Elleste Duet Tablets

Elleste Duet Tablets are a combined hormone replacement therapy (HRT) prescribed to women experiencing menopausal symptoms. Available in a 2 mg strength, they contain oestradiol, a naturally occurring form of oestrogen, alongside norethisterone acetate, a progestogen. Together, these two hormones work to reduce the frequency and severity of hot flushes, night sweats, mood disturbance, and other troublesome symptoms associated with the menopause. Elleste Duet is designed for women who still have their uterus, providing both oestrogenic benefit and progestogenic protection of the uterine lining.

Menopause is a natural stage of life, yet for many women the physical and psychological changes it brings can significantly affect day-to-day wellbeing. HRT tablets such as Elleste Duet have been used for decades to support women through this transition. If you are considering HRT, a clinical consultation is the essential first step to establish whether this treatment is right for you.

Elleste Duet is a sequential combined HRT tablet. It contains two types of hormone: oestradiol valerate (a synthetic form of the oestrogen oestradiol) and norethisterone acetate (a synthetic progestogen). The tablets are packaged in a calendar-style blister strip of 28 tablets, divided into two phases across the monthly cycle.

The first phase comprises 16 white tablets containing only oestradiol 2 mg. The second phase comprises 12 green tablets, each containing oestradiol 2 mg plus norethisterone acetate 1 mg. This sequential approach means that the progestogen is introduced in the second half of the cycle, mimicking the natural hormonal rhythm of the menstrual cycle and allowing a regular withdrawal bleed.

The menopause occurs when the ovaries gradually stop producing oestrogen and progesterone. Falling oestrogen levels are responsible for most menopausal symptoms, including hot flushes, vaginal dryness, disturbed sleep, and mood changes. Elleste Duet replaces the oestrogen the body is no longer producing, reducing these symptoms.

Oestradiol, the active oestrogen in Elleste Duet, binds to oestrogen receptors throughout the body, including in the brain, bone, cardiovascular system, and urogenital tissues. By restoring oestrogen activity at these receptor sites, the treatment helps to stabilise body temperature regulation, support bone density, and improve quality of life during the menopausal transition.

Because oestrogen given alone (unopposed oestrogen) can cause the uterine lining to thicken excessively, potentially increasing the risk of endometrial cancer, Elleste Duet includes norethisterone acetate during the second phase of each cycle. This progestogen counteracts oestrogen-driven thickening of the endometrium and promotes a regular withdrawal bleed, protecting the uterus in women who have not had a hysterectomy.

In summary, the combined sequential approach of Elleste Duet provides the symptom-relieving benefits of oestrogen alongside the uterine safety offered by a progestogen.

Starting Treatment

Your prescriber will advise when to begin taking Elleste Duet. If you are currently having periods, treatment usually starts on the first day of your period or within the first five days of bleeding. If your periods are irregular or have stopped, your prescriber will advise a suitable starting day.

Taking the Tablets

Take one tablet daily without a break, following the direction of the arrows on the blister pack. Swallow each tablet whole with a drink of water. Tablets can be taken with or without food, at whatever time of day suits you best, though consistency is important: aim to take your tablet at approximately the same time each day.

Begin with the 16 white oestrogen-only tablets, then continue with the 12 green combined tablets. After completing all 28 tablets, start a new pack immediately. You should expect a withdrawal bleed, similar to a light period, during or shortly after taking the green tablets.

Missed Doses

If you miss a tablet and remember within 12 hours, take it as soon as possible and continue the pack as normal. If more than 12 hours have passed, skip the missed tablet and resume your usual schedule the following day. Do not take two tablets to make up for a missed one. Missing tablets may trigger spotting or breakthrough bleeding and could reduce the effectiveness of the treatment.

Duration of Treatment

The duration of HRT is an individual clinical decision. Most guidelines recommend using the lowest effective dose for the shortest time necessary to manage symptoms. Your prescriber will review your treatment regularly and discuss the benefits and risks as they apply to you.

Elleste Duet 2 mg

Elleste Duet is available in a single sequential combined formulation. The 2 mg oestradiol phase tablets provide oestrogenic activity throughout the cycle. The combined phase tablets add 1 mg norethisterone acetate to protect the endometrium. Your prescriber will determine whether this strength is appropriate based on your individual symptom severity, medical history, and tolerability.

Elleste Duet Conti is a separate formulation containing a fixed-dose continuous combination and is not the same product. Your prescriber will clarify which formulation has been prescribed for you.

Do not adjust your dose without consulting your prescriber. If you feel your symptoms are not adequately controlled, or if you experience side effects, speak to your prescriber or pharmacist before making any changes.

Common Side Effects

As with all medicines, Elleste Duet can cause side effects, though not everyone experiences them. The following effects are reported commonly (affecting up to 1 in 10 people):

1. Breast tenderness or discomfort
2. Headache or migraine
3. Nausea
4. Bloating or abdominal discomfort
5. Irregular or breakthrough bleeding, particularly in the first few months
6. Mood changes, including low mood or irritability
7. Leg cramps
8. Weight change

Less Common and Serious Side Effects

Some side effects are uncommon but require prompt medical attention. Contact your doctor or seek urgent medical assistance if you experience any of the following:

1. Sudden chest pain or shortness of breath, which may indicate a blood clot (deep vein thrombosis or pulmonary embolism)
2. Sudden severe headache, visual disturbance, or weakness, which may suggest stroke
3. Jaundice or severe upper abdominal pain
4. A new lump in your breast
5. Significant increase in blood pressure

Longer-Term Risk Considerations

Combined HRT is associated with a small increase in the risk of breast cancer compared with HRT using oestrogen alone. This risk increases with the duration of use and reduces after stopping treatment. Elleste Duet is also associated with a small increase in the risk of venous thromboembolism (blood clots). Your prescriber will weigh these risks against the benefits of treatment for you individually.

