Kliofem

Kliofem is a type of hormone replacement therapy (HRT) designed to help alleviate the symptoms of menopause in women who have not had a period for at least one year. Kliofem is a continuous HRT, meaning that you take it every day with no breaks to allow for a monthly bleed. You will decide how long to take it in consultation with your doctor, as you should always aim to take the lowest possible dose of an HRT for the shortest possible time to alleviate the symptoms. Kliofem contains two types of hormone: estradiol, which is an oestrogen identical to the one produced by the ovaries and works to combat the drop in oestrogen when the ovaries stop producing eggs, and norethisterone acetate, which is a progestogen that works in a similar way to the body’s own hormone progesterone and helps to prevent issues such as the thickening of the womb lining when taking an HRT containing oestrogen.

The menopause does not happen overnight – it is a slow process that takes place gradually over the space of around seven years. Around 8 out 10 women develop some kind of menopausal symptoms, ranging from hot flushes (in three-quarters of women) to lower libido and depression. Not everyone has the same experience of menopause: sometimes the symptoms are mild and easy to cope with, but for the less fortunate, they seriously affect their ability to lead a normal life. The usual medication for menopausal symptoms is an HRT: these come various types, from creams to combat specific issues to pills and patches for a more general treatment.

Kliofem is a type of hormone replacement therapy (HRT) designed to help alleviate the symptoms of menopause in women who have not had a period for at least one year. Kliofem is a continuous HRT, meaning that you take it every day with no breaks to allow for a monthly bleed. You will decide how long to take it in consultation with your doctor, as you should always aim to take the lowest possible dose of an HRT for the shortest possible time to alleviate the symptoms.

Kliofem contains two types of hormone: estradiol, which is an oestrogen identical to the one produced by the ovaries and works to combat the drop in oestrogen when the ovaries stop producing eggs, and norethisterone acetate, which is a progestogen that works in a similar way to the body’s own hormone progesterone and helps to prevent issues such as the thickening of the womb lining when taking an HRT containing oestrogen.

Kliofem HRT is used for women who have had at least one year since their last period to alleviate the symptoms of menopause, including:

• Hot flushes;
• Night sweats;
• Headaches;
• Mood swings;
• Anxiety;
• Frequent urinary tract infections;
• Difficulty sleeping;
• Palpitations;
• Reduced muscle mass;
• Lower sex drive;
• Vaginal dryness;
• Joint pain or stiffness;
• Weak bones, osteoporosis.

You will only be prescribed Kliofem is these symptoms seriously affect your ability to lead a normal life.

Kliofem is also used to help ward off osteoporosis if you are at increased risk of fractures and other medicines are unsuitable.

You should always follow the instructions given to you by your doctor or pharmacist when it comes to taking any medication. Kliofem HRT comes in tablet form. Start taking the Kliofem tablets on any day unless you are switching from an HRT that gives you a monthly bleed, in which case start taking Kliofem HRT on the day your monthly bleed finishes. Swallow the Kliofem tablet whole with a glass of water, and aim to take the tablet at around the same time each day.

Kliofem tablets contain 2 mg of estradiol and 1 mg of norethisterone acetate. Take one tablet each day. Kliofem comes in a calendar pack to help you remember to take it. Each time you take out a tablet, turn the dial to the next pill. If you forget to take your Kliofem tablet, take it as soon as you remember unless it is close to the time for your next tablet, then simply skip the tablet and carry on as normal. Never take a double dose to make up for skipping a tablet.

Like all medicines, Kliofem HRT comes with a warning of some side effects, although of course not everyone taking Kliofem will get them. There are some diseases that are reported more often in women using HRT compared with women who are not. These include:

• Breast cancer;
• Abnormal growth or cancer of the lining of the womb;
• Ovarian cancer;
• Blood clots in the leg veins or lungs;
• Memory loss (dementia);
• Heart disease;
• Stroke.

There is also a risk of an allergic reaction, though this is uncommon. Monitor for the following signs:

• Itching, rashes, hives;
• Shortness of breath;
• Swelling around the face, lips and throat;
• Feeling dizzy;
• Sweating.

If you suspect an allergic reaction, stop taking the medicine and seek immediate medical assistance.

Very common side effects (affect more than 1 in 10 people):

• Breast pain or tenderness;
• Vaginal bleeding.

Common side effects (affect 1 to 10 people out of 100):

• Headache;
• Migraine, either new or worsened;
• Vaginal inflammation;
• Vaginal infection;
• Depression, either new or worsened;
• Back pain;
• Nausea;
• Weight gain caused by fluid retention;
• Swelling of arms and legs;
• Enlarged or swollen breasts;
• Back pain;
• Uterine fibroid aggravation, occurrence or recurrence;
• Abdominal pain.

Uncommon side effects (affect 1 to 10 people out of 1000)

• Bloating, swelling, flatulence;
• Acne;
• Hair loss;
• Inflammation of a vein;
• Itching or hives;
• Allergic reaction;
• Nervousness;
• Drug ineffective.

