Elleste Duet

How does Elleste Duet work?

Elleste Duet contains estradiol hemihydrate and norethisterone acetate, which are synthetic form of oestrogen and progesterone naturally produced in women. As women approach menopause, their ovaries begin to produce less oestrogen, which can cause symptoms such as irregular periods, mood swings, hot flushes and sweats. Elleste Duet helps to supplement these falling levels and relieve symptoms. Oestrogen also stimulates the growth of the womb lining which, if allowed to build up, increases the risk of endometrial cancer in women who have not had a hysterectomy, or who do not have a mirena coil fitted. The progesterone supplement in Elleste Duet counters this effect, inducing a monthly bleed and reducing the risk of endometrial cancer.

Declining levels of oestrogen in women can also lead to a weakening of the bones, known as osteoporosis. Elleste Duet  2mg is also used for short-term prevention of osteoporosis in postmenopausal women.  

What is Elleste Duet?

Elleste Duet is a form of hormone replacement therapy (HRT). It supplements the natural hormones oestrogen and progesterone to relieve the symptoms of menopause and to prevent osteoporosis in postmenopausal women.

Elleste Duet is NOT a contraceptive. If you are under 50, or if it is less than 12 months since your last period, you may still need to use additional contraception to avoid pregnancy. Speak to your doctor for advice.  

Active ingredients

The active ingredients in Elleste Duet are estradiol hemihydrate and norethisterone acetate.

Inactive ingredients

The inactive ingredients of Elleste Duet are lactose monohydrate, maize starch, povidone, talc, magnesium stearate, macrogol 400 and hypromellose (E464).

Elleste Duet 1mg tablets also contain the colours indigo carmine (E132), quinoline yellow (E104) and titanium dioxide (E171). Elleste Duet 2mg tablets contain the colours sunset yellow (E110), titanium dioxide (E171) and black iron oxide (E172).

Elleste Duet dosage

Always take Elleste Duet as instructed by your doctor. Elleste Duet comes in 1mg and 2mg tablets. The recommended dose is 1 tablet per day at roughly the same time each day.

How to use Elleste Duet

A pack of Elleste Duet 1mg contains 16 white tablets containing estradiol hemihydrate (oestrogen) and 12 green tablets containing estradiol hemihydrate and norethisterone (oestrogen and progestogen). The Elleste Duet 2mg pack contains 16 orange tablets and 12 grey tablets. 

If you no longer have regular bleeds, you can start taking Elleste Duet at any time. If you still experience regular bleeds, start taking Elleste Duet on the first day of your bleed. Start at the beginning of a sheet with the oestrogen-only tablets, start a new sheet the day after finishing the last. You should experience a monthly bleed at the beginning of each sheet, when you stop taking the oestrogen-progesterone tablets and return to oestrogen only. 

Swallow one tablet a day with some water at around the same time each day. It helps to make this a part of your daily routine - try taking your pill with breakfast every day, or when you brush your teeth. If you forget to take a dose, try and take it within the next 12 hours. If 12 hours have already passed when you remember, just skip the dose and take the next one at the normal time. Never take a double dose to make up for the missed one.  

Elleste Duet side effects

Like all medications, Elleste Duet may cause side effects in some people. Common side effects (effect less than 1 in 10 people) include:

• Headaches.
• Breast tenderness.
• Painful periods.
• Problems with your menstrual cycle.
• Mood swings, or feeling down and anxious.
• Change in libido.
• Difficulty sleeping or feeling dizzy.
• Nausea, sickness or diarrhoea.
• Indigestions or stomach cramps.
• Acne, rashes, itchiness or dry skin.
• Back pain or pain in the extremities.
• Breast enlargement.
• Heavy periods or increased vaginal discharge, breakthrough bleeding, spasms of the womb.
• Vaginal infection, excessive thickening of the lining of the womb.
• Feeling of weakness.
• Swelling of the ankles, fingers or feet.
• Increase of weight.

Uncommon side effects, affecting up to 1 in 100 people, include:

• Migraines or feeling dizzy.
• High blood pressure.
• Varicose veins.
• Sickness.
• Gallstones or gallbladder disease.
• Change in skin colour.
• Muscle cramps.
• Increased level of chemicals in the blood.

  Rare side effects (affect up to 1 in 1,000 people) may include the following:

• Hypersensitivity
• Tingling or numbness
• Blood clot in the vein
• Muscle weakness
• Myoma, cysts or polyps in the womb

Very rare side effects only affect up to 1 in 10,000 people and can include:

• Increase in body and facial hair.
• Yellowing of the skin.
• Loss of hair from the scalp.

Contraindications

Always consult a doctor before starting Elleste Duet. Do NOT take this medication if:

• You are allergic to any of the ingredients in Elleste Duet.
• You have or have ever had breast cancer.
• You have or have ever had endometrial cancer, or any other cancer which is sensitive to oestrogen.
• You are experiencing unexplained vaginal bleeding.
• You have excessive thickening of the womb lining which is not being treated.
• You have or have ever had thrombosis (blood clot in the vein).
• You have a blood clotting disorder.
• You have or have recently had a disease caused by blood clots in the arteries.
• You have or have ever had a liver disease.
• You have porphyria.

