How to Use Femoston Conti
For a postmenopausal woman in her 50s with an intact uterus experiencing menopausal symptoms, Femoston Conti (1 mg estradiol + 5 mg dydrogesterone) should be taken as one tablet daily, continuously without breaks, using the lowest effective dose for the shortest duration necessary to control symptoms. 1, 2, 3
Indication and Patient Selection
- Femoston Conti is appropriate for postmenopausal women with an intact uterus who require treatment for moderate to severe vasomotor symptoms (hot flashes, night sweats) or genitourinary symptoms. 1, 2
- The combination of estrogen plus progestin is mandatory in women with an intact uterus to prevent endometrial hyperplasia and cancer, which occurs with unopposed estrogen use. 4, 2
- This medication should NOT be initiated solely for prevention of chronic conditions like osteoporosis or cardiovascular disease—it is for symptom management only. 4, 1
Dosing Regimen
- Take one tablet daily at the same time each day, continuously without any pill-free intervals. 5
- The continuous combined regimen (daily estrogen + daily progestin) minimizes breakthrough bleeding compared to sequential regimens. 2
- Femoston Conti contains 1 mg 17β-estradiol and 5 mg dydrogesterone, which represents a standard-dose formulation. 5
- For women requiring lower doses, ultra-low-dose formulations (0.5 mg estradiol + 2.5 mg dydrogesterone) are available and may reduce risks while maintaining efficacy. 6, 7
Timing and Duration
- Initiate therapy when menopausal symptoms begin, ideally when the patient is under 60 years old or within 10 years of menopause onset, as the risk-benefit profile is most favorable during this window. 1
- Reassess the need for continued therapy every 3-6 months, attempting to taper or discontinue medication at these intervals. 3
- Use the medication for the shortest duration necessary to control symptoms—breast cancer risk increases with duration beyond 5 years. 1
- If symptoms recur after discontinuation, therapy can be restarted at the lowest effective dose. 3
Expected Bleeding Pattern
- During the first 1-3 months, irregular spotting or light bleeding is common as the endometrium adjusts. 5, 8
- By 6-12 months, approximately 80% of women achieve amenorrhea (no bleeding). 5, 8
- About 41% of women remain completely amenorrhea-free throughout the entire treatment period. 5
- Severe bleeding is rare—if persistent or heavy bleeding occurs, endometrial evaluation is mandatory to rule out hyperplasia or malignancy. 3, 5
Endometrial Safety
- Femoston Conti provides excellent endometrial protection, with a hyperplasia rate of only 0.4% after one year of use. 5
- The dydrogesterone component induces progestational atrophy in the endometrium, preventing estrogen-driven proliferation. 5
- Despite this safety profile, any undiagnosed persistent or recurring abnormal vaginal bleeding requires endometrial sampling before continuing therapy. 3
Absolute Contraindications
Do not prescribe Femoston Conti if the patient has: 1
- Personal history of breast cancer or other estrogen-dependent malignancies
- Active or history of venous thromboembolism (DVT/PE) or stroke
- Active or history of coronary heart disease or myocardial infarction
- Active liver disease
- Antiphospholipid syndrome or thrombophilic disorders
- Undiagnosed abnormal vaginal bleeding
Relative Contraindications Requiring Caution
- Smoking in women over age 35 significantly amplifies cardiovascular and thrombotic risks—smoking cessation is mandatory before initiating HRT. 1
- History of gallbladder disease (oral HRT increases risk with RR 1.48-1.8). 1
- Family history of breast cancer without personal history is NOT an absolute contraindication but requires careful risk-benefit discussion. 1
Risk Profile to Discuss with Patient
For every 10,000 women taking combined estrogen-progestin therapy for 1 year, expect: 4, 1
Harms: 7 additional coronary events, 8 more strokes, 8 more pulmonary emboli, 8 more invasive breast cancers
Benefits: 6 fewer colorectal cancers, 5 fewer hip fractures, 75% reduction in vasomotor symptom frequency
The absolute increase in risk is modest but cumulative with duration of use. 4
These risks apply to the average population—individual risk factors may shift the balance. 4
Monitoring Requirements
- Annual clinical review to assess ongoing symptom burden, compliance, and necessity of continued therapy. 1
- No routine laboratory monitoring is required unless prompted by specific symptoms or concerns. 1
- Continue standard mammography screening per guidelines. 1
- Monitor for signs of venous thromboembolism (leg pain, swelling, chest pain, shortness of breath). 4
- Monitor for stroke symptoms (sudden headache, vision changes, weakness, speech difficulty). 4
Alternative Formulations to Consider
- Transdermal estradiol patches (50 μg/day) plus oral micronized progesterone (200 mg at bedtime) may offer a superior risk profile with lower rates of venous thromboembolism and stroke compared to oral formulations. 1
- Micronized progesterone is preferred over synthetic progestins due to lower breast cancer risk. 1
- For vaginal symptoms alone, low-dose vaginal estrogen preparations can be used without systemic progestin. 1, 2
Critical Pitfalls to Avoid
- Never initiate HRT in women over 65 years old—if already on therapy at age 65, reassess necessity and attempt discontinuation or dose reduction. 1
- Never continue HRT beyond symptom management needs—it is not for chronic disease prevention. 4, 1
- Never use unopposed estrogen in women with an intact uterus—this dramatically increases endometrial cancer risk. 4
- Never prescribe HRT to women with a personal history of breast cancer, regardless of hormone receptor status. 1
- Do not assume all HRT formulations carry equal risk—transdermal routes and micronized progesterone have more favorable profiles than oral conjugated equine estrogen with medroxyprogesterone acetate. 1