Trisequens Calendar Pack

Order Trisequens to adapt better to the menopause

Trisequens is an HRT used to relieve the symptoms of menopause by supplementing the body’s natural levels of oestrogen and progesterone with synthetic versions.

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Strength Quantity Price Stock
2mg/1mg84 tablets£28.99In Stock
Prices exclude a prescription fee. This treatment requires a quick online consultation,
which a doctor will review to determine if a prescription is appropriate.

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Information

Dr Samantha Miller

Reviewed by Dr Samantha Miller MB ChB
(2017, University of Glasgow)
GMC number: 7561464

Information last reviewed 06/06/2021

About

What is Trisequens?

Trisequens is a form of hormone replacement therapy (HRT) used to relieve the symptoms of menopause. It contains the hormones estradiol and norethisterone acetate, which supplement the body’s natural levels of oestrogen and progesterone, and is suitable for women who have not had a hysterectomy. Trisequens can also be prescribed to prevent osteoporosis in women who have been unsuccessful with other forms of HRT. Trisequens is a triphasic HRT, meaning that it provides 3 different doses of hormones throughout the month.

How does Trisequens work?

During menopause, the level of oestrogen produced by the ovaries declines, resulting in symptoms such as mood swings, hot flushes and night sweats, vaginal dryness and a weakening of the bones known as osteoporosis. Trisequens contains estradiol, which supplements the body’s natural oestrogen levels to help prevent these symptoms. The norethisterone (progesterone) counteracts excessive growth of the womb lining (endometrial hyperplasia) stimulated by an increase in oestrogen, reducing the risk of developing endometrial cancer or endometriosis (growth of the uterus lining outside of the womb). Trisequens effectively controls menopausal symptoms, while producing a regular and predictable monthly bleed. 

Ingredients

Active ingredients

The active ingredients in Trisequens are estradiol (as estradiol hemihydrate) and norethisterone acetate.

Blue tablets contain estradiol 2mg (as estradiol hemihydrate)
White tablets contain estradiol 2mg (as estradiol hemihydrate) and norethisterone acetate 1mg
Red tablets contain estradiol 1mg (as estradiol hemihydrate)

Inactive ingredients

The inactive ingredients in Trisequens are lactose monohydrate, maize starch, hydroxypropylcellulose, talc, magnesium stearate, and hypromellose.

The blue tablets also contain titanium dioxide (E171), indigo carmine (E132) and macrogol 400.
The white tablets also contain tricetin
The red tablets also contain titanium dioxide (E171), red iron oxide (E172) and propylene glycol.

Dosage

How to use Trisequens?

Always take Trisequens as instructed by a doctor or pharmacist. Each 28 day course comes in the form of a disk-shaped pack containing blue, white and red tablets in the right quantity and order, marked with an indicator of where on the disk to start. An inner disk is marked with the days of the week, which can be adjusted so that the correct day of the week lines up with the first tablet, helping you to remember to take your pill each day for the 28 day course. A transparent dial points to the day’s tablet and can only be moved to the next day once each tablet has been removed from its plastic shell.

Tablets should be swallowed whole with a glass of water. Take the correct tablet for each day at around the same time each day. On the next day, move the dial one space clockwise and tip out the next tablet. If you forget to take a tablet, try and remember to take it within 12 hours. If 12 hours have already passed, just skip the dose and take the next day’s tablet at the normal time. Never take a double dose to make up for a missed one.

Trisequens dosage

Each pack of Trisequens contains 28 tablets for a cycle of 28 days. On days 1–12, you should take 1 blue tablet, containing 2mg estradiol, per day. On days 13–22, you should take 1 white tablet, containing 2mg estradiol and 1mg norethisterone acetate, per day. On days 23–28, you should take 1 red tablet, containing 1mg estradiol, per day. You are expected to have a bleed every cycle with Trisequens, which usually occurs at the beginning of a new pack.

Side Effects

Trisequens side effects

Like all medications, Trisequens can cause side effects in some patients. You should stop taking Trisequens and seek medical attention immediately if you experience any symptoms of hypersensitivity (allergy), such as hives, itching, swelling, difficulty breathing, low blood pressure, feeling dizzy, and sweating.

Common side effects, which can affect up to 1 in 10 patients, include:

  • Breast pain, tenderness, swelling or enlargement
  • Irregular periods or excessive bleeding during your periods
  • Headaches or migraines
  • Weight gain
  • Fluid retention
  • Abdominal pain, swelling or discomfort
  • Vaginal inflammation
  • Vaginal infection e.g. thrush
  • Mood changes including depression
  • Nausea
  • Back pain
  • Leg cramps
  • Uterine fibroids
  • Swelling of arms or legs

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

  • Bloating or flatulence (excess wind)
  • Acne
  • Alopecia (hair loss)
  • Male pattern hair growth
  • Itching or hives
  • Superficial thrombophlebitis (inflammation of a vein, typically in the leg)
  • Persistence of menopausal symptoms despite treatment
  • Allergic reaction
  • Nervousness
  • Endometrial hyperplasia (thickening of the lining of the womb)
  • Painful periods

Rare side effects (affecting up to 1 in 1,000 women) include:
Pulmonary embolism (blood clot in the lung), which may cause breathlessness, chest pain or coughing up blood
Deep vein thrombosis (DVT, blood clot in the leg), which may cause swelling and pain in the calf

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

  • Endometrial cancer (cancer of the womb)
  • Increase in blood pressure
  • Gallbladder disease or gallstones
  • Excessive secretion of sebum or skin eruption
  • Recurrent attacks of oedema (swelling)
  • Insomnia
  • Dizziness
  • Anxiety
  • Change in sexual desire
  • Visual disturbance
  • Weight loss
  • Vomiting
  • Heartburn
  • Vaginal itching
  • Heart attack and stroke

Trisequens can cause an increased risk of certain conditions:

  • Breast cancer
  • Ovarian cancer
  • Venous thrombosis (blood clots in the legs or the lung)
  • Stroke
  • Memory loss if started over the age of 65

If you have any questions or are worried about the side effects of Trisequens, speak to a doctor or pharmacist for more information.

