Femoston Tablets

Femoston Tablets are a sequential combined hormone replacement therapy (HRT) taken orally to relieve the symptoms of the menopause. The 1/10 mg strength contains two active ingredients in a single pack: oestradiol hemihydrate, a form of the oestrogen oestradiol, and dydrogesterone, a selective progestogen that closely resembles the body's naturally produced progesterone. The tablets are taken daily in a continuous cycle, with the progestogen introduced during the second phase of each 28-day pack to protect the womb lining and produce a regular withdrawal bleed.

Femoston 1/10 occupies a specific clinical space within the HRT landscape. It delivers a low oestrogen dose paired with dydrogesterone, a progestogen with a receptor selectivity profile that distinguishes it from synthetic progestogens such as norethisterone acetate. This pairing is clinically relevant for women who are sensitive to progestogenic side effects or who have not tolerated norethisterone-based preparations in the past.

Menopause affects every woman differently, and the decision to use HRT is a personal one made in partnership with a prescriber. This page sets out factual clinical information about Femoston 1/10 to help you understand the treatment before a consultation. A registered prescriber must assess your individual circumstances before any prescription can be considered.

Femoston 1/10 is a film-coated oral tablet supplied in a 28-day calendar pack. The pack contains two distinct tablet types arranged in sequence. The first 14 tablets are white and contain oestradiol hemihydrate 1 mg only. The remaining 14 tablets are grey and contain oestradiol hemihydrate 1 mg alongside dydrogesterone 10 mg. The sequential structure means that oestrogen is delivered throughout the full cycle, while dydrogesterone is added only in the second half, mirroring the natural hormonal rhythm of the ovarian cycle.

Dydrogesterone is the defining characteristic of the Femoston range and sets it apart from the majority of oral combined HRT tablets available in the UK. Unlike norethisterone acetate, which has androgenic activity and some glucocorticoid-like properties, dydrogesterone is a retroprogesterone with high selectivity for the progesterone receptor and minimal activity at other steroid receptors. This receptor profile is associated with a more progesterone-like effect on the endometrium and may be better tolerated by women who experience mood changes, bloating, or acne with norethisterone-based therapies.

Femoston is manufactured by Viatris UK Healthcare Ltd and is classified as a Prescription Only Medicine. It is intended for women who have a uterus, as the dydrogesterone component provides the endometrial protection required when oestrogen is used by women who have not had a hysterectomy.

Femoston 1/10 works through the combined action of two distinct hormonal mechanisms operating in sequence across the 28-day cycle. Understanding each phase separately helps explain why the sequential structure matters clinically.

The Oestrogenic Phase: Days 1 to 14

During the first 14 days of each cycle, oestradiol acts alone. After absorption through the gastrointestinal tract, oestradiol travels through the portal circulation to the liver, where it undergoes first-pass metabolism before entering the systemic circulation. From there, it binds to oestrogen receptors in target tissues throughout the body.

In the hypothalamus, oestradiol stabilises the temperature control mechanism that becomes dysregulated at the menopause, reducing the frequency and severity of vasomotor symptoms such as hot flushes and night sweats. In the urogenital tissues, it restores the cellular architecture of the vaginal epithelium, supporting lubrication and reducing vulvovaginal discomfort. In bone, it acts as an inhibitor of osteoclastic activity, slowing the accelerated bone resorption that follows oestrogen withdrawal and helping to preserve bone mineral density over time.

The Combined Phase: Days 15 to 28

In the second half of the cycle, dydrogesterone is added to the continuing oestrogen dose. Dydrogesterone binds to progesterone receptors in the endometrium and initiates secretory transformation of the uterine lining, which oestrogen has been stimulating to proliferate throughout the first 14 days. This transformation prepares the endometrium for shedding, which occurs as a withdrawal bleed at or after the end of each 28-day pack.

This progestogenic action is medically essential for women with a uterus. Oestrogen taken without progestogen over an extended period stimulates continuous endometrial proliferation, which increases the risk of endometrial hyperplasia and endometrial cancer. Dydrogesterone prevents this by inducing the secretory phase and ultimately the withdrawal bleed, resetting the cycle each month.