Rare side effects (affect 1 to 10 people out of 10,000)

• Blood clots in the blood vessels of the legs or the lungs.

Very rare side effects (affect fewer than 1 person in 10,000)

• Cancer of the lining of the womb;
• Excessive thickening of the lining of the womb;
• Gall bladder disease, gall stones;
• Increased blood pressure;
• Worsening of high blood pressure;
• Acute or recurring oedema;
• Vomiting;
• Heart attack and stroke;
• Heartburn;
• Visual disturbances;
• Weight loss;
• Changes in libido;
• Insomnia, dizziness, anxiety.

Other side effects of combined HRT include:

• Gall bladder disease;
• Dry eyes;
• Various skin disorders including:
• Red or purple discolorations on the skin and/or eyes, nose, mouth;
• Painful reddish skin nodules;
• Discoloration of the skin, especially on the face or neck;
• Rash with target-shaped reddening or sores.

You should not take Kliofem if any of the following apply to you (if you are unsure, discuss it with a medical professional):

• If you have or have had cancer which is sensitive to oestrogens, such as cancer of the womb;
• If you have or have had breast cancer;
• If you have excessive thickening of the womb lining;
• If you have unexplained vaginal bleeding;
• If you have or have ever had a disease caused by blood clots in the arteries such as a heart attack, stroke or angina;
• If you have or have ever had a blood clotting disorder;
• If you have or have ever had liver disease;
• If you have or have ever had a blood clot in a vein, in the legs or lungs;
• If you have a rare blood problem called porphyria;
• If you are allergic to estradiol, norethisterone acetate or any of the other ingredients listed on the pack.

If any of the conditions above appear while you are taking Kliofem HRT, then you should stop taking the tablets and consult your doctor immediately.

If you notice any of the following while taking Kliofem HRT, stop taking it and speak to your doctor straight away:

• Yellowing of the skin or the whites of your eyes (this may be a sign of liver disease);
• A large rise in blood pressure;
• Migraine-like headaches which happen for the first time;
• Signs of a blood clot, for example, painful swelling and redness of the legs, sudden chest pain, difficulty breathing;
• If you become pregnant.

You should not take Kliofem HRT if you are pregnant or breastfeeding – it is designed for post-menopausal women only.

If you have had any of the following prior to taking with Kliofem HRT, you will need to let your doctor know as they may return or worsen during the treatment, so you will need regular check-ups:

• High blood pressure;
• Fibroids inside your womb;
• Growth of the womb lining outside your womb or a history of excessive womb lining;
• Increased risk of developing blood clots;
• Mgraine or severe headaches;
• Increased risk of getting oestrogen-sensitive cancer;
• A liver disorder;
• Gallstones;
• Diabetes;
• A disease of the immune system affecting many organs of the body;
• A high level of fat in your blood;
• Fluid retention caused by cardiac or kidney problems;
• Asthma;
• Epilepsy;
• A disease affecting the eardrum and hearing;
• Lactose intolerance.

Always discuss any medication you are taking with your doctor or pharmacist, as some medicines may interfere with Kliofem or vice versa. This can cause irregular bleeding among other problems. While not an exhaustive list, you should take special care with medicines for:

• Tuberculosis;
• Epilepsy;
• HIV infections;
• Hepatitis c;
• Herbal remedies containing St John’s Wort;
• Medicines containing ketoconazole (a fungicide).

Kliofem HRT may have an impact on a concomitant treatment with cyclosporine.

Kliofem HRT is available in pharmacies, so you can buy it at the most convenient pharmacy for you – either locally, in a supermarket pharmacy or order online and get your medication delivered directly to your home or office.

No, you cannot buy Kliofem HRT without a prescription. Hormone replacement therapies are carefully monitored and are only prescribed to women whose lives are seriously affected by the symptoms of menopause. You will need to consult a doctor either online or in person to discuss your symptoms and your family history to decide whether Kliofem HRT is the best medication for you and if so, the length of treatment. You will also need regular check-ups throughout your treatment, including blood pressure and weight monitoring. Finding the most suitable HRT can be a process of trial and error to see how your body responds.

NHS UK (2019). Hormone replacement therapy (HRT) – Side effects. [online] nhs.uk. Available at: https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/side-effects/ [accessed 8 Jan 2020].

Novo Nordisk A/S (2016). [online] Medicines.org.uk. Available at: https://www.medicines.org.uk/emc/files/pil.1045.pdf [accessed 8 Jan 2020].

Payne, J. (2017). Menopause | Symptoms and Treatment. [online] Patient.info. Available at: https://patient.info/womens- health/menopause [accessed 8 Jan 2020].

Willacy, H. (2018). Hormone Replacement Therapy (Risks and Benefits). HRT. [online] Patient.info. Available at: https://patient.info/doctor/hormone-replacement-therapy-including-benefits-and-risks [accessed 8 Jan 2020].