Elleste Solo

What is Elleste Solo?

Elleste Solo is a hormone replacement therapy (HRT). It contains estradiol, a form of oestrogen, and is used to supplement falling levels of oestrogen in women, relieving the symptoms of menopause.

It 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 GP for advice.  

How does it work?

The treatment contains estradiol, a form of the female hormone oestrogen. During menopause, the level of oestrogen naturally produced by women decreases, causing symptoms such as hot flushes and sweats, irregular periods and mood swings. Menopause also causes a weakening of the bones, known as osteoporosis. It works by supplementing the natural levels of oestrogen in women, relieving symptoms of menopause and temporarily preventing osteoporosis.

Increasing the level of oestrogen in the body also causes the womb lining to build up, which significantly increases the risk of endometrial cancer. Progesterone is the hormone responsible for countering the effect of oestrogen on the womb lining. Since it does not contain a progesterone synthetic, this treatment is only suitable for women who have had a hysterectomy, or who have a intrauterine system (IUS), or mirena coil fitted.  

Active ingredients

The active ingredient is estradiol hemihydrate.

Inactive ingredients

The inactive ingredients are lactose monohydrate, maize starch, povidone, talc, magnesium stearate, macrogol 400, titanium dioxide (E171), and hypromellose (E464). 

The 2 mg tablet also contains the colouring sunset yellow (E110).  

How to use Elleste Solo

Elleste Solo 1mg or 2mg Tablets

If you still have regular periods, start taking the tablets on the first day of your period. If you no longer have regular periods, you can start taking Elleste Solo tablets at any time. 

• You should take one tablet each day at around the same time. 
• Tablets should be swallowed whole and taken with water.
• Follow the direction of the arrows and the days of the week that are marked on the pack and take a tablet each day until the pack is empty. 
• When you finish a pack, start the next pack on the next day.

If you forget to take a dose, try and take it within 12 hours of the normal time. If 12 hours has already passed, don’t worry, just take the next dose at the normal time. Never take a double dose to make up for a missed one. 

If you are switching from another form of HRT, speak to your doctor on how to switch treatments. It is usually recommended to finish the current pack of your previous treatment before starting a new one.  

Elleste MX40 or MX80 Patches

Always use medications as instructed by the prescribing doctor. The usual dose is to use two patches a week. These should be applied one at a time and left on the skin for 3-4 days, before being replaced with the second patch. 

• The patch should be placed on dry, unbroken skin, below the waistline (the lower back or buttocks are common places to use).
• Do not place your new patch in the same place you have just used.
• Do not apply the patch to your breast. 

If you have regular periods, apply the first patch within 5 days of the start of your period. If you are not having regular periods, you can start using the patches at any time. If you are changing from another type of HRT, you should finish the treatment cycle first. You can speak to your doctor for clarification on this.

Dosage Information

Elleste Solo Tablets

Elleste Solo tablets are available in 1mg and 2mg strengths. Your doctor will prescribe you the minimum dose possible according to your symptoms, although 2 mg is commonly prescribed for the prevention of osteoporosis. The recommended dose is 1 tablet taken once daily around the same time of day.

Elleste Solo Patches

Elleste Solo Patches are known as MX40 or MX80, depending upon how much active medication they contain. MX40 patches contain 40mcg and MX80 patches contain 80mcg of medication. 

Elleste Solo Side Effects

Like all medications, this treatment can cause side effects in some people. Common side effects (affecting up to 1 in 10 people) can include:

• Nausea.
• Stomach cramps.
• Headaches.
• An increase in the size of fibroids in the womb.
• Breakthrough bleeding.
• Weight changes.
• Swelling of the legs.
• Breast tenderness or enlargement.
• Mood swings.
• Changes in libido.

Uncommon side effects, which can affect up to 1 in 100 people, include:

• Sickness.
• Indigestion.
• Flatulence.
• Gallstones or gallbladder disease.
• Dizziness.
• Migraines.
• Vaginal thrush.
• Increase in blood pressure.
• Leg cramps.
• Rare side effects experienced by less than 1 in 1000 people, include:
• Loss of hair from the scalp.
• Increase in body or facial hair.
• Itchiness or rashes.

Additionally, there is a slight increase in risk of developing the following diseases in women using HRT:

• Breast cancer
• Endometrial hyperplasia or cancer
• Ovarian cancer
• Venous Thrombosis (blood clots in the legs or lungs)
• Heart disease
• Stroke
• Probably memory loss in patients over the age of 65

Contraindications

Always consult a doctor before taking this or any other form of HRT. Do NOT take this medication if:

• You are allergic to any of the ingredients.
• 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 this medication 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 this one, 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 this treatment, 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 it 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)

Lifestyle changes to improve menopause symptoms

Certain lifestyle changes can help to manage the symptoms of menopause and increase the effectiveness of HRT. Cutting down on caffeine, alcohol and spicy foods, as well as quitting smoking and wearing loose-fitting clothes, can help reduce the impact of hot flushes and night sweats. Regular exercise is known to reduce stress, as well as strengthening your bones and improving your general wellbeing. You can increase your intake of vitamin D, which is vital for the absorption of calcium, to help keep your bones strong and healthy. Vaginal moisturisers and lubricants can help with vaginal dryness and can be bought in any chemist with the help of a pharmacist.

Alternatives to HRT

HRT is the most widely used treatment for the symptoms of menopause and is generally accepted to the most effective option. Some women choose to try taking herbal supplements, 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.

Elleste Solo vs Elleste Duet

An alternative to Solo is Elleste Duet, which contains synthetic forms of both oestrogen (estradiol hemihydrate) and progesterone (norethisterone acetate). This means it is suitable for use in women who have not had a hysterectomy and who do not have a IUS fitted. Duet also allows for a monthly bleed and is therefore suitable for women who still experience regular periods, or who have had a natural period within the last 12 months.

Elleste Solo MX vs Elleste Solo

Elleste Solo is also available as 40 microgram or 80 microgram transdermal patches called Elleste Solo MX. Transdermal patches also contain estradiol, which is absorbed into the bloodstream and works in the same way as the tablets. While the patches tend to have less side effects, some women may find that they irritate the skin. You can speak to your doctor for advice on which treatment is best for you.

Elleste Solo vs other forms of HRT

HRT comes in many different forms which are accessible through the NHS and can be purchased online from Dr Felix. Like Elleste Solo, Premarin contains an oestrogen supplement only, and are therefore suitable for use in women who have had a hysterectomy or who have a IUS fitted. Oestrogen-only HRTs are also available as transdermal patches such as Evorel, which are worn on the skin and tend to have less side effects.

For women who have not undergone a hysterectomy, or do not have a IUS fitted, HRTs containing both oestrogen and progesterone supplements are available. For women who have not had a bleed for at least 12 months, Elleste Duet Conti, Climesse and Kliovance are preferable, as they do not induce a simulation of a monthly bleed. Alternatively, 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. Women who still experience monthly bleeding  in the early stages of menopause will need to be prescribed Elleste Duet, which simulates the natural rise and fall of progesterone and results in a monthly bleed.

Is Elleste Solo bioidentical?

The oestrogen supplement in Solo is estradiol, which is bioidentical to the natural form of oestrogen which decreases with menopause.

Sources

• Patient information leaflet > Elleste Solo
• Patient information leaflet > Elleste MX
• NHS > HRT