I’ve been taking Premique. What’s happened to supply? Are there any alternatives?

I've been on Premique for more than 15 years, after going through early menopause. The pharmacy says there's a problem with supply. Has it been discontinued? Is Premique low dose still available? If not, are there any alternatives?

25 April 2018

The manufacturer of Premique, Pfizer, had two Premique products: Premique (which contained 0.625mg conjugated oestrogen (a mixture of naturally occurring oestrogens) and 5mg of Medroxyprogesterone (a type of progesterone) and Premique low dose.

As the names suggest, the difference between the two products was dosage. Premique low dose contains 0.3mg of conjugated oestrogen and 1.5mg of Medroxyprogesterone.

In November 2016 Pfizer discontinued Premique 0.625mg/5mg and started only producing Premique low dose.

Currently stocks of Premique low dose are ‘being managed’ – that is to say your pharmacist can order them in when requested but is unlikely to able to keep a supply on the shelf. Pfizer were unable to say when stocks will be freely available.

In this situation we would advise you to order further supplies of Premique low dose a week or two earlier than required to allow time for delivery to your pharmacy. Meanwhile if do run out we suggest you contact your GP, who will be able to suggest an alternative.

What is the closest alternative HRT to Premique Low Dose?

The closest alternative HRT is Premarin 0.3mg and Medroxyprogesterone 2.5mg. It will mean taking two tablets daily. Pfizer who make Premique low dose and Premarin have assured us that Premarin has the same conjugated oestrogens are those in Premique low dose. The active ingredients in Premique low dose are conjugated estrogens 0.3mg and medroxyprogesterone acetate (MPA) 1.5 mg Please note that you will be getting slightly more Medroxyprogesterone than that in Premique low dose.

What is Premique?

Premique is a medicine that alleviates symptoms of the menopause.

Between the ages of 45 and 55 years old, most women start the menopause. This is where you stop having your monthly menstrual periods – it is officially diagnosed once you have no menstrual periods for 12months.

During the menopause your body stops making regular amounts of oestrogen. The amount of oestrogen in the body reduces considerably, and you can start experiencing symptoms.

The symptoms of the menopause are different for every woman, but can include:

  • Hot flushes
  • Night sweats
  • Low mood
  • Anxiety
  • Vaginal dryness
  • Difficulty sleeping
  • Frequent headaches
  • Urinary tract infections
  • Greater risk of osteoporosis.

Premique provides oestrogen to replace the lack of natural oestrogen produced by the body. This is why it is known as a hormone replacement therapy (known as HRT).

If you are thinking about starting HRT – whether that is Premique or any other product – you must discuss this with your doctor.

What are the side effects of Premique and other HRT medication?

All HRT treatment has side effects so check your patient information leaflet for these. Some risks associated with HRT that are of more concern include:

  • Risk of breast cancer
  • Risk of endometrial cancer
  • Risk of ovarian cancer
  • Risk of venous thromboembolism such as deep vein thrombosis (DVT)
  • Risk of stroke
  • Risk of heart disease.

It is important to get your HRT dose absolutely right because the higher the amount of oestrogen the higher your risk of developing these – the lower amount of oestrogen, the lower the risk.

Recent evidence and the National Institute for Health and Care Excellence's (NICE) new guidelines say that the risks of HRT are small and are usually outweighed by the benefits.

We have more information about HRT in a previous Ask the Expert response.

What are the alternatives to Premique?

Premique (i.e. the original 0.625mg version) combined both conjugated oestrogens and progesterone (medroxyprogesterone acetate) in one tablet. This is a form of continuous combined HRT, prescribed for post-menopausal women who still have a uterus and not had a period for more than one year. If this is the one you were previously taking and you would like – or need – to continue taking it, speak to you doctor to arrange a suitable alternative.

There are three main altenatives open to you.

Option 1

One of the options is to take the two ingredients in Premique – oestrogen and progesterone – as two different tablets. Premarin is a brand of conjugated oestrogens tablets are available in 0.3mg, 0.625mg and 1.25mg.

If you wanted to have the exact amount as what is in Premique you could take one tablet of Premarin 0.625mg and one Medroxyprogesterone 5mg tablet.

Climanor and Provera are two brands of Medroxyprogesterone 5mg tablets currently available on the market.

Option 2

The second option is to take various forms of oestradiol and progesterone in a combined tablet or patch.

Oestradiol is a synthetic form of oestrogen.

Kliovance, Femostin Conti, Indivina and Angelique are alternatives to Premique. These contain 1mg of oestradiol but various different types’ progesterone.

Of these Indivina is the closest to Premique, in terms of the progesterone content because it contains the Medroxyprogesterone acetate 5mg.

If you prefer to try a HRT patch, Evorel Conti is the first line of this type of treatment option.

Each Evorel Conti patch contains oestradiol 50micrograms and norethisterone 170micrograms. You change the patch twice a week.

If you suffer from skin allergies or if there is poor absorption with Evorel conti then Femseven Conti patches may be an option. This means that if Evorel Conti is failing to provide relief from the menopausal symptoms or you are having an allergic reaction to the adhesive then you could try using Femseven patches.

Each Femseven Conti patch contains oestradiol 50micrograms and Levonorgestrel 10micrograms. You change the patch once a week.

Option 3

The third option is to switch to Tibolone 2.5mg tablets. Tibolone tablets contain a synthetic molecule with oestrogen, progestogen and androgenic properties.

Next steps

As you can see there are various different options open to you. Your doctor will decide which of the options will be the most suitable for you after taking into consideration your own particular risks and your individual needs.

We suggest you discuss this matter with your GP and select an alternative HRT that is best for you.

If you have any further questions about this or any other aspect of the menopause please contact a member of our Health at Hand team.

Sources and further reading

Hormone Replacement Therapy

The low-down of high blood pressure

Useful resources

Women's Health Concern

Ageing Well centre

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