Dydrogesterone's progesterone-receptor selectivity means it achieves robust endometrial protection without the androgenic, glucocorticoid, or mineralocorticoid receptor interactions that characterise some other progestogens. This selectivity underpins its clinical reputation as a well-tolerated progestogen with a mode of action close to that of endogenous progesterone.

Starting Your First Pack

If you are currently menstruating, Femoston 1/10 is usually started on the first day of your period. This aligns the pack cycle with your natural hormonal rhythm from the outset. If your periods are irregular, have become very infrequent, or have stopped entirely, your prescriber will advise on an appropriate starting day based on your individual clinical picture.

Daily Tablet Routine

Take one tablet every day, following the arrows printed on the calendar blister strip. Swallow each tablet whole with a glass of water. The tablets may be taken with or without food, but choosing a consistent time each day, whether morning or evening, supports stable serum oestradiol levels and reduces the risk of missed doses. Do not skip the grey tablets or take only the white tablets: the progestogen phase is clinically essential for endometrial protection and must not be omitted.

After completing all 28 tablets, begin the next pack immediately without a gap. The withdrawal bleed typically begins during the final grey tablets of each cycle or within a few days of completing the pack. This bleed is expected and does not indicate a return of fertility.

If You Miss a Tablet

If you forget to take a tablet and remember within 12 hours of the usual time, take the missed tablet immediately and continue as normal. If more than 12 hours have passed, leave the missed tablet and continue with the next tablet in the pack. Do not take two tablets on the same day to make up for a missed dose. Missing tablets occasionally may result in breakthrough spotting or a temporary return of menopausal symptoms such as hot flushes, but is not otherwise harmful.

How Long Should You Take Femoston?

The duration of HRT treatment is an individual clinical decision made with your prescriber. NICE guidance recommends using HRT at the lowest effective dose for as long as it continues to provide benefit, subject to regular review. Most prescribers schedule a clinical review at three months after initiation, and then annually thereafter, to reassess symptom control, tolerability, and whether any changes to the dose or formulation are appropriate.

Femoston 1/10 mg

Femoston 1/10 contains oestradiol 1 mg in each tablet and dydrogesterone 10 mg in the grey combined-phase tablets. The 1 mg oestradiol dose represents a low starting point within the oral combined HRT range and is appropriate for women initiating HRT for the first time, or for those who require a gentle introduction to combined therapy.

The Femoston range also includes a 2/10 mg formulation, in which oestradiol is provided at a 2 mg dose throughout the cycle alongside the same 10 mg dydrogesterone in the second phase. A prescriber may consider the 2/10 mg formulation if the 1/10 mg strength does not provide adequate symptom control after an assessment period, typically three months. There is also a Femoston Conti preparation containing oestradiol 1 mg and dydrogesterone 5 mg in every tablet, designed for fully postmenopausal women who prefer a bleed-free continuous regimen. This page focuses on the 1/10 mg sequential formulation.

Dose Assessment and Review

Because Femoston 1/10 is a sequential combined HRT, the prescriber must assess both the oestrogenic and progestogenic effects of the preparation at each review. If vasomotor symptoms persist at 1 mg oestradiol, a dose increase may be warranted. If the progestogenic phase is associated with significant side effects, the prescriber may consider whether dydrogesterone at 10 mg remains the most appropriate choice or whether an alternative regimen would better suit the patient. Neither decision should be made without clinical input.

Commonly Reported Effects

The following side effects are reported commonly in women taking Femoston 1/10 and typically reflect the pharmacological activity of oestradiol and dydrogesterone as the body adjusts to the new hormonal environment:

1. Headache or migraine, particularly in the first few weeks of treatment
2. Breast tenderness or engorgement
3. Nausea, abdominal bloating, or mild cramping
4. Mood change, including low mood, irritability, or heightened emotional sensitivity
5. Irregular or breakthrough bleeding during the first two to three cycles, before the withdrawal bleed pattern stabilises
6. Fluid retention, particularly in the lower limbs
7. Vaginal discharge

Most of these effects are transient. They are most pronounced in the first eight to twelve weeks as serum hormone levels find a steady state. If they persist beyond this point, speak to your prescriber, who can assess whether the dose or formulation requires adjustment.

