Trisequens Calendar Pack

Trisequens is a form of hormone replacement therapy (HRT) containing estradiol and norethisterone, forms of the female hormones oestrogen and progesterone. It is used to treat some of the effects of the menopause. If you would like to purchase HRT, simply complete a 2 minute online consultation and our UK registered doctors will review your answers, before issuing a prescription if appropriate. Our NHS registered pharmacy will dispense and dispatch your medicine in discreet packaging.

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2mg/1mg84 tablets28.99
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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.

How does Trisequens work?

During menopause, the level 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 theses 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). 

Ingredients

Active ingredients

The active ingredients in Trisequens are estradiol and norethisterone acetate.

Inactive ingredients

The inactive ingredients in Trisequens are lactose monohydrate, maize starch, hydroxypropyl cellulose, talc, magnesium stearate, hypromellose, talc, titanium dioxide (E171), indigo carmine (E132), macrogol 400, triacetin, red iron oxide (R172) 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 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 has 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 2 mg estradiol, per day. On days 13 - 22, you should take 1 white tablet, containing 2 mg estradiol and 1 mg norethisterone acetate, per day. On days 23 - 28, you should take 1 red tablet, containing 1 mg estradiol, per day.

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 or tenderness
  • Irregular periods or excessive bleeding during your periods
  • Headaches
  • Weight gain cause by fluid retention
  • Vaginal inflammation
  • Migraines
  • Fungal infection of the vagina
  • Depression
  • Nausea
  • Breast swelling or enlargement
  • Back pain
  • Leg cramps
  • Uterine fibroid, aggravation, occurence or reoccurence
  • Swelling of arms of legs
  • Weight gain

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

  • Abdominal pain, bloating, swelling or flatulence
  • Alopecia (hair loss)
  • Male pattern hair growth
  • Itching or hives
  • Superficial thrombophlebitis (inflammation of a vein)
  • Drug ineffective
  • Allergic reaction
  • Nervousness
  • Endometrial hyperplasia
  • Painful periods

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
  • Angioneurotic oedema
  • Insomnia, dizziness, anxiety
  • Change in sexual desire
  • Visual disturbance
  • Weight loss
  • Vomiting
  • Heartburn
  • Vaginal itching
  • Heart attack and stroke

In up to 1 in 1,000, Trisequens can cause an increased risk of developing a blood clot in the blood vessels of the legs or lungs (deep vein thrombosis, lung embolism).

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
  • You have, have ever had, or are suspected of having breast cancer
  • You have a form of oestrogen-sensitive cancer
  • You have unexplained vaginal bleeding
  • You have endometrial hyperplasia (excessive thickening of the womb lining)
  • You have or have ever had thrombosis (blood clot in a vein)
  • You have a blood clotting disorder
  • You have or have recently had a heart attack, angina, or any other disease caused by a blood clot in an artery
  • You have or have ever had a liver disease
  • You 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 (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 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 interfere with the effect of Trisequens and lead to irregular bleeding:

  • Medicines for epilepsy, such as phenobarbital, phenytoin and carbamazepine
  • Medicines for tuberculosis, such as rifampicin
  • 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 and be accessed on prescription through the NHS and online at Dr Felix. Alternatively, herbal supplements and remedies are another choice for relieving symptoms such as hot flushes and mood swings, although their effectiveness is unknown. 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 has the benefit of coming in the form of an easy to use, disk shaped calendar pack. Like Trisequens, Kliovance, Climesse, Elleste Duet and Elleste Duet Conti contain both an oestrogen and a progesterone supplement and are therefore suitable for women who have not had a hysterectomy, or who do not have an intrauterine system (IUS), or mirena coil, fitted. While, Kliovance, Climesse and Elleste Duet Conti are continuous HRTs, Trisequens and Elleste Duet cause a monthly bleed, and are therefore better suited to women who have experienced a natural period within the last 12 months. Tibolone (brand name Livial) is a synthetic steroid which mimics the actions of oestrogen and progesterone in the body, but is only suitable for women who have not had a natural period in the last 12 months.

Women who have had a hysterectomy or who have an 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).

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 which are strictly controlled in Qatar and Kuwait. When travelling to 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 prescribe the lowest dose possible for the shortest possible amount of time, as long-term use or 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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