Speak to your doctor if you have any questions about the conditions listed above. You should also tell your doctor and take extra care when taking Elleste Duet if you have any of the following, as you may need to see your doctor more often for medical check-ups:

• Fibroids inside your womb
• Endometriosis (growth of the womb lining outside of the womb) or endometrial hyperplasia (excessive growth of the womb lining)
• Increased risk of developing thrombosis (blood clots)
• Increased risk of developing oestrogen-sensitive cancers
• High blood pressure
• A liver disorder
• Diabetes
• Gallstones
• Migraines or severe headaches
• A disease of the immune system
• Epilepsy
• Asthma
• Otosclerosis (a disease affecting the eardrum or hearing)
• Triglycerides (high level of fat in your blood)
• Fluid retention due to kidney or cardiac problems.

You should stop taking Elleste Duet immediately and consult your doctor if you notice:

• Any of the conditions listed above.
• Jaundice (yellowing of the skin or whites of the eyes). This could be a sign of liver disease.
• A significant rise in blood pressure, characterised by headaches, tiredness, dizziness.
• Migraine-like headaches.
• You become pregnant.
• Painful swelling of the legs, sudden chest pain or difficulty breathing, which could be signs of a blood clot.

HRT that contains a progesterone as well as an oestrogen synthetic, such as Elleste Duet, has a reduced risk of leading to endometrial cancer. However, evidence suggest that this HRT could lead to an increased risk of breast cancer. While taking this medication, it is important to regularly check your breasts any lumps you can see or feel, dimpling of the skin or changes to the nipple, and speak to your doctor if you are concerned. 

Drug interactions

Before taking Elleste Duet, tell your doctor if you are taking any other medications, including those bought over the counter without a prescription. In particular, the following medicines may interfere with Elleste Duet and cause irregular bleeding:

• Epilepsy medications, such as phenobarbital, phenytoin and carbamazepine
• Tuberculosis medications, such as rifampicin and rifabutin
• Medications for HIV infection, such as nevirapine, efavirenz, ritonavir, telaprevir and nelfinavir
• Herbal remedies containing St John’s Wort (hypericum perforatum)

Elleste vs Elleste Duet

An alternative to Elleste Duet is Elleste Solo, which contains estradiol (oestrogen) only and is bioidentical. Because it does not contain progesterone, Elleste Solo is only suitable for women who have had a hysterectomy, or who have an intrauterine system (IUS), or mirena coil, fitted. If neither of these cases apply to you, your doctor will not prescribe Elleste Solo.

Elleste Duet vs Elleste Duet Conti

Another alternative to Elleste Duet is Elleste Duet Conti. Elleste Duet Conti provides a dose of both oestrogen and progesterone throughout the month, meaning you will not experience a monthly bleed. This option is only recommended for women who have not experienced a natural period for 12 months or more.

Alternatives to HRT

HRT is widely accepted as the most effective treatment for the symptoms of menopause. Some people may choose a herbal supplements as an alternative, although the effectiveness of these treatments is unknown. It is important to speak to a doctor or pharmacist about the effects of different herbal supplements.  

Lifestyle changes to improve menopause symptoms

Making certain lifestyle changes can help you to deal with the symptoms on menopause and increase the benefits of treatments such as HRT. The impact of hot flushes and night sweat can be reduced by cutting down on caffeine, alcohol and spicy foods, as well as by avoiding smoking and wearing loose clothing. Exercising regularly can help with stress management whilst simultaneously strengthening your bones and improving your general wellbeing. Increasing your intake of vitamin D, which is vital for absorbing calcium, can also contribute to keeping your bones strong and reducing the impact of osteoporosis. For those experiencing vaginal dryness, there are many moisturisers and lubricants available, and a pharmacist will be able to give advice on which is best for you.

Elleste vs other HRT

There are several different types of HRT which are accessible both via the NHS and online from Dr Felix. Elleste Duet Conti, Climesse and Kliovance also contain synthetic forms of both oestrogen and progesterone and so are suitable for women who have not had a hysterectomy, or who do not have an intrauterine system (IUS) fitted. Unlike Elleste Duet, these treatments are only suitable for women who have not had a bleed for at least 12 months. Tibolone, brand name Livial, is a type of steroid which works by activating the oestrogen and progesterone receptors. It is a selective steroid which carries a slightly lower risk of breast cancer.

Hormone replacement therapies containing oestrogen only are also available, but are only suitable for women who have had a hysterectomy or who have a IUS fitted. An IUS will do the job of providing the progesterone needed to counteract the risk of endometrial cancer associated with oestrogen supplements. Oestrogen only therapies can be purchased in tablet form (Premarin, Elleste Solo) or in the form of patches to be worn on the skin (Elleste Solo MX80, Elleste Solo MX40, Evorel).

Is Elleste Duet bioidentical?

Elleste Duet contains estradiol hemihydrate, a synthetic form of oestrogen, and norethisterone acetate, a synthetic form of progesterone. While estradiol hemihydrate is bioidentical, norethisterone acetate is not, so Elleste Duet cannot be said to be fully bioidentical. 

Sources

• Patient Information Leaflet
• NHS > HRT
• Healthline > Bioidentical hormone replacement therapy