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• Evidence regarding the risks associated with HRT in the treatment of premature menopause is limited. You can start taking Progynova tablets on any convenient day unless you are still having menstrual bleeding, in which case take the first tablet on day 5 of bleeding.Each pack of Progynova tablets 2mg is a calendar pack of 28 tablets. Physical (including pelvic and breast) examination should be guided by this and by the contraindications and warnings for use. After cessation of drug therapy enzyme induction may be sustained for about 4 weeks.When co-administered with sex hormones, many combinations of HIV protease inhibitors and non-nucleoside reverse transcriptase inhibitors including combinations with HCV inhibitors, can increase or decrease plasma concentrations of oestrogen. The results of most epidemiological studies to date relevant to inadvertent foetal exposure to oestrogens indicate no teratogenic or foetotoxic effects.No studies on the effects on the ability to drive and use machines have been performed. In the Million Women Study the use of five years of combined (sequential or continuous) HRT did not increase risk of endometrial cancer (RR of 1.0 (0.8-1.2)).Use of estrogen-only or combined estrogen-progestogen HRT has been associated with a slightly increased risk of having ovarian cancer diagnosed diagnosed (see Section 4.4).

During treatment, periodic check-ups are recommended of a frequency and nature adapted to the individual woman. Results of the WHI studies are presented:The risk of coronary artery disease is slightly increased in users of combined oestrogen-progestogen HRT over the age of 60 (see section 4.4).The use of oestrogen-only and oestrogen-progestogen therapy is associated with an up to 1.5-fold increased relative risk of ischaemic stroke.

You should take Progynova tablets 2mg for as long as your doctor recommends.Keep Progynova tablets 2mg in their calendar pack until used. - The effect of oestrogens on the bone mineral density is dose-dependent.

• Unopposed oestrogen stimulation may lead to premalignant or malignant transformation in the residual foci of endometriosis. Patients should be told to contact their doctors immediately when they are aware of a potential thromboembolic symptom (e.g. Other binding proteins may be elevated in serum i.e. In women with an intact uterus, a progestogen should be added to Progynova for at least 12 - 14 days each month/28 day cycle. In women aged 50 to 54 who are not taking HRT, about 2 women in 2000 will be diagnosed with ovarian cancer over a 5-year period.HRT is associated with a 1.3 - 3-fold increased relative risk of developing venous thromboembolism (VTE), i.e. For prevention of postmenopausal osteoporosis one tablet of Progynova 2 mg is to be taken daily. Oestrogens prevent bone loss following menopause or ovariectomy.Ovulation is not inhibited during the use of Progynova, and the endogenous production of hormones is hardly affected.- During the climacteric, the reduction and finally loss of ovarian estradiol secretion can result in instability of thermoregulation, causing hot flushes associated with sleep disturbance and excessive sweating, and urogenital atrophy with symptoms of vaginal dryness, dyspareunia and urinary incontinence.

Due to the low level of absolute risk in younger women, however, the balance of benefits and risks for these women may be more favourable than in older women. Investigations, including appropriate imaging tools, e.g mammography, should be carried out in accordance with currently accepted screening practices, modified to the clinical needs of the individual.

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