Description
How it works
Around the menopause, the ovaries produce far less oestrogen, which can lead to:
- Hot flushes and night sweats
- Sleep problems, low mood or irritability
- Vaginal dryness or discomfort during sex
- Joint or muscle aches
Elleste Duet replaces some of this missing hormone:
- Estradiol (oestrogen) eases menopausal symptoms and helps slow down bone loss that occurs after the menopause.
- Norethisterone acetate (progestogen), taken in the second part of the cycle, protects the lining of the womb (endometrium) from becoming too thick, which reduces the risk of endometrial hyperplasia and endometrial cancer in women who still have a uterus.
Elleste Duet is a sequential HRT:
- First part of the month: oestrogen only (white tablets)
- Second part: oestrogen + progestogen (green tablets)
This regimen mimics a more natural cycle and is typically used for peri- or early postmenopausal women who may still get some bleeding.
Important: Elleste Duet is not a contraceptive and will not prevent pregnancy.
Who it may be suitable for
Elleste Duet may be suitable for:
- Perimenopausal and postmenopausal women with oestrogen-deficiency symptoms that affect quality of life
- Women who still have their womb and need combined oestrogen–progestogen HRT
- Women who are within a few years of their last natural period and are suitable for a cyclical/sequential HRT pattern
Experience in women over 65 years is limited, so treatment in this group needs individual assessment and regular review.
Who should not take Elleste Duet
Do not take this medicine if you:
- Have breast cancer now, have had it in the past, or are suspected of having it
- Have or are suspected of having an oestrogen-dependent tumour (e.g. endometrial cancer)
- Have unexplained genital/vaginal bleeding
- Have untreated endometrial hyperplasia (thickening of the womb lining)
- Have ever had a blood clot in a vein (deep vein thrombosis or pulmonary embolism)
- Have a known thrombophilic disorder (e.g. protein C, protein S or antithrombin deficiency)
- Have active or recent arterial disease (e.g. angina, heart attack, stroke)
- Have acute liver disease, or a history of liver disease with abnormal liver tests
- Are allergic to estradiol, norethisterone, or any of the ingredients
- Have porphyria
- Are pregnant or breastfeeding (HRT is not indicated in pregnancy or while nursing)
It must not be used in children or adolescents.
Use with extra care / medical supervision
You may still be able to use Elleste Duet , but need closer monitoring, if you have or have had:
- Fibroids (uterine leiomyoma) or endometriosis
- Risk factors for blood clots (obesity, prolonged immobility, major surgery, strong family history, systemic lupus erythematosus, cancer)
- Strong family history of breast cancer
- High blood pressure
- Liver problems, including liver adenoma
- Diabetes, with or without vascular complications
- Gallstones or gallbladder disease
- Migraine or severe headaches
- Systemic lupus erythematosus (SLE)
- Previous endometrial hyperplasia
- Epilepsy, asthma or otosclerosis
- Markedly raised triglycerides
- Tendency to fluid retention, heart or kidney disease
- Hereditary or acquired angioedema
Treatment should be reviewed at least once a year, and continued only while the benefits outweigh the risks.
Side Effects
Not everyone gets side effects, and many are mild and settle as your body adjusts in the first few months.
The most commonly reported effects are:
- Breast tension and pain
- Period-type pain (dysmenorrhoea)
- Irregular bleeding or spotting
- Headache
From clinical data, other side effects include:
Mood and nervous system
- Depression, low mood, nervousness, mood swings
- Headache, migraine
- Dizziness, difficulty sleeping (insomnia)
- Tingling sensations (paraesthesia)
Circulation
- Raised blood pressure (hypertension)
- Varicose veins
- Venous blood clots (venous thromboembolism) or thrombophlebitis (less common but serious)
Digestive system
- Nausea, abdominal pain, bloating, indigestion, diarrhoea
- Occasionally vomiting
Skin and hair
- Acne, rash, itching, dry skin
- Skin discolouration (for example, brown patches – chloasma)
- Unwanted hair growth (hirsutism) or hair loss (alopecia)
Muscles, joints and general
- Back pain, pain in arms or legs
- Muscle cramps or muscle weakness
- Fluid retention and swelling (oedema), especially ankles/legs
- Weight gain
Breast and reproductive system
- Breast pain, tenderness, enlargement
- Menstrual disorders, heavier or irregular bleeding, painful periods
- Vaginal discharge or infection
- Endometrial hyperplasia, uterine fibroids or cysts in some cases
Liver and gallbladder
- Gallbladder disease, gallstones
- Cholestatic jaundice (itching and yellowing of the skin/eyes)
There are also long-term risks associated with HRT in general (oestrogen-only and combined), including:
- A small increase in the risk of breast cancer (related to treatment duration)
- Increased risk of endometrial cancer if oestrogen is used without adequate progestogen in women with a womb
- Slight increase in ovarian cancer risk
- Increased risk of blood clots in the legs or lungs (DVT/PE)
- Slightly increased risk of coronary artery disease in older women
- Increased risk of ischaemic stroke, particularly with age
Stop taking Elleste Duet and seek urgent medical help if you notice:
- Painful swelling, redness or warmth in one leg
- Sudden chest pain, shortness of breath, or coughing up blood
- Sudden severe headache or migraine, especially with visual or speech problems
- Yellowing of the skin or eyes, dark urine or severe itching
- A new breast lump or nipple changes
- Sudden heavy vaginal bleeding, or new bleeding after being period-free for some time
Patient Information Leaflet
Please see HERE for the Patient Information Leaflet
Additional Info
Key points about Elleste Duet :
- Type of medicine: Continuous sequential combined HRT tablet
- Active ingredients:
- White tablet: estradiol
- Green tablet: estradiol + norethisterone acetate
- Indication: Treatment of oestrogen-deficiency symptoms in peri- and postmenopausal women
- Bone health: Helps reduce bone loss, but the 2 mg strength (Elleste Duet 2 mg) is the one additionally licensed for prevention of postmenopausal osteoporosis in high-risk women; Elleste Duet is primarily for symptom relief.