Contraindications

Do NOT take Trisequens if you:

  • Are allergic to any of the ingredients in this medication
  • Are pregnant or breastfeeding
  • Have, have ever had, or are suspected of having breast cancer
  • Have a form of oestrogen-sensitive cancer
  • Have unexplained vaginal bleeding
  • Have endometrial hyperplasia (excessive thickening of the womb lining)
  • Have or have ever had thrombosis (blood clot in a vein)
  • Have a blood clotting disorder
  • Have or have recently had a heart attack, angina, or any other disease caused by a blood clot in an artery
  • Have or have ever had a liver disease and your liver function remains abnormal
  • Have porphyria 

You should tell your doctor before taking Trisequens if you have ever experienced any of the following:

  • Fibroids inside the womb
  • Endometriosis (growth of the womb lining outside of the womb) or endometrial hyperplasia (excessive growth of the womb lining)
  • Increased risk of developing blood clots
  • Increased risk of developing an oestrogen-sensitive cancer
  • High blood pressure
  • A liver disorder
  • Diabetes
  • Gallstones
  • Migraines or severe headaches
  • Systemic lupus erythematosus (SLE, a disease of the immune system affecting many organs of the body
  • Epilepsy
  • Asthma
  • Otosclerosis (a disease affecting the eardrum and hearing)
  • Triglycerides (high level of fat in the blood)
  • Fluid retention due to heart or kidney problems
  • Lactose intolerance

Drug interactions

Before taking Trisequens, tell your doctor or pharmacist if you are taking any other medications, including those purchased over the counter without a prescription. The following medications may interact with Trisequens:

  • Medicines for epilepsy, such as phenobarbital, phenytoin and carbamazepine
  • Medicines for tuberculosis, such as rifampicin and rifabutin
  • Medicines for HIV infection, such as nevirapine, efavirenz, ritonavir and nelfinavir
  • Herbal remedies containing St John’s wort (hypericum perforatum)
  • Medicine for hepatitis C infection, such as telaprevir
  • Medicines containing ketoconazole, which may increase the effects of Trisequens

Treatment Options

Alternatives to HRT

HRT is the most accessible and effective treatment for the symptoms of menopause and is available online through Dr Felix. Alternatively, herbal supplements and remedies are other options for relieving symptoms such as hot flushes and mood swings, although their effectiveness is unknown. Many women choose not to take any treatment for menopausal symptoms. Make sure to speak to a doctor or pharmacist about the contents and effectiveness of herbal remedies before trying them.

Trisequens vs other types of HRT

There are several different types of HRT available in the UK, and a doctor will be able to help you find the one which is best for you. Trisequens is a cyclical combined HRT, meaning that you take a different level of hormone throughout the month. This kind of regime allows for a monthly bleed, and is, therefore, most suited to women who are still menstruating. Trisequens is triphasic, meaning there are three different hormone formulations taken throughout the cycle, denoted by different coloured pills. Elleste Duet is an alternative cyclical HRT, which is biphasic, i.e. there are two different hormone formulations taken throughout the cycle. Evorel Sequi is an alternative to pills, as it comes in patches, which are applied twice weekly and may be preferable if pills cause side effects.

For women who have stopped menstruating, but who still have their womb, continuous combined HRT which contains the same dose of hormone every day of the month is more suitable. Examples of oral continuous combined HRT are Elleste Duet Conti and Kliovance, and Evorel Conti comes in a patch form. 

Women who have had a hysterectomy or who have a Mirena IUS supplying them with progesterone are able to take oestrogen-only HRT. These can be taken orally (Elleste Solo, Premarin) or applied to the skin as transdermal patches (Elleste Solo MX80, Elleste Solo MX40, Evorel).

A slightly different HRT formulation is tibolone (brand name Livial), which is a synthetic steroid that mimics the actions of oestrogen and progesterone in the body, this is suitable for those who have stopped menstruating.

HRT can be confusing as there are many different options, so be sure to speak to your doctor to find which one is right for you.

Lifestyle changes to improve menopause symptoms

Alongside HRT, a few simple lifestyle changes can help you to manage the symptoms of menopause. The impact of hot flushes can be reduced by cutting down on caffeine, alcohol and spicy foods, and by quitting smoking. Exercise regularly and try to increase your intake of vitamin D to help keep your bones strong and healthy. For those experiencing vaginal dryness, a range of moisturisers and lubricants can be purchased from any pharmacy with help from a pharmacist.

Q&A

Why is Trisequens banned in Qatar and Kuwait?

Trisequens is on the long list of medicines that are strictly controlled in Qatar and Kuwait. This is because certain medications produce effects that contravene local laws. When travelling to Gulf Cooperation Council (GCC) countries, always check with a travel doctor which medicines are prohibited or controlled; even for simple painkillers such as paracetamol, you may be required to carry a written note or prescription from a doctor.

Is Trisequens safe?

Trisequens is considered a safe and effective treatment for the symptoms of menopause. Your doctor will generally prescribe the lowest dose possible for the shortest possible amount of time, as long-term use of HRT carries a small risk of developing oestrogen-sensitive cancers, such as breast cancer and endometrial cancer. Many women continue to use HRT for years without any problems, but it is important to go for regular health checkups, including breast cancer screenings and cervical smear tests.

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