# Menopausal Symptoms - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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. - Verified date: 2026-08 ## 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. ## Treatment metadata - Estradiol valerate — 1 mg — oral.solid - Tibolone — 2.5 mg — oral.solid - Progesterone — 200 mg — oral.solid ## Complete treatment card ```text MENOPAUSAL SYMPTOMS 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 against 4 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (12) - Flushing symptoms are the commonest, affecting 75% to 80%: hot flushes, night sweats, palpitations and migraine [hot flushes · night sweats · palpitations] - Hot flushes come without warning by day or night, last about 3 to 4 minutes, and begin as a flush spreading over the upper body [hot flushes] - They interrupt daily life and sleep, last 1 to 6 years on average, and in 10% to 15% of women persist for up to 15 years - Alcohol, smoking, obesity, inactivity and emotional stress make them worse [obesity] - Migraine often changes: swinging oestrogen early on can worsen it, many improve afterwards, and migraine with aura carries added stroke risk, especially with smoking or the pill - Genitourinary syndrome affects 50% to 75%: as the lining thins and loses elasticity there is vaginal dryness, burning, itching and irritation [itching · vaginal dryness] - Bladder and urethra carry oestrogen receptors too, so frequency, urgency and painful urination follow as the urethra thins [burning on passing urine] - Repeated urine infections become likelier because a higher vaginal pH lets bladder organisms colonise - Leaking urine is not caused by the falling oestrogen itself; it tracks excess weight, diabetes and age [urinary incontinence] - Up to 70% have psychological symptoms: anger or irritability, anxiety or tension, low mood, poor concentration, and loss of confidence [anxiety · irritability · low mood · poor concentration] - Sleep complaints are common regardless of hormone therapy or flushes: trouble falling asleep, waking early, and waking repeatedly in the night [insomnia] - Sexual desire and function fall and pain with intercourse increases, sometimes starting nearly 2 years before the last period SIGNS - what you find (6) - Blood pressure may rise as the arteries constrict - Many gain weight through the transition, on average about 5 pounds or 2 kg - Height can drop as bone is lost to osteoporosis - Breasts become fattier and shrink back after the menopause - Vaginal examination shows dryness and the changes of urogenital atrophy [atrophy] - Joint pains appear, and muscle bulk, strength and function gradually decline TESTS (8) - The diagnosis is made clinically on age and symptoms; laboratory testing is usually unnecessary and the symptoms start before hormones measurably change - Hormones are worth measuring in particular situations: no periods after hysterectomy or endometrial ablation, and anovulatory cycles, where FSH and oestradiol help - An FSH above 30 mIU/mL is an objective marker, but pelvic surgery raises it temporarily so wait at least 3 months afterwards - An oestradiol below 20 pg/mL points to menopause - FSH between 40 and 50 varies enormously and settles only 3 to 6 years after the menopause, which limits the routine value of FSH and oestradiol - Inhibin B and AMH do not help make the diagnosis, and AMH as a predictor of when menopause will come remains contested - Where the absent periods may not be menopausal, add a pregnancy test, TSH and prolactin - Oestrogens, androgens and hormonal contraceptives distort FSH, so test at least 2 weeks after stopping them IF NOT THIS - what else fits (6) - At 45 or older with the usual symptoms, no test is needed; below that age other causes of absent periods must be excluded - Pregnancy is the commonest reason periods stop and must be excluded first - Scarring inside the uterus: Asherman syndrome after curettage, or chronic endometritis, tuberculosis in particular - Failure of the hypothalamic-pituitary-ovarian axis from obesity, anorexia, bulimia, chronic illness such as kidney disease or inflammatory bowel disease, drugs, heavy exercise, poor nutrition, stress or cancer - Also coeliac disease, adrenal disorders, past chemotherapy or radiation, Sheehan syndrome, and a pituitary adenoma - Ovarian causes: a tumour, polycystic ovary syndrome, and premature ovarian insufficiency Source StatPearls "Menopause" - disease-level clinical article Status traced to the source above 1. ESTRADIOL VALERATE [1st line] Adult 1-2 mg once daily continuously (add progestogen if intact uterus) - long-term (review annually) Peds Adult-only condition - paediatric section not applicable Source Progynova® 2 mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1417) Why 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. Caution 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. Egypt ESTRAVODOSE 1 MG 28 F.C. TABS. TECHNOPHARM 33.00 EGP (1.18/unit) 2. TIBOLONE [2nd line] Adult 2.5 mg once daily - long-term (review annually) Peds Adult-only condition - paediatric section not applicable Source Livial (tibolone) 2.5 mg tablets SmPC sections 4.1-4.4 (eMC product 1597) Why Synthetic steroid with combined estrogenic, progestogenic, and androgenic activity, used as an alternative hormone therapy for vasomotor symptoms in women who are clearly postmenopausal. Caution 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. Egypt LIVIAL 2.5MG 28 TAB. ORGANON > MUL... 205.00 EGP (7.32/unit) 3. PROGESTERONE [add-on - not a substitute] Adult 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 - For as long as systemic oestrogen is continued Peds Adult-only condition - paediatric section not applicable Source Egyptian National Drug Formulary - Endocrine System 2024 (progesterone monograph) Why 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. Caution 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. Egypt UTROCARE 200 MG 30 S.G. CAPS. SAFE PHARMA >... 204.00 EGP PROGEST 200MG 30 ORAL/VAGINAL CAPS. PHARCO 246.00 EGP HYSTROGEST 200 MG 30 S.G.CAPS. SAFE PHARMA >... 264.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)