{ "schema_version": 1, "kind": "condition", "id": "menopause-symptoms", "name": "Menopausal Symptoms", "category": "chronic", "sources": "Livial (tibolone) 2.5 mg tablets SmPC sections 4.1-4.4 (eMC product 1597) · Egyptian National Drug Formulary - Endocrine System 2024 (progesterone monograph) · Progynova® 2 mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1417) · Carlson K, Vadakekut ES. Menopause. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. NBK507826.", "review_status": "reviewed", "verified_against": "Livial (tibolone) 2.5 mg tablets SmPC sections 4.1-4.4 (eMC product 1597) · Egyptian National Drug Formulary - Endocrine System 2024 (progesterone monograph) · Progynova® 2 mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1417) · Carlson K, Vadakekut ES. Menopause. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. NBK507826.", "verified_date": "2026-08", "treatments": [ { "id": 1146, "generic": "Estradiol valerate", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 1.0, "adult_dose": "1-2 mg once daily continuously (add progestogen if intact uterus)", "adult_duration": "long-term (review annually)", "dose_source": "Progynova® 2 mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1417)", "rationale": "Oral estrogen replacement that corrects the declining estrogen driving vasomotor symptoms (hot flashes, night sweats) of menopause; needs an added progestogen whenever the uterus is intact, per the cautions.", "cautions": [ "Do not start if there is postmenopausal bleeding - refer to exclude endometrial cancer first.", "Unopposed estrogen increases endometrial cancer risk; must add progestogen if uterus present.", "Contraindicated in active/past VTE, breast cancer, or severe active liver disease.", "Use lowest effective dose for shortest duration necessary.", "Estradiol valerate, not ethinyl estradiol. The register carries a pack labelled ETHINYL OESTRADIOL 50 MCG whose scientific name in the source data is simply 'estradiol', and that is the only product it returns. Ethinyl estradiol is a synthetic oestrogen of far higher hepatic and thrombotic potency and is not an HRT agent - 50 mcg of it is a contraceptive dose, not a replacement one." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable to children", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ESTRAVODOSE 1 MG 28 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TECHNOPHARM", "price_egp": 33.0, "pack_count": 28, "unit_price": 1.18, "strength_mg": 1.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "menopause-symptoms" }, { "id": 1147, "generic": "Tibolone", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 2.5, "adult_dose": "2.5 mg once daily", "adult_duration": "long-term (review annually)", "dose_source": "Livial (tibolone) 2.5 mg tablets SmPC sections 4.1-4.4 (eMC product 1597)", "rationale": "Synthetic steroid with combined estrogenic, progestogenic, and androgenic activity, used as an alternative hormone therapy for vasomotor symptoms in women who are clearly postmenopausal.", "cautions": [ "Increases stroke risk in women aged >60 years.", "Combines estrogenic, progestogenic, and androgenic properties.", "Only suitable for postmenopausal women (>12 months after last period).", "Not started until at least twelve months after the last period.", "Ischaemic stroke risk rises from the first year. The relative rise is the same at any age, but the baseline climbs steeply with age, so in an older woman the actual added risk is much larger.", "Breast cancer risk up to doubled beyond five years of use, showing from about three years, and it does not fall away immediately on stopping.", "Bleeding or spotting still happening after six months needs investigating properly, biopsy included - it is not the drug settling in." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable to children", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "LIVIAL 2.5MG 28 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ORGANON > MULTIPHARMA", "price_egp": 205.0, "pack_count": 28, "unit_price": 7.32, "strength_mg": 2.5, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "menopause-symptoms" }, { "id": 1148, "generic": "Progesterone", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 200.0, "adult_dose": "Micronised progesterone 200 mg at bedtime for 12 days, from day 15 to day 26 of each cycle; alternatively 100 mg at bedtime from day 1 to day 25, which causes less withdrawal bleeding", "adult_duration": "For as long as systemic oestrogen is continued", "dose_source": "Egyptian National Drug Formulary - Endocrine System 2024 (progesterone monograph)", "rationale": "21 live products. The formulary's oral indication is adjunctive use with an oestrogen in post-menopausal women with an intact uterus. The condition currently offers estradiol valerate with no progestogen, which is unopposed oestrogen - a real endometrial cancer risk in any woman who still has a uterus.", "cautions": [ "This is endometrial protection, not treatment for hot flushes. It is given ONLY alongside the systemic oestrogen, and only to a woman who still has a uterus.", "The tibolone already listed does not need an added progestogen - it is a single agent.", "Take at bedtime; micronised progesterone is sedating.", "Contraindicated in undiagnosed vaginal bleeding, active or recent venous thromboembolism, severe hepatic disease, and hormone-dependent cancer.", "Investigate any unscheduled bleeding that starts after the first 6 months of therapy, or that persists beyond it.", "Check the excipients - some soft capsules are formulated in peanut or soya oil.", "A woman who has had a hysterectomy does not need this and should not be given it." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable - menopausal hormone therapy is an adult indication.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "UTROCARE 200 MG 30 S.G. CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SAFE PHARMA > OCTOBER PHARMA", "price_egp": 204.0, "pack_count": null, "unit_price": null, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PROGEST 200MG 30 ORAL/VAGINAL CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 246.0, "pack_count": null, "unit_price": null, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HYSTROGEST 200 MG 30 S.G.CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SAFE PHARMA > GLOBE INTERNATIONAL PHARMACEUTICALS", "price_egp": 264.0, "pack_count": null, "unit_price": null, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "menopause-symptoms" } ] }