This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Conjugated oestrogens with medroxyprogesterone oral low dose

Updated 2 Feb 2023 | Oestrogens and HRT


Tablets containing conjugated oestrogens and medroxyprogesterone acetate

Drugs List

  • conjugated oestrogens 300microgram and medroxyprogesterone 1.5mg modified release tablet
  • PREMIQUE LOW DOSE 300microgram+1.5mg modified release tablet
  • Therapeutic Indications


    HRT for treatment of oestrogen deficiency in women with intact uterus


    For initiation and continuation of treatment, the lowest effective dose for the shortest duration should be used.

    Patients should be re-evaluated periodically to determine if treatment is still necessary.


    One tablet daily continuously.

    Starting treatment
    Post-menopausal women not currently receiving hormone replacement therapy or women who are transferring from a continuous combined hormonal treatment may begin treatment at any time.

    In women transferring from another sequential hormone replacement therapy regimen, treatment should begin the day following the completion of the previous regimen.

    Breakthrough bleeding may occur in the early stages of treatment. If this persists and endometrial abnormality has been ruled out, consider a higher strength preparation or a cyclic regimen.


    One tablet daily continuously.

    Starting treatment
    Post-menopausal women not currently receiving hormone replacement therapy or women who are transferring from a continuous combined hormonal treatment may begin treatment at any time.

    In women transferring from another sequential hormone replacement therapy regimen, treatment should begin the day following the completion of the previous regimen.

    Breakthrough bleeding may occur in the early stages of treatment. If this persists and endometrial abnormality has been ruled out, consider a higher strength preparation or a cyclic regimen.

    Additional Dosage Information

    Missed tablet
    In the event of one missed tablet, it should be taken as soon as the patient remembers. Therapy may then continue as before.

    If more than one tablet has been forgotten, only the most recent should be taken. Patients should not take double doses to make up for missed tablets.

    Breakthrough bleeding may occur in the event of missed tablets.


    Major surgery with prolonged post-operative immobilisation
    Abnormal liver function test
    Breast cancer
    Deep vein thrombosis
    Hereditary fructose intolerance
    History of breast cancer
    History of thromboembolic disorder
    Myocardial infarction
    Oestrogen dependent neoplasm
    Pulmonary embolism
    Thromboembolic disorder
    Uncontrolled endometrial hyperplasia
    Undiagnosed gynaecological haemorrhage

    Precautions and Warnings

    Body mass index above 30kg per square metre
    History of recurrent spontaneous abortion
    Predisposition to thromboembolic disease
    Risk factor for oestrogen-dependent neoplasm
    Severe trauma
    Cardiac impairment
    Diabetes mellitus
    Epileptic disorder
    Glucose-galactose malabsorption syndrome
    Hepatic adenoma
    History of endometrial hyperplasia
    Hypophyseal neoplasm
    Lactose intolerance
    Renal impairment
    Systemic lupus erythematosus
    Uterine fibroids

    Patients on thyroid replacement therapy may require increased doses
    Assess family medical history prior to commencing treatment
    Exclude breast cancer before treatment
    Exclude oestrogen dependent neoplasm before treatment
    Contains lactose
    Preparation contains sucrose
    Do breast & pelvic exam. before & during treatment if clinically indicated
    Exclude pregnancy prior to initiation of treatment
    Abnormal and/or irregular bleeding should be investigated
    Advise patients of risks/benefits & review need for treatment regularly
    Monitor blood glucose closely in patients with diabetes mellitus
    Women with hypertriglyceridaemia need special surveillance
    Advise patient that changes in their breasts should be reported to Dr/nurse
    Advise patient to contact a doctor if symptoms of thromboembolism develop
    Avoid immobilisation-treatment may cause increased risk of thromboembolism
    May affect results of some laboratory tests
    Discontinue 4 - 6 weeks before major surgery
    Advise patient to seek advice at first indications of pregnancy
    Discontinue at first signs of thrombophlebitis or thromboembolism
    Discontinue if cholestasis develops
    Discontinue if first occurrence or worsening of migraine/severe headache
    Discontinue if jaundice or other evidence of hepatic impairment occurs
    Discontinue if significant rise in blood pressure occurs
    Advise patient not to take St John's wort concurrently
    Advise patient grapefruit products may increase plasma level
    Female: Not for contraception.Use non-hormonal contraception, if required

    For the treatment of menopausal symptoms the benefits of short-term HRT are considered to outweigh the risks in the majority of women.
    In all cases, it is good practice to use the lowest effective dose for the shortest possible time and to review the need to continue treatment at least annually.
    For postmenopausal women over 50 years who are at an increased risk of bone fracture, HRT should be used to prevent osteoporosis only in those who are intolerant of, or contraindicated for, other osteoporosis therapies.

    Physical examination should be guided by this and a knowledge of the contraindications, precautions and warnings for use of the product. Investigations including mammography should be carried out in accordance with currently accepted screening practices and modified according to the clinical needs of the individual.

