Treatments · the prescribing layer
HRT doses and brand names, decoded
Nobody hands you the key. Here's what the numbers on the box mean, how the routes compare, which brand name is which molecule in your country, and what the first six months usually feel like.
This page decodes a conversation. It is not dosing advice, and nothing here is a reason to change what you're taking on your own. Prescribing is your doctor or specialist's job. Walking in able to say "I'm on 50 mcg and still flushing at three months" is yours.
30-second orientation
- Almost all modern systemic HRT is the same molecule, estradiol, delivered four different ways. The route changes the risk profile more than the brand does.
- If you have a uterus, estrogen has to be paired with something that protects the lining. That's the second half of every prescription.
- Three months at a steady dose is the usual point to judge whether it's working, not three weeks.
- Brand names are country-specific and mean nothing about quality. Estradot and Vivelle-Dot are the same patch with different labels.
The dose ladder
What the numbers on the box actually mean
Doses are usually started low and stepped up until symptoms settle. There is no single correct dose: the right one is the lowest that does the job for you, and it is common to land somewhere in the middle of these ranges.
| Route | Lower end | Middle | Higher end | How it's taken |
|---|---|---|---|---|
| Estradiol patch | 25 mcg/24h | 37.5–50 mcg/24h | 75–100 mcg/24h | Changed once or twice a week depending on the brand. |
| Estradiol gel (pump) | 1 pump (0.75 mg) | 2 pumps (1.5 mg) | 3–4 pumps (2.25–3 mg) | Rubbed into arms or thighs daily, left to dry fully. |
| Estradiol gel (sachet) | 0.25–0.5 mg | 1 mg | 1.5 mg | Single-dose sachets, one application area daily. |
| Estradiol spray | 1 spray (1.53 mg) | 2 sprays | 3 sprays | Sprayed on the forearm, one non-overlapping area per spray. |
| Oral estradiol | 0.5 mg | 1 mg | 2 mg | One tablet daily. Goes through the liver first, unlike the routes above. |
| Conjugated estrogens (oral) | 0.3 mg | 0.45 mg | 0.625 mg | One tablet daily. An older, non-body-identical estrogen still widely prescribed in North America. |
Ranges reflect commonly prescribed products in the UK, Canada, the US and Australia. Specific licensed doses vary by product and country, and higher doses than these are sometimes used, particularly in premature ovarian insufficiency.
| If you're on… | Roughly comparable to a patch of… |
|---|---|
| 1 pump gel (0.75 mg) / 0.5 mg sachet / 1 spray | About 25 mcg |
| 2 pumps gel (1.5 mg) / 1 mg sachet / 2 sprays | About 50 mcg |
| 3 pumps gel (2.25 mg) / 1.5 mg sachet / 3 sprays | About 75 mcg |
| 4 pumps gel (3 mg) | About 100 mcg |
| Oral estradiol 1 mg | About 25–50 mcg (absorption differs a lot by route) |
| Oral estradiol 2 mg | About 50–100 mcg |
Approximate only. Absorption varies substantially between people, and oral estradiol behaves differently from transdermal because it passes through the liver first. Useful for orientation when switching route; not a conversion to make yourself.
Why route matters more than dose for risk: transdermal estradiol bypasses the liver and has not been associated with the increased clot risk seen with oral estrogen, which is why patches, gels and sprays are recommended first-line for most people and specifically for anyone with clot risk factors, migraine with aura, higher BMI, or liver conditions.
Brand names by country
Same molecule, different label
Most of the confusion online is people from different countries discussing the same drug under different names, or assuming a brand they've never heard of must be inferior. This is the decoder ring. It also makes moving country, or reading an overseas forum, much less disorienting.
| What it is | UK & Ireland | Canada | United States | Australia & NZ |
|---|---|---|---|---|
| Estradiol patch | Estradot, Evorel, Femseven, Progynova TS | Estradot, Climara, Estalis (combined) | Vivelle-Dot, Climara, Minivelle, Menostar, Combipatch (combined) | Estradot, Climara, Estalis (combined) |
| Estradiol gel | Oestrogel (pump), Sandrena (sachet) | Estrogel (pump), Divigel (sachet) | EstroGel, Divigel, Elestrin | Estrogel (pump), Sandrena (sachet) |
| Estradiol spray | Lenzetto | Not routinely available | Evamist | Lenzetto |
| Oral estradiol | Elleste Solo, Zumenon, Progynova | Estrace and generics | Estrace and generics | Progynova, Estrofem |
| Micronized progesterone | Utrogestan | Prometrium and generics | Prometrium and generics | Prometrium, Utrogestan |
| Levonorgestrel IUD (52 mg) | Mirena, Levosert, Benilexa | Mirena | Mirena, Liletta | Mirena |
| Vaginal estrogen | Vagifem, Vagirux, Ovestin, Blissel, Estring, Imvaggis | Vagifem, Estring, Premarin cream | Vagifem, Yuvafem, Imvexxy, Estring, Estrace cream, Premarin cream | Vagifem, Ovestin |
| Vaginal DHEA (prasterone) | Intrarosa | Intrarosa | Intrarosa | Limited availability |
| Testosterone for women | Testogel or Tostran, off-label at a fraction of the male dose | AndroFeme 1% via Special Access, or off-label male products | Off-label male products; no female-licensed product | AndroFeme 1%, licensed for women in Australia |
Availability changes and this is not exhaustive. Supply, licensing and coverage differ by country and by year; a pharmacist is the fastest source of truth on what's currently stocked near you.