The Dydrogesterone Difference in Side Effect Profile

Because dydrogesterone has low activity at the androgen, glucocorticoid, and mineralocorticoid receptors, side effects associated with norethisterone-based HRT such as acne, greasy skin, mood depression, and fluid retention may be less pronounced for some women taking Femoston 1/10. This is not a guaranteed outcome and varies between individuals, but it is a clinically recognised property of dydrogesterone's receptor selectivity. If you have previously stopped HRT due to progestogenic side effects, mention this specifically during your consultation, as it may influence the prescriber's choice of formulation.

Serious Side Effects Requiring Urgent Attention

The following symptoms are uncommon but indicate a potentially serious medical event. Seek immediate emergency medical care if you experience:

1. Sudden chest pain, shortness of breath, or coughing up blood, which may indicate a blood clot in the lung
2. Sudden pain, swelling, or redness in one leg, which may indicate a deep vein thrombosis
3. Sudden severe headache, visual changes, or weakness on one side of the body, which may indicate a stroke
4. Jaundice, persistent upper abdominal pain, or pale stools
5. A newly discovered breast lump or change in breast appearance
6. Unexplained vaginal bleeding occurring outside the expected withdrawal window

Long-Term Risk Considerations

Sequential combined HRT carries a small increase in the risk of breast cancer relative to no HRT, an effect that increases with the duration of use and diminishes after stopping. Evidence published in the Lancet (2019) by the Collaborative Group on Hormonal Factors in Breast Cancer provides the most comprehensive current data on this relationship. The venous thromboembolism risk associated with oral combined HRT, including Femoston, is higher than that of transdermal oestrogen, a distinction relevant for women with personal or family risk factors for clotting. Your prescriber will weigh these risks against the benefits of treatment based on your individual profile.

Licensed Indications

Femoston 1/10 is licensed in the UK for two clinical indications:

1. Relief of symptoms of oestrogen deficiency in women experiencing natural or surgically induced menopause, or premature ovarian insufficiency, including vasomotor symptoms, urogenital atrophy, mood disturbance, and disrupted sleep
2. Prevention of osteoporosis in postmenopausal women at increased risk of fracture where other licensed osteoporosis treatments are not suitable or not tolerated

Femoston 1/10 is specifically formulated for women who have a uterus. The dydrogesterone component provides the endometrial protection that women with an intact uterus require when taking oestrogen. Women who have had a hysterectomy do not need the progestogen component and would typically be prescribed an oestrogen-only preparation.

Women Who Should Not Take Femoston 1/10

A prescriber must take a full medical history before considering Femoston 1/10. It is contraindicated in women who have, or have had:

1. Known, suspected, or previous breast cancer
2. Known or suspected oestrogen-dependent malignant tumours, including endometrial cancer
3. Undiagnosed abnormal vaginal bleeding
4. Untreated endometrial hyperplasia
5. Previous or current venous thromboembolic disease, including deep vein thrombosis or pulmonary embolism
6. Known thrombophilic disorders such as protein C, protein S, or antithrombin deficiency
7. Active or recent arterial thromboembolic disease, including myocardial infarction, angina, or stroke
8. Acute liver disease or a history of liver disease where liver function tests have not returned to normal
9. Known hypersensitivity to oestradiol hemihydrate, dydrogesterone, or any excipients
10. Porphyria

Conditions Requiring Enhanced Clinical Vigilance

Prescribers will consider Femoston 1/10 with additional caution in women with a history of: uterine fibroids, endometriosis, hypertension, gallbladder disease, migraine with aura, systemic lupus erythematosus, a personal or close family history of breast cancer, diabetes, or a previous history of gestational cholestasis. In some of these circumstances, more frequent clinical monitoring may be recommended. A thorough and honest disclosure of your medical background during the consultation process is essential for safe prescribing.

Femoston 1/10 is a Prescription Only Medicine, which means it can only be supplied after a clinical consultation in which a registered prescriber has assessed whether it is appropriate for you. The consultation is the primary clinical event. The prescription is a possible outcome, not a predetermined one.

