Femoston Dosing and Frequency for Hormone Replacement Therapy
Femoston is available in multiple formulations with different dosing regimens: the standard sequential regimen uses 2 mg estradiol continuously with 10 mg dydrogesterone for 12-14 days per month, while continuous combined regimens use either 1 mg estradiol with 5 mg dydrogesterone daily or a low-dose option of 0.5 mg estradiol with 2.5 mg dydrogesterone daily. 1, 2, 3, 4
Standard Sequential Regimen (Femoston)
The typical sequential regimen consists of 2 mg oral estradiol taken continuously every day, combined with 10 mg dydrogesterone taken for 12-14 days of each 28-day cycle. 1, 2
This sequential approach is recommended for women who accept or prefer withdrawal bleeding, which typically occurs after the dydrogesterone phase. 5
The 10 mg dydrogesterone dose provides complete endometrial protection when used for 12-14 days per month in sequential regimens. 1
Cyclical vaginal bleeding occurs in most treatment cycles but is generally light to moderate with highly predictable onset timing. 2
Continuous Combined Regimens (Femoston-Conti)
For women who prefer to avoid withdrawal bleeding, the continuous combined regimen uses 1 mg estradiol plus 5 mg dydrogesterone taken daily without interruption. 1, 4
This continuous regimen provides excellent endometrial safety (treatment failure rate of only 0.4%) and achieves amenorrhea in approximately 41% of women throughout treatment. 4
The percentage of women without bleeding increases from 71% during the first cycle to around 80% by the end of the first year. 4
Low-Dose Option (Femoston Low)
A low-dose continuous combined formulation contains 0.5 mg estradiol plus 2.5 mg dydrogesterone taken daily, designed to minimize risks while maintaining efficacy. 3
This low-dose preparation aligns with current recommendations to use the lowest effective dose for the shortest duration consistent with treatment goals. 1, 3
The low-dose formulation aims to potentially minimize breast cancer risk, thrombosis danger, and metabolic disturbances while still opposing endometrial hyperplasia and achieving high rates of amenorrhea. 3
Clinical Decision Algorithm
Choose sequential regimen (2 mg estradiol + 10 mg dydrogesterone for 12-14 days/month) if:
- Patient accepts or prefers predictable withdrawal bleeding 5
- Patient is perimenopausal or recently postmenopausal 2
Choose continuous combined regimen (1 mg estradiol + 5 mg dydrogesterone daily) if:
- Patient prefers to avoid withdrawal bleeding 5
- Patient is at least 1 year postmenopausal 4
- Standard dose is needed for symptom control 4
Choose low-dose continuous regimen (0.5 mg estradiol + 2.5 mg dydrogesterone daily) if:
- Patient has mild symptoms requiring treatment 3
- Patient has cardiovascular risk factors warranting lowest possible dose 3
- Patient is concerned about minimizing hormone exposure 3
Important Clinical Considerations
Common initial side effects (mood changes, breast tenderness, bloating, breakthrough bleeding) typically resolve within the first 3 months of therapy. 5
A clinical review should occur after 3 months to assess symptom improvement, side effect profile, and compliance. 5
If significant side effects persist beyond 6 months, consider switching to an alternative formulation or dosing regimen. 5
Dydrogesterone is preferred over medroxyprogesterone acetate for women with cardiovascular risk factors due to its more favorable cardiovascular and thrombotic risk profile. 6, 1
Treatment should use the lowest effective dose for the shortest duration consistent with treatment goals, as risks including venous thromboembolism, CHD, and stroke occur within the first 1-2 years of therapy. 1