Kliofem is a hormone tablet that you take every day to help with symptoms such as hot flushes caused by the menopause. You may also be prescribed Kliofem to help prevent osteoporosis if you have an increased risk of fractures.

Kliofem will only be prescribed to you if you still have a womb, and usually only if it has been at least 12 months since your last natural period.

Kliofem is part of a group of medicines known as Hormone Replacement Therapy (HRT) which are used to treat symptoms of the menopause.

During the menopause there are natural changes to your hormone levels as your body stops preparing itself for pregnancy. The reduction in hormones can produce unpleasant symptoms such as hot flushes, night sweats, vaginal dryness and severe mood swings.

Kilofem stops hot flushes and night sweats by providing your body with the hormones it is missing.

The active ingredients in Kliofem are two artificial hormones: estradiol and norethisterone acetate. Estradiol provides your body with the oestrogen it needs, while norethisterone acetate provides your body with progesterone. As Kliofem contains both artificial oestrogen and artificial progesterone, it is called combined HRT.

How long does it take for Kliofem to work?

It usually takes up to 10 days to feel the initial benefits of taking combined HRT, and it may take up to 3 months before you feel it is working fully.

How effective is Kliofem?

Kliofem is effective at relieving symptoms caused by the menopause. There are risks associated with taking combined HRT, and your doctor can advise you if taking Kliofem is right for you.

What is the normal dosage of Kliofem?

There is one dosage of Kliofem. You take one tablet daily, which is 2mg estradiol and 1mg norethisterone acetate combined.

You will only be prescribed Kliofem if:

• your menopause symptoms are having a severe impact on your life
• you still have a womb

Always follow the instructions from your doctor on how to take Kliofem:

• take one tablet at the same time each day
• swallow the tablet whole with a glass of water
• once you have finished the pack of 28 tablets, start taking the next pack immediately

If you are already taking another form of HRT, you may need to follow specific instructions on when to stop taking that one and start taking Kliofem. Your doctor will advise you.

What should I do if I forget to take my Kliofem tablet?

If you forget to take your tablet at your normal time and it is within 12 hours of when you would usually take it, take the missing dose. If it is more than 12 hours since you should have taken the tablet, then wait and take your next dose as usual.

Do not take a double dose if you forget to take your pill.

What should I do if I take too much Kliofem?

If you take too much Kliofem, get medical advice as soon as you can. Taking more Kliofem than you are prescribed can cause symptoms such as nausea and vomiting, irregular vaginal bleeding, breast tenderness, low mood, tiredness, acne and growth of body and facial hair.

How long should I take Kliofem?

It is usually recommended to use Kliofem while it is needed to stop your menopause symptoms but not for longer than five years. You should always follow the guidance from your doctor.

If you want to stop taking Kliofem, consult your doctor about alternatives and advice on gradual withdrawal.

You need a prescription from a doctor to buy Kliofem. This means you cannot get it over the counter from a pharmacist.

Can I buy Kliofem online?

You can buy Kliofem online from a registered and reputable online doctor such as Superdrug Online Doctor if you have already been prescribed it by your doctor. The process is simple:

1. Complete the brief medical questionnaire.
2. Our doctors will review your answers and make sure it is safe to continue to prescribe you Kliofem.
3. You can then buy Kliofem and choose to collect it from your local Superdrug pharmacy or get it sent to an address of your choice.
4. At any point, you can message our doctors for advice through your Patient Account.

The GPhC's online checker can reassure you that the site you are using to buy medication is operating legally and safely.

Can I buy Kliofem on the NHS?

You can get Kliofem on the NHS following a consultation with your doctor. With Superdrug Online Doctor, this consultation can be done easily and quickly online.

All medications can have side effects. Whether or not you get any side effects and how much they impact you varies from person to person. Side effects often calm down over a few days. Talk to your doctor if yours do not or they are severely impacting your life.

Seek medical attention urgently if you experience any of the following:

• severe allergic reaction (difficulty breathing, feeling dizzy, rapid heartbeat, sweating, hives, itching)
• an increase in blood pressure
• whites of your eyes or skin goes yellow (signs of jaundice)
• new migraine-type headaches
• sudden chest pain, swollen legs and difficulty breathing (signs of a blood clot)

Common side effects impact 1 in 10 people and can include the following:

• breast pain, tenderness or swelling
• vaginal bleeding or inflammation
• headaches or new migraines
• nausea or abdominal pain
• weight increase
• low mood
• back pain or leg cramps

Uncommon side effects impact 1 in 100 people:

• bloating
• abnormal hair growth
• acne
• itching/hives
• anxiety

There are also rare and very rare side effects, which affect 1 in 1000 and 1 in 10000 people. These are listed in the Patient Information Leaflet. Some diseases occur more often in women who are taking HRT compared to women who are not. These include:

• breast cancer
• cancer of the lining of the womb
• ovarian cancer
• blood clots in the veins of the legs or lungs
• heart disease and stroke

Attending your regular check-ups and discussing any changes to your body with your doctor is essential.

Is there an increased risk of getting a blood clot or having a stroke from taking Kliofem?