At Pharmacy Planet, your consultation will ask you to provide a comprehensive account of your symptoms and how they are affecting your daily life, your full medical and gynaecological history including the age at which your periods began to change, any family history of breast cancer, cardiovascular disease, or blood clotting conditions, and details of all medicines and supplements you currently take.

Femoston 1/10's dydrogesterone component makes it a formulation often considered for women with a history of progestogen intolerance. If previous HRT or contraceptive pills containing norethisterone or levonorgestrel caused significant mood changes, weight gain, acne, or bloating, this is important information to share with your prescriber. It may directly influence whether Femoston 1/10, with its dydrogesterone content, is selected over an alternative combined HRT.

If the prescriber cannot reach a safe prescribing decision based on your online consultation alone, they will contact you for additional information or recommend a face-to-face assessment. Additional steps may include confirmation of a recent blood pressure reading, a mammogram result, or laboratory investigations where clinically indicated. A prescription is issued only where the clinical picture supports it.

If a prescription for Femoston 1/10 is issued, a review is typically scheduled at three months. At that point, the prescriber will assess whether the withdrawal bleed is occurring as expected, whether symptoms are adequately controlled, and whether any side effects have emerged. Annual reviews follow, at which the ongoing appropriateness of treatment is re-evaluated in light of your evolving clinical circumstances.

Store Femoston 1/10 tablets below 30°C. Unlike some medicines that require storage below 25°C, the SmPC for Femoston 1/10 specifies a 30°C upper limit, reflecting the relative stability of the film-coated tablet formulation. However, avoid storing tablets in locations subject to extreme heat fluctuations, direct sunlight, or prolonged warmth, such as a car glove compartment or a windowsill.

Keep the tablets in their original calendar blister pack. The sequential structure of the pack, white tablets first followed by grey tablets, is a clinical instruction as well as a packaging feature. Do not remove tablets from the blister in advance or transfer them to another container, as doing so removes the sequential guidance and increases the risk of taking the phases out of order. Disrupting the sequence, particularly skipping or delaying the grey dydrogesterone tablets, compromises endometrial protection.

Check the expiry date on the carton before starting each new pack. Do not use tablets past this date. Keep all medicines, including Femoston 1/10, out of the sight and reach of children. Return unused or expired packs to your community pharmacy for safe disposal through the medicines return scheme. Do not dispose of medicines in household waste bins or by flushing them 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 registered with the General Pharmaceutical Council (GPhC) and operates under the clinical oversight of a qualified superintendent pharmacist. Our prescribers are registered healthcare professionals whose decisions are guided by clinical evidence, current NICE guidance, and the individual patient's medical history. We do not treat the prescribing process as a formality.

For Femoston 1/10 specifically, our prescribers understand that dydrogesterone-based HRT occupies a distinct clinical position within the oral combined HRT category. The formulation is particularly relevant for women who have had negative experiences with norethisterone-containing preparations, those who are sensitive to progestogenic side effects, and those for whom a progesterone-selective progestogen may offer a better tolerated hormonal environment. We take that clinical nuance seriously during the consultation.

We also recognise that the conversation around menopause is one many women have not had the opportunity to have with a healthcare professional who listens without time pressure. Our consultations are confidential, completed online at a time that suits you, and reviewed by clinically qualified prescribers. If you would like to find out whether Femoston 1/10 may be appropriate for your situation, you can begin a consultation using the link on this page.

1. Femoston 1/10 mg Film-coated 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. NICE. Menopause: diagnosis and management. NG23. Updated December 2019. Available at: www.nice.org.uk/guidance/ng23. Accessed June 2025.
4. British National Formulary (BNF). Estradiol with dydrogesterone. Available at: bnf.nice.org.uk. Accessed June 2025.
5. 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.
6. Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk. Lancet 2019; 394(10204):1159–1168.
7. Stanczyk FZ, Hapgood JP, Winer S, Mishell DR Jr. Progestogens used in postmenopausal hormone therapy: differences in their pharmacological properties, intracellular actions, and clinical effects. Endocr Rev 2013; 34(2):171–208.
8. British Menopause Society. Dydrogesterone in HRT. Available at: thebms.org.uk. Accessed June 2025.