Kliovance

Kliovance is a Hormone Replacement Therapy (HRT) designed to help relieve the symptoms of menopause in women who have not had a natural period for more than one year. Kliovance is what is known as a combined HRT, which means it contains two types of the female hormone – in this case progesterone and oestrogen. When you go through the menopause, the level of these hormones in the body drops radically as your body stops producing eggs, and taking an HRT can help to alleviate menopausal symptoms. Kliovance is a continuous HRT, meaning that there are no breaks in the treatment to allow for a monthly bleed – you take the tablets continuously. You will need to work out with your doctor how long the continuous period is as you should take HRTs at the lowest dose and for the shortest time possible to relieve your symptoms.

While menopause is a natural process for women around the ages of 45-55, it is not necessarily an easy time of life. The drop in oestrogen experienced by the body can have very unpleasant side effects, including hot flushes, mood swings and alterations in sex drive. Sometimes, making simple lifestyle changes can be enough to help cope with symptoms of the menopause, but at others, the side effects are so strong that they cause upset day-to-day life. If such cases, there are a variety of HRTs that may be able to provide some relief.

Kliovance is a Hormone Replacement Therapy (HRT) designed to help relieve the symptoms of menopause in women who have not had a natural period for more than one year. Kliovance is what is known as a combined HRT, which means it contains two types of the female hormone – in this case progesterone and oestrogen. When you go through the menopause, the level of these hormones in the body drops radically as your body stops producing eggs, and taking an HRT can help to alleviate menopausal symptoms. Kliovance is a continuous HRT, meaning that there are no breaks in the treatment to allow for a monthly bleed – you take the tablets continuously. You will need to work out with your doctor how long the continuous period is as you should take HRTs at the lowest dose and for the shortest time possible to relieve your symptoms.

Kliovance is used for women who are going through the menopause to help combat unpleasant symptoms caused by the drop in oestrogen in the body. These include:

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

Kliovance is only prescribed for women who still have a womb and have had at least a year since their last natural period, and also only if your menopausal symptoms are seriously affecting your ability to lead a normal life.

Kliovance can also be used to help ward off osteoporosis in postmenopausal women if you have an increased risk of fractures due to the menopause and you cannot take certain other medications.

You should always follow the instructions of your doctor or pharmacist when it comes to taking medication and check with them if you are unsure. If you are switching from an HRT where you have a monthly bleed, then start taking Kliovance straight after the bleeding has ended. Otherwise you can start whenever is convenient.

Kliovance HRT comes in tablet form. Take one Kliovance tablet a day at around the same time each day, and when you finish the pack, start a new pack straight away. Kliovance HRT comes in a calendar pack to help you keep track of the days so that you do not forget to take your tablet. If you forget to take your tablet at the usual time, take it as soon as you remember – it can help to set a daily alarm on your phone. If you miss a day, do not double up – simply skip that day and carry on as normal (you may experience some spotting).

With any HRT, your doctor should ensure you are on the lowest possible dose for the shortest possible time to alleviate the symptoms. The active ingredients in Kliovance HRT are estradiol and norethisterone acetate, and the Kliovance tablets come in two different doses: 0.5 mg and 1 mg. With both doses, you take one Kliovance tablet every day, continuously until you and your doctor decide to stop.

As with all medication, Kliovance tablets come with a warning of some side effects, although of course not everyone taking Kliovance HRT will experience them. There are also some diseases that are reported more often in women using HRT compared to those 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.

If you have had any of the following prior to starting treatment with Kliovance HRT, you will need to let your doctor know as they may return or worsen during the treatment, meaning that 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;
• A liver disorder;
• Gallstones;
• Diabetes;
• Increased risk of developing blood clots;
• Migraine or severe headaches;
• Increased risk of getting oestrogen sensitive cancer;
• Asthma;
• Epilepsy;
• 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;
• A disease affecting the eardrum and hearing;
• Lactose intolerance.

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

• Breast pain or tenderness;
• Vaginal bleeding.

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

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

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

• Hair loss;
• Bloating, abdominal pain, swelling, flatulence;
• Acne;
• Inflammation of a vein;
• Abnormal hair growth;
• Itching or hives;
• Allergic reaction;
• Nervousness;
• Leg cramps.

Rare side effects (affects 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)

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

Other side effects of combined HRT include:

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

You should not take Kliovance tablets 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 excessive thickening of the womb lining;
• If you have or have had breast cancer;
• If you have unexplained vaginal bleeding;
• 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 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 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 Kliovance HRT, then you should stop taking the tablets and consult your doctor immediately.

• Yellowing of the skin or the whites of your eyes (this may be a sign of liver disease);
• If you become pregnant;
• 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,

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

Always discuss any medication you are taking with your doctor or pharmacist, as some medicines may interfere with Kliovance 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;
• HIV infections;
• Epilepsy;
• Hepatitis c;
• Herbal remedies containing St John’s Wort;
• Medicines containing ketoconazole (a fungicide).

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

You can obtain Kliovance HRT from any reputable pharmacy, so you can buy it at the most convenient one for you – either locally, in a supermarket pharmacy or order online and get your prescription delivered directly to your door (you will need to submit a recent blood pressure reading).

No, you cannot buy Kliovance HRT without a prescription. Hormone replacement therapies come with warnings of serious side effects, so you will need to make an appointment with a doctor – either your regular GP or an online doctor. You will need to discuss your medical history and that of your family in detail and you should also discuss your symptoms and the various types of HRT available to work out which is best for you. Once you start your treatment, you will need regular check- ups to ensure that you are taking the lowest possible dose and that side effects are kept to a minimum. Finding the most suitable HRT can be a process of trial and error to see how your body responds.

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Menopause – Treatment. [online] nhs.uk. Available at: https://www.nhs.uk/conditions/menopause/treatment/ [accessed 20 Dec 2019].

Novo Nordisk Healthcare (2016). Kliovance – Patient Information Leaflet (PIL) – (emc). [online] Medicines.org.uk. Available at: https://www.medicines.org.uk/emc/product/1046/pil [accessed 20 Dec 2019].