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Cyclo-Progynova is a hormone replacement therapy (HRT) preparation. Each pack contains two types of tablets. The white tablets contain estradiol valerate and the pale brown tablets contain estradiol valerate in combination with norgestrel. Estradiol valerate (previously spelt oestradiol valerate in the UK) and norgestrel are forms of the main female sex hormones, oestrogen and progesterone. Estradiol valerate is a naturally occuring form of oestrogen and norgestrel is a synthetic form of progesterone.

Womens' ovaries gradually produce less and less oestrogen in the period up to the menopause, and oestrogen blood levels decline as a result. The declining levels of oestrogen can cause distressing symptoms, such as irregular periods, hot flushes, night sweats, mood swings and vaginal dryness or itching.

Oestrogen (in this case in the form of estradiol valerate) can be given as a supplement to replace the falling levels in the body and help reduce these distressing symptoms of the menopause. This is known as hormone replacement therapy (HRT). HRT is usually only required for short-term relief from menopausal symptoms and its use should be reviewed at least once a year with your doctor

A progestogen (in this case in the form of norgestrel) is needed as part of HRT for women who have not had a hysterectomy. This is because in women with an intact womb, oestrogen stimulates the growth of the womb lining (endometrium), which can lead to endometrial cancer if the growth is unopposed. A progestogen is given to oppose oestrogen's effect on the womb lining and reduce the risk of endometrial cancer, though it does not eliminate this risk entirely. This is known as combined HRT.

Cyclo-Progynova is a sequential form of combined HRT. This means that oestrogen is taken on a continuous basis and progesterone is added for a portion of each month. The white tablets taken in the first 11 days of each Cyclo-Progynova cycle contain only estradiol. The brown tablets taken in the next 10 days of each cycle contain both estradiol and norgestrel. After these 21 days you then have a seven day tablet-free break before the next cycle is started, rather like the combined contraceptive pill. This type of HRT is more suitable for women who are still having irregular periods, because it usually results in a monthly withdrawal bleed in the pill-free week.

HRT is also sometimes used to prevent osteoporosis in postmenopausal women. The declining level of oestrogen at menopause can affect the bones, causing them to become thinner and more prone to breaking. Oestrogen supplements help prevent bone loss and fractures that may occur in women in the years after menopause.

However, in December 2003, a review of the available evidence on the risks and benefits of HRT by the Medicines and Healthcare products Regulatory Agency (MHRA) and the Committee on Safety of Medicines (CSM) in the UK, concluded that the risks of using HRT long-term to prevent osteoporosis in women aged over 50 years exceed the benefits. As a result, this medicine should not be used as a first-line option for preventing postmenopausal osteoporosis in women over 50. However, it may be used as a second-line option for women at high risk of fractures who cannot take other medicines that are licensed for preventing osteoporosis.

Women considered to be at high risk of developing fractures following the menopause include those who have had an early menopause, those with a family history of osteoporosis, those who have had recent prolonged corticosteroid therapy (eg prednisolone), those with a small thin frame, and smokers.

You can read more about the risks and benefits of HRT and other medicines for preventing osteoporosis in the factsheets about menopause and osteoporosis linked below.

What is it used for?Hormone replacement therapy to relieve symptoms of the menopause.Second-line option for preventing osteoporosis in postmenopausal women who are at high risk of fractures and cannot take other medicines licensed for preventing osteoporosis.

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