Safe Prescribing Policy for HRT

In April 2023, a joint safety alert was issued by the British Menopause Society, the Faculty of Sexual and Reproductive Health, the Royal College of General Practitioners, and the Royal College of Obstetricians and Gynaecologists. This alert highlighted concerns about an increasing number of women being prescribed high doses of oestrogen that exceed licensed product limits.

At Horsley Medical Practice we follow the guidelines suggested by the British Menopause society which recommends that the dose of oestrogen is not increased out of license, and  different forms of oestrogen are not added together (eg gel and patch or tablets end gel etc. The upper recommended limits are:

Estradiol 0.06% gel: Maximum of 4 pumps daily

Estradiol patch: Maximum of 100 mcg twice weekly

Oral Estradiol tablets: Maximum of 2 mg daily

Lenzetto Spray: Maximum 3 sprays daily

We are aware that some private providers may prescribe oestrogen above these recommended limits. However, our practice policy is that we cannot prescribe any medication that would contribute, even in part, to an overall treatment dose exceeding these limits, as this would constitute prescribing beyond currently available safety guidelines. This decision was made with careful consideration, as unlicensed prescribing carries both clinical and legal responsibilities and the prolonged use of excessive oestrogen doses may pose significant health risks.

Therefore, if you are receiving oestrogen above the recommended limits, we request that you obtain your full medication supply privately. Alternatively, you may choose to reduce your prescribed oestrogen dose. If you believe you are taking a higher dose than recommended, or a combination of different oestrogen products (not including vaginal oestrogen cream or pessaries) and would like to discuss this further please make an appointment with a GP or ANP.

The full BMS statement can be accessed here:

https://thebms.org.uk/2023/04/joint-bms-fsrh-rcgp-rcog-sfe-and-rcn-womens-health-forum-safety-alert/

 

Published on 4 November 2026