decide which of the options is most suitable for you after taking into consideration your own particular risks and individual needs.
For more information about the different HRT products available, or if you're struggling to get your usual HRT please contact the Health at Hand team and speak to a pharmacist (telphone service available for members only), or submit your question online via our Ask the Expert service and we'll get back to you with an answer as soon as we're able - usually within a matter of hours.
The Ask the Expert service is available 24 hours a day, 365 days a year to help with any health concerns you have, whether you're an AXA Health member or not.
You can find further information about the menopause and other female health issues in our women's health hub.
Please note at the time of writing (14th August 2019) the HRT products mentioned are currently available in the UK. We have checked with the manufacturers that there are no shortages of stock apart from those exceptions named in the article.
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