The second half of the prescription
What pairs with what
Estrogen on its own thickens the lining of the uterus. If you have one, something has to balance that. This is the part of the prescription people most often can't explain, and the part most worth understanding.
| Your situation | What endometrial protection usually looks like |
|---|---|
| Uterus, still having periods (sequential) | Micronized progesterone 200 mg at night for 12–14 nights of each cycle, producing a monthly bleed. |
| Uterus, periods stopped or a year into sequential | Micronized progesterone 100 mg every night (continuous combined), aiming for no bleed once settled. |
| Uterus, heavy bleeding or wanting contraception too | A 52 mg levonorgestrel IUD covers the lining and contraception at once. Smaller-frame coils are not licensed for this job. |
| No uterus (hysterectomy) | Estrogen alone. Progestogen is usually not needed, with endometriosis history as the main exception to discuss. |
| Vaginal estrogen only | Systemic absorption is very low. Standard low-dose vaginal estrogen does not normally require added progestogen. |
Micronized progesterone is body-identical and is not the same drug as a synthetic progestin. That distinction matters for how it feels and for how it was studied.
The first six months
What usually happens, and when
The single most common reason people stop hormone therapy is stopping too early, during the weeks when side effects are loudest and benefits haven't arrived yet. Knowing the shape of the curve makes that stretch survivable.
- 1
Week 1–2
Settling in
Breast tenderness, mild nausea, headaches or a bloated feeling are common early and are usually the body reacting to a new baseline rather than a sign the dose is wrong. Skin irritation under a patch shows up here too.
- 2
Week 2–4
First real signal
For a lot of people, night sweats and sleep are the first things to shift. Mood and flushing often start to move in this window as well, though partially, not completely.
- 3
Week 6–12
Where the honest read is
Vasomotor symptoms are generally substantially better by three months if the dose and route are right. Most early side effects have faded. Guidelines suggest a review around this point rather than earlier.
- 4
Month 3–6
Bleeding settles, or doesn't
Unscheduled bleeding in the first three to six months of continuous combined therapy is common and usually settles. Bleeding that persists past six months, or new bleeding after a settled stretch, is something to get assessed rather than wait out.
- 5
Month 6–12
The slower wins
Joint aches, vaginal and urinary symptoms, skin, and libido tend to move on a longer clock. Vaginal estrogen in particular often takes eight to twelve weeks to do its real work.
Get seen sooner
Don't wait out chest pain, breathlessness, a swollen or painful calf, sudden severe headache, vision changes, or a new breast lump. Bleeding that starts after twelve months with no periods, or bleeding that persists past six months on continuous therapy, also needs assessing rather than watching.
When it isn't working
Six conversations worth having
"It's not working" is hard for a prescriber to act on. These are the same complaints, phrased in a way that points at a next step.
The menu
Hormone therapy options
All eleven options side by side, each with its evidence grade and sources.
See the optionsThe vocabulary
The hormones, in plain language
What estrogen, progesterone, testosterone, FSH and LH each actually do.
Start thereThe pushback
HRT myths, honestly answered
Eight things you'll still hear in 2026, and what the evidence says.
Read the mythsReferences & further reading
Where this comes from
Dose ranges, route recommendations and review timings on this page follow published national guidance and society position statements. Brand availability was checked against national product listings and changes over time.
Guidelines and position statements
Menopause: diagnosis and management (NG23)
NICE, UK
Transdermal estradiol as a first-line route, endometrial protection requirements, and review at three months after starting.
VisitTools for clinicians, including HRT prescribing guidance
British Menopause Society
Practical dose equivalence and product tables for UK-licensed estradiol and progestogen preparations.
VisitThe 2022 Hormone Therapy Position Statement
The Menopause Society (formerly NAMS)
North American consensus on dosing, route, duration, and the risk profile of hormone therapy by age and time since menopause.
VisitGuideline No. 422: Menopause and Medical Management
SOGC, Canada
Canadian prescribing guidance, including product availability and endometrial protection options.
VisitKey studies behind the route advice
Use of hormone replacement therapy and risk of venous thromboembolism
Vinogradova et al, BMJ 2019
The nested case-control study underpinning the transdermal-first recommendation: no increased VTE risk with transdermal estradiol, unlike oral.
VisitGlobal Consensus Position Statement on the Use of Testosterone Therapy for Women
Davis et al, JCEM 2019
The multi-society statement on testosterone dosing, monitoring in the female physiological range, and the single evidence-based indication.
Visit