Yes, there is a slight increase in the risk of getting a blood clot while taking Kliofem. Between 4 and 7 out of 1000 women in their 50s who are not taking HRT can expect to get a blood clot in a vein. This rises to between 9 and 12 cases for women taking combined HRT such as Kliofem.

For strokes, the risk in women not taking HRT is 8 in 1000. In women who are taking HRT it is 11 in 1000.

Is there an increased risk of getting cancer from taking Kliofem?

There is a small increased risk of getting breast cancer from taking Kliofem. In women aged 50 to 54 who are not taking HRT, the incidence of breast cancer is 13 to 17 in 1000; for those women taking combined HRT, it is 21 in 1000. The increased risk depends on how long you take HRT and reduces after you stop taking it.

There is an even smaller increase in the risk of getting ovarian cancer (which is a much rarer form of cancer). In women aged 50 to 54 who are not taking HRT, the likelihood of ovarian cancer is 2 in 1000; for those women taking combined HRT, this is 3 in 1000. The risk of getting cancer from taking HRT will depend on different factors in your personal and family medical history. Your doctor can advise you on the benefits and risks of taking HRT.

Does Kliofem cause weight gain?

Women report that taking HRT causes weight gain, and it is listed as a side effect of taking HRT. However, the evidence from medical studies does not support this. Weight gain is often associated with the menopause, and some women find that taking HRT can help maintain a healthy weight.

Does Kilofem cause depression?

Kliofem contains progesterone, and a reported side effect of taking progesterone is low moods. If you think taking Kliofem is making you depressed, talk to your doctor about alternative forms of HRT.

Does Kliofem cause bleeding?

You might experience bleeding when you first start taking Kliofem. This usually stops, but if it continues after 6 months or starts after you have been taking Kliofem for six months, you should see your doctor.

Kliofem is generally a safe and effective medication to help with hot flushes and to prevent osteoporosis. There are certain health conditions and certain medications that make Kliofem less effective or potentially unsafe.

You should not take Kliofem if you:

• are allergic to any of the ingredients in Kliofem
• are pregnant
• have or have had breast cancer or cancer of the womb lining
• have or have had liver disease
• have unexplained vaginal bleeding
• have untreated excessive thickening of the womb lining
• have or have ever had blood clots in a vein, such as in the legs or the lungs
• have or have ever had a disease caused by blood clots in the arteries such as heart attack, stroke or angina
• have a blood clotting disorder or porphyria

You should tell your doctor if you are taking any medication and herbal supplements, and especially if you are taking any of the following:

• nevirapine, efavirenz, ritonavir and nelfinavir for HIV infections
• rifampicin and rifabutin for tuberculosis
• phenobarbital, phenytoin and carbamazepine for epilepsy
• telaprevir for hepatitis C infections
• cyclosporine
• herbal remedies containing St John’s Wort
• medicines containing the fungicide called ketoconazole

Can I drink alcohol while taking Kliofem?

Drinking alcohol while taking Kliofem does not cause side effects, so it is generally considered safe to drink while taking Kliofem. Some studies suggest a link between an increased risk of breast cancer from drinking alcohol while taking HRT. More research needs to be done in this area, but it is a good idea to limit your alcohol intake for your general health while taking HRT.

Kliofem is a type of combined HRT to treat menopausal symptoms. There are alternatives to taking HRT and there are also other options if you want to take combined HRT but Kliofem doesn’t work for you.

HRT alternatives

HRT comes in different forms such as gels, tablets and creams. It can be used to treat specific symptoms such as night sweats, vaginal dryness, hot flushes, low mood and a reduced sex drive.

The type of HRT your doctor prescribes will vary depending on whether you are still getting your periods or are postmenopausal. If you have had your womb removed (hysterectomy), this will also impact what your doctor will recommend.

Systemic HRT

When you take HRT that is absorbed into your body, it is called systemic HRT. There are 3 main types:

1. oestrogen-only: usually only recommended if you have had your womb removed
2. combined oestrogen and progesterone:
3. tibolone (a medicine that your body breaks down to make oestrogen and progesterone)

Kliofem is a combined oestrogen and progesterone HRT in tablet form. Other brand names for combined HRT are Elleste Duet Conti, Kliovance and Femoston Conti. Different brands can have different types of oestrogen and progesterone in different quantities, so you may find one works better for you than another.

You can also take combined HRT as patches, such as Evorel Conti.

Is Kliofem the same as Elleste Duet Conti?

Yes, Kliofem and Elleste Duet Conti have the same hormones in the same quantities. The difference is in the brand name.

Alternative remedies

Evening primrose oil, angelica, ginseng, St John’s wort, and black cohosh are used by some women to treat menopausal symptoms. Scientific evidence is mixed in terms of what are the right doses and whether the benefits will last.

St John’s wort can interact with other medicines with serious implications.

Lifestyle changes

The following can also help you to deal with menopause symptoms:

• taking regular exercise and eating healthily
• keeping your room cool at night
• reducing your stress levels and the amount of alcohol and caffeine you drink
• stopping smoking