Trisequens

What is Trisequens Hormone Replacement Therapy?

Trisequens is a combined hormone replacement therapy that contains oestrogen (estradiol) and norethisterone acetate which is a synthetic form of the hormone progesterone.

Trisequens is taken every day without a break to reduce menopausal symptoms in women who still have a uterus but have not had a menstrual period in at least the last 6 months. Trisequens should cause you to have a monthly bleed.

Trisequens is a sequential type of HRT, which means that inside each pack of 28 tablets, the different colour tablets have different amounts of hormones. This guarantees that you get the most appropriate dose of each hormone throughout the month.

What is Trisequens used for?

During menopause, the oestrogen levels in a woman's body drop, which can cause women to experience some unwanted symptoms. These can vary from person to person but often include:

• Night sweats
• Hot flushes
• Vaginal dryness
• Reduced sex drive
• Low mood, depression, and anxiety
• Disturbed sleep and insomnia
• Fatigue
• Mood swings
• Irritability

These are just a few of the menopausal symptoms that some women will experience. For more information take a look at this guide on recognising the early signs of menopause.

Taking Trisequens, which contains estrogen, can help to alleviate these menopausal symptoms and can also reduce the chance of postmenopausal women developing osteoporosis.

How does Trisequens work?

Trisequens tablets contain both oestrogen and a form of progesterone in varying amounts, which mimic the female body's natural menstrual cycle. Taking additional oestrogen after menopause helps to reduce menopausal symptoms by replacing the hormone levels in the blood that would have previously been produced by the ovaries.

Taking hormone replacement therapy, such as Trisequens, which also contains progesterone is prescribed to women that are postmenopause but still have a uterus. This is because it has been shown to reduce the risk, for women who take HRT, of developing endometrial cancer.

Alternatives to Trisequens

There are currently many varieties of hormone replacement therapy available on prescription including others containing oestrogen-only HRT or combined HRT containing both synthetic oestrogen and progesterone.

Progynova is an oestrogen-only HRT tablet that contains estradiol valerate. Equivalent HRT treatments include Elleste Solo tablets and Zumenon tablets.

Hormone replacement therapy is available in different formats such as HRT tablets and patches, creams and vaginal inserts. Some postmenopausal women will find certain methods more suitable for them than others. For more information about what HRT you can buy from The Independent Pharmacy visit our Menopause page.

If you are looking to start hormone replacement therapy or would like to change to a different treatment you should discuss your options with your doctor or specialist.

Trisequens dosage

Trisequens tablets are for oral use only and come in a wheel calendar packet containing 28 tablets.

Each packet contains blue, white and red film-coated tablets which contain different amounts of hormones. When starting your Trisequens tablets you must start with the blue tablets. Once you finish your 28 days of tablets, start your new packet the next day, do not have a break.

You will take:

• Blue Tablet: Days 1 - 12, these contain 2 mg estradiol
• White Tablet: Days 13 - 22, these contain 2 mg estradiol and 1 mg of norethisterone
• Red Tablet: Days 22 - 28, these tablets contain 1 mg of estradiol

To start each pack of Trisequens:

• Turn the inner disk to the blue tablets on the set day of the week.
• Break the plastic tab over the tablet and tip the tablet out.
• Move the dial clockwise 1 space every day as directed by the arrows and take that tablet.

Please make sure to read the Patient Information Leaflet thoroughly before starting Trisequens.

Trisequens Ingredients

The blue tablets contain the active ingredients: estradiol 2 mg

The white tablets contain the active ingredients: estradiol 2 mg and norethisterone acetate 1 mg

The red tablets contain the active ingredients: estradiol 1 mg

The inactive ingredients in each tablet: lactose monohydrate, maize starch, hydroxypropyl cellulose, talc, magnesium stearate, hypromellose.

The coloured film-coating of the tablets contain: titanium dioxide (E171), indigo carmine (E132), macrogol 400, triacetin, red iron oxide (E172) and propylene glycol.

Trisequens side effects

Trisequens, like with any other medicines, may cause some people to experience side effects. However, this doesn’t mean that you will definitely experience any unwanted side effects from taking Trisequens, and if you do then most women find these improve within the first three months. If side effects don’t improve or you are worried you should speak to a doctor or pharmacist immediately for advice.

If you experience an allergic reaction, severe side effects or any of the health conditions indicated in the warning and precautions section of the Patient Information Leaflet you must seek immediate medical advice either by calling 999 or by attending your nearest emergency department.

The most common side effects associated with Trisequens HRT users are:

• Headache and migraines
• Breast tenderness, breast pain, or enlargement
• Vaginal thrush & unexplained vaginal bleeding
• Nausea & vomiting, abdominal pain
• Painful swelling of the hands, ankles and feet
• Muscle cramps
• Weight gain
• Depression

Please make sure to read the Patient Information Leaflet thoroughly before starting Trisequens.

Trisequens warnings

Please make sure to read the Patient Information Leaflet for full details on the warnings and precautions, before starting Trisequens.

Using any HRT treatment, including Trisequens, carries risks. You should consider these risks and decide whether taking HRT is right for you. If you have any questions or concerns you should discuss these with your GP or specialist.

Continuing to receive HRT on repeat prescription from The Independent Pharmacy is dependent on you seeing your GP for a check-up at least once a year.

If you experience any of the following, before or while taking Trisequens, stop taking and consult your doctor immediately:

• You suspect or develop breast or endometrial cancer
• You have any unexplained vaginal bleeding or endometrial hyperplasia
• You have or have ever had a venous blood clot or have a clotting disorder
• You have had a heart attack, stroke or angina

If you have ever experienced any of the following, consult your doctor before starting Trisequens and again if your condition worsens during treatment:

• You have recently stopped taking or are currently taking any other prescribed or non-prescribed (including herbal) medication.
• Uterine fibroids
• Endometriosis or endometrial hyperplasia
• High blood pressure or very high levels of fat in your blood
• Liver, kidney or heart disorders
• Diabetes, SLE, epilepsy or asthma
• Gallstones
• Migraine or severe headaches
• Hypothyroidism
• Hereditary angioedema

Trisequens and cancer

Studies have indicated that taking a combined estrogen-progestogen HRT such as Trisequens can slightly increase your risk of developing breast cancer and ovarian cancer.

The risk of developing breast cancer increases the longer you take HRT but returns to normal up to 5 years after stopping treatment. For this reason, it is advised that you only take HRT for the shortest amount of time to manage your symptoms.

You should continue to check your breasts regularly for changes including lumps and dimples if you notice any irregularities you must see a doctor as soon as possible.

Trisequens and your circulation

Taking oral HRT makes you 3 times more likely to experience blood clots and 1.5 times more likely to experience a stroke. If you think you are developing symptoms of a blood clot at any time call NHS 111 or are having a stroke call 999.

Trisequens in pregnancy & breastfeeding

Trisequen should only be prescribed for postmenopausal women and is not a contraceptive. If you have had a period in the last 12 months or are under 50 years old you should discuss contraception with your doctor before taking Trisequens.

If you become pregnant while taking HRT stop taking it straight away and contact your doctor. You should also not take Trisequens if you are breastfeeding.