- Route: Oral – tablet swallowed whole
- Not contraceptive: does not prevent pregnancy; women who could still conceive should use non-hormonal contraception
- Contains lactose: both tablet types contain lactose monohydrate and are unsuitable for women with rare hereditary problems of galactose intolerance, total lactase deficiency, or glucose-galactose malabsorption.
- Driving and machines: no or negligible effect on ability to drive or use machines.
Interactions:
- Some medicines can increase the breakdown of oestrogens and progestogens and may reduce HRT effectiveness or change bleeding patterns, for example:
- Certain epilepsy medicines (phenobarbital, phenytoin, carbamazepine)
- Rifampicin, rifabutin
- Some HIV medicines (e.g. nevirapine, efavirenz, ritonavir, nelfinavir)
- Herbal products containing St John’s wort
- HRT containing oestrogens may lower lamotrigine levels, potentially reducing seizure control.
- Oestrogens can alter some blood test results, especially thyroid function and hormone-binding proteins.
Regular check-ups are recommended, including breast examinations and mammograms, following your doctor’s advice.
Directions
Elleste Duet tablets are for oral use. Swallow them whole with water, without crushing or chewing.
Standard dosing schedule
Elleste Duet is a continuous sequential HRT taken in a 28-day cycle:
- Days 1–16:
- Take one white tablet ( estradiol) once daily
- Days 17–28:
- Take one green tablet ( estradiol + norethisterone acetate) once daily
At the end of the 28 days, you start the next pack straight away with no tablet-free break.
Try to take your tablet at about the same time each day to help you remember.
The aim is always to use the lowest effective dose for the shortest time needed to control symptoms.
When to start
- If you have established amenorrhoea (no periods) or very long gaps between periods:
- You can usually start at any time.
- If you are still having periods:
- It is advised to start on the first day of bleeding.
- If you are switching from another HRT:
- From a cyclical or continuous sequential HRT: finish the current cycle, then start Elleste Duet the next day without a break.
- From a continuous combined HRT: you may start at any time if you are not bleeding, or on the first day of a bleed if you still have periodic bleeding.
Always follow the advice and schedule set by your prescriber.
Missed a dose?
If you forget to take a tablet:
- If less than 12 hours late:
- Take the missed tablet as soon as you remember, then take the next tablet at the usual time.
- If more than 12 hours late:
- Skip the missed tablet and take your next tablet at the usual time.
Do not take two tablets together to make up for a missed dose.
Missing tablets increases the likelihood of breakthrough bleeding or spotting.
FAQs
What is Elleste Duet used for?
Elleste Duet is a combined oestrogen-progestogen HRT used to treat oestrogen-deficiency symptoms such as hot flushes, night sweats, and mood changes in peri- and postmenopausal women who still have their womb.
What does “continuous sequential HRT” mean?
Continuous sequential HRT involves taking one tablet every day without a break, starting with oestrogen-only tablets for the first 16 days followed by combined tablets for the remaining 12 days, a pattern that usually results in a monthly bleed for perimenopausal women.
Will I still get bleeding on Elleste Duet?
Many women experience a regular monthly withdrawal bleed or occasional spotting while using this sequential HRT, but you should consult a doctor if bleeding becomes very heavy, prolonged, or occurs unexpectedly after a period of no bleeding.
Is Elleste Duet a contraceptive?
No, Elleste Duet is not a contraceptive and does not prevent pregnancy, so you should use non-hormonal methods like condoms if you are still able to conceive.
When should I start taking it?
If you no longer have periods you can typically start at any time, but if you still have them you should start on the first day of bleeding; switching from other HRT depends on your current cycle and should be guided by your prescriber.
What if I miss a tablet?
If you miss a tablet by less than 12 hours you should take it immediately, but if more than 12 hours have passed you should skip the dose and resume as normal without doubling up, though you may experience some spotting as a result.
Does Elleste Duet cause weight gain?
While some women experience mild weight changes or fluid retention, these effects vary and are often linked to menopause itself, making a balanced diet and regular exercise important throughout treatment.
What serious risks should I be aware of?
Systemic HRT carries small increased risks of breast, endometrial, and ovarian cancers, as well as blood clots, stroke, and heart disease, which should all be reviewed annually with your 24 HR Pharmacy clinician based on your personal risk factors.
How long can I stay on Elleste Duet?
There is no set maximum duration for treatment, but the general guideline is to use the lowest effective dose for the shortest time necessary to manage symptoms, with annual reviews to determine if treatment should be continued or adjusted.
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