For further detail on all known side effects and their frequencies, please refer to the Patient Information Leaflet supplied with your medicine or consult your prescriber.

Who Is This Treatment For?

Elleste Duet is licensed for the following indications in women with a uterus who have not had a hysterectomy:

1. Relief of menopausal symptoms, including hot flushes, night sweats, vaginal dryness, and mood disturbance
2. Prevention of osteoporosis in postmenopausal women who are at increased risk of fracture and who are intolerant of, or have a contraindication to, other osteoporosis treatments

Who Should Not Take This Treatment?

A prescriber must take a thorough medical history before issuing a prescription. Elleste Duet is generally not suitable for women who have, or have had:

1. Known, suspected, or past breast cancer
2. Known or suspected oestrogen-dependent tumours (including endometrial cancer)
3. Unexplained vaginal bleeding
4. Untreated endometrial hyperplasia
5. A previous or current venous thromboembolic disorder (DVT, pulmonary embolism)
6. Known thrombophilic disorders such as protein C, protein S, or antithrombin deficiency
7. Active or recent arterial thromboembolic disease (angina, myocardial infarction, stroke)
8. Acute liver disease or a history of liver disease where liver function has not returned to normal
9. Porphyria
10. Known hypersensitivity to any component of the tablets

Special Caution Required

Your prescriber will exercise particular caution and may recommend closer monitoring if you have a history of hypertension, gallstones, diabetes, systemic lupus erythematosus, endometriosis, migraine, or a family history of breast cancer or venous thromboembolism. This is not an exhaustive list and reflects why a thorough clinical consultation is essential before treatment can be considered.

Because Elleste Duet is a Prescription Only Medicine, the clinical consultation is the necessary first step in this process. A prescription can only be issued if a registered prescriber determines, following a thorough assessment, that the medicine is clinically appropriate for you as an individual.

During your online consultation with Pharmacy Planet, you will be asked about your symptoms, medical history, current medicines, family history, and lifestyle factors. A qualified prescriber will review all of this information carefully. If it is safe and appropriate to do so, they may issue a prescription. There is no guarantee that a prescription will be issued: the prescriber's sole obligation is to your safety.

You may be asked to attend a face-to-face appointment if the online consultation cannot provide sufficient clinical information to make a safe prescribing decision. Some women will require additional investigations, such as blood tests or a blood pressure check, before HRT can be started.

HRT is a treatment that requires ongoing clinical oversight. If a prescription is issued, your prescriber will advise when to return for a review, typically after three months initially and then annually. Regular reviews allow the prescriber to assess your symptoms, monitor for side effects, check any relevant health parameters, and discuss whether continued treatment remains appropriate.

Store Elleste Duet tablets below 25°C in a dry place, away from direct heat and light. Keep the tablets in their original blister packaging until use. Do not store medicines in the bathroom, as humidity can affect the tablets. Keep all medicines out of the sight and reach of children.

Do not use Elleste Duet after the expiry date printed on the pack. If you have unused or expired tablets, return them to your pharmacy for safe disposal. Do not dispose of medicines in household waste or down the sink.

Choosing the right HRT is a clinical decision, not a one-size-fits-all choice. Delivery route, oestrogen type, progestogen class, and bleed preference all shape which preparation is most appropriate for any individual woman. The tables below group products by formulation type so that like is compared with like, helping you understand how each option differs from others in its class before you speak with a prescriber.

Oral Tablets

The table below compares commonly prescribed oral HRT tablets, grouped by regimen type. All oral preparations undergo hepatic first-pass metabolism, which is associated with a higher venous thromboembolism risk than transdermal alternatives.

Pharmacy Planet is a GPhC-registered online pharmacy staffed by qualified pharmacists and healthcare professionals. All prescriptions issued through our service are reviewed by registered prescribers who base their decisions solely on clinical suitability. We do not issue prescriptions on the basis of questionnaire responses alone where additional clinical information is required.

Our consultation process is designed to be straightforward, confidential, and accessible. We understand that menopause is a personal journey, and we are committed to providing information and access to treatment in a setting that respects your privacy and supports informed decision-making.

If you would like to find out whether Elleste Duet may be right for you, we encourage you to begin a consultation with one of our prescribers. You can do so by following the consultation link on this page.

1. Elleste Duet 2mg Tablets – Summary of Product Characteristics (SmPC). Viatris UK Healthcare Ltd. Available at: www.medicines.org.uk/emc. Accessed June 2025.
2. NHS. Hormone replacement therapy (HRT). Available at: www.nhs.uk/conditions/hormone-replacement-therapy-hrt. Accessed June 2025.
3. British Menopause Society (BMS). BMS Consensus Statement: HRT and bone protection. Available at: thebms.org.uk. Accessed June 2025.
4. MHRA. Hormone-replacement therapy: updated advice. Drug Safety Update, vol 12 issue 11, June 2019. Available at: www.gov.uk/drug-safety-update. Accessed June 2025.
5. British National Formulary (BNF). Estradiol with norethisterone. Available at: bnf.nice.org.uk. Accessed June 2025.
6. NICE. Menopause: diagnosis and management. NG23. November 2015, updated December 2019. Available at: www.nice.org.uk/guidance/ng23. Accessed June 2025.