    There is an increased risk of breast cancer in women currently or recently using Hormone Replacement Therapy (HRT). The risk of breast cancer increases with the duration of treatment and returns to normal after 5 years of stopping treatment.

    Ovarian cancer is much rarer than breast cancer. Evidence suggests a slight increased risk in women taking oestrogen-only or combined oestrogen and progestogen HRT, which becomes apparent within 5 years of use and diminishes over time after stopping.

    Examinations to rule out endometrial abnormalities should be undertaken at regular intervals. Prolonged monotherapy with oestrogens increases the risk of endometrial hyperplasia and carcinoma in postmenopausal women unless supplemented by administration of a progestogen to protect the endometrium. Unless there is a previous diagnosis of endometriosis it is not recommended to add a progestogen in hysterectomised women.

    Pregnancy and Lactation


    Conjugated oestrogens with medroxyprogesterone acetate are contraindicated in pregnancy.

    Should pregnancy occur, treatment should be discontinued immediately.

    Oestrogens have been associated with cardiovascular defects, eye and ear abnormalities and hypospadias in the newborn when having been exposed to these in the womb. However, some studies have failed to find a relationship with cardiovascular defects and non-genital malformations. Down's syndrome has also been associated with oestrogens as a group.

    Development alterations in the psychosexual performance of boys have been attributed to exposure to oestrogen and progestogen in the womb. Males who have been exposed to oestrogen and progestogen have demonstrated a trend to have less heterosexual characteristics and fewer masculine interests than males who have not been exposed to these hormones prenatally.

    Medroxyprogesterone has been found to exhibit dose-related teratogenicity and toxicity in animals. If medroxyprogesterone is administered within 4 weeks of conception then foetal growth retardation may be a low risk complication, but more research needs to be done to confirm these findings.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Conjugated oestrogens with medroxyprogesterone acetate are contraindicated in breastfeeding.

    Oestrogens have been used to suppress postpartum breast engorgement in patients who do not desire to breast feed. Oestrogenic agents demonstrate lower infant weight gain, decreased milk production and decreased composition of nitrogen and protein content of human milk. Even though the extent of these changes is low, the changes in milk production and composition may be of nutritional importance in malnourished mothers. Because of the reasons mentioned above the use of this medication during lactation should be avoided.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at


    Encourage patients to participate in the national breast cancer screening programme and the national cervical cancer screening programme as appropriate for their age. Breast awareness should also be encouraged and patients advised to report any changes in their breasts to their doctor or nurse

    Advise patients to contact their doctor if they are aware of a potential thromboembolic symptom (e.g. painful swelling of a leg, sudden pain in the chest, dyspnoea).

    Patients should be advised not to take St John's Wort concurrently with this medication.

    Advise patient to seek advice at the first indications of pregnancy.

    Advise patient grapefruit products may increase the plasma level of the drug.

    Side Effects

    "Spotting" bleeding
    Abdominal pain
    Aggravation of porphyria
    Altered glucose tolerance
    Anaphylactic reaction
    Anaphylactoid reaction
    Breakthrough bleeding
    Breast enlargement
    Breast pain
    Breast secretion
    Breast tenderness
    Change in amount of cervical secretion
    Change in menstrual flow
    Changes in libido
    Cholestatic jaundice
    Deep vein thrombosis (DVT)
    Endometrial hyperplasia
    Enlargement of hepatic haemangiomas
    Erythema multiforme
    Erythema nodosum
    Exacerbation of epilepsy
    Exacerbation of hypocalcaemia
    Exacerbation of otosclerosis
    Exacerbation of pre-existing asthma
    Fibrocystic breast changes
    Fluid retention
    Gallbladder disease
    Increase in plasma triglyceride concentration
    Increased risk of breast cancer
    Increased risk of endometrial cancer
    Increased size of uterine fibroids
    Intolerance to contact lenses
    Leg cramps
    Mood changes
    Myocardial infarction
    Ovarian cancer
    Premenstrual-like syndrome
    Pulmonary embolism
    Retinal vascular thrombosis
    Sodium retention
    Superficial vein thrombophlebitis
    Vaginal candidiasis
    Vascular purpura
    Venous thrombosis
    Weight changes

    Effects on Laboratory Tests

    Some laboratory tests may be influenced by oestrogens, for example tests for glucose tolerance, liver function or thyroid function.

    Hormone replacement therapy, especially oestrogen-progestogen combined treatment may increase the density of mammographic images and adversely effect the detection of breast cancer.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: April 2016

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Joint Formulary Committee. British National Formulary. 71st ed. London: BMJ Group and Pharmaceutical Press; 2016.

    Summary of Product Characteristics: Premique Low Dose 0.3mg/1.5mg Modified Release Tablets. Pfizer Limited. Revised April 2016.

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.