Clinical reference

Menopausal Symptoms

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Livial (tibolone) 2.5 mg tablets SmPC sections 4.1-4.4 (eMC product 1597) · Egyptian National Drug Formulary - Endocrine System 2024 (progesterone monograph) · Progynova® 2 mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1417) · Carlson K, Vadakekut ES. Menopause. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. NBK507826.

Verified against4 documents

Livial (tibolone) 2.5 mg tablets SmPC sections 4.1-4.4 (eMC product 1597)
Egyptian National Drug Formulary - Endocrine System 2024 (progesterone monograph)
Progynova® 2 mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1417)
Carlson K, Vadakekut ES. Menopause. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. NBK507826.

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (12)

Flushing symptoms are the commonest, affecting 75% to 80%: hot flushes, night sweats, palpitations and migraine [hot flushes · night sweats · palpitations]
Hot flushes come without warning by day or night, last about 3 to 4 minutes, and begin as a flush spreading over the upper body [hot flushes]
They interrupt daily life and sleep, last 1 to 6 years on average, and in 10% to 15% of women persist for up to 15 years
Alcohol, smoking, obesity, inactivity and emotional stress make them worse [obesity]
Migraine often changes: swinging oestrogen early on can worsen it, many improve afterwards, and migraine with aura carries added stroke risk, especially with smoking or the pill
Genitourinary syndrome affects 50% to 75%: as the lining thins and loses elasticity there is vaginal dryness, burning, itching and irritation [itching · vaginal dryness]
Bladder and urethra carry oestrogen receptors too, so frequency, urgency and painful urination follow as the urethra thins [burning on passing urine]
Repeated urine infections become likelier because a higher vaginal pH lets bladder organisms colonise
Leaking urine is not caused by the falling oestrogen itself; it tracks excess weight, diabetes and age [urinary incontinence]
Up to 70% have psychological symptoms: anger or irritability, anxiety or tension, low mood, poor concentration, and loss of confidence [anxiety · irritability · low mood · poor concentration]
Sleep complaints are common regardless of hormone therapy or flushes: trouble falling asleep, waking early, and waking repeatedly in the night [insomnia]
Sexual desire and function fall and pain with intercourse increases, sometimes starting nearly 2 years before the last period

Signs — what you find (6)

Blood pressure may rise as the arteries constrict
Many gain weight through the transition, on average about 5 pounds or 2 kg
Height can drop as bone is lost to osteoporosis
Breasts become fattier and shrink back after the menopause
Vaginal examination shows dryness and the changes of urogenital atrophy [atrophy]
Joint pains appear, and muscle bulk, strength and function gradually decline

Tests (8)

The diagnosis is made clinically on age and symptoms; laboratory testing is usually unnecessary and the symptoms start before hormones measurably change
Hormones are worth measuring in particular situations: no periods after hysterectomy or endometrial ablation, and anovulatory cycles, where FSH and oestradiol help
An FSH above 30 mIU/mL is an objective marker, but pelvic surgery raises it temporarily so wait at least 3 months afterwards
An oestradiol below 20 pg/mL points to menopause
FSH between 40 and 50 varies enormously and settles only 3 to 6 years after the menopause, which limits the routine value of FSH and oestradiol
Inhibin B and AMH do not help make the diagnosis, and AMH as a predictor of when menopause will come remains contested
Where the absent periods may not be menopausal, add a pregnancy test, TSH and prolactin
Oestrogens, androgens and hormonal contraceptives distort FSH, so test at least 2 weeks after stopping them

If not this — what else fits (6)

At 45 or older with the usual symptoms, no test is needed; below that age other causes of absent periods must be excluded
Pregnancy is the commonest reason periods stop and must be excluded first
Scarring inside the uterus: Asherman syndrome after curettage, or chronic endometritis, tuberculosis in particular
Failure of the hypothalamic-pituitary-ovarian axis from obesity, anorexia, bulimia, chronic illness such as kidney disease or inflammatory bowel disease, drugs, heavy exercise, poor nutrition, stress or cancer
Also coeliac disease, adrenal disorders, past chemotherapy or radiation, Sheehan syndrome, and a pituitary adenoma
Ovarian causes: a tumour, polycystic ovary syndrome, and premature ovarian insufficiency

SourceStatPearls "Menopause" - disease-level clinical article

Presentation findings are traced to the source above.

ESTRADIOL VALERATE

1st line

Strength1 mg

Formoral.solid

Adult dose and duration

1-2 mg once daily continuously (add progestogen if intact uterus) - long-term (review annually)

Paediatric dose

Adult-only condition - paediatric section not applicable

Dose source

Progynova® 2 mg Tablets SmPC section 4.2 Posology and method of administration (eMC product 1417)

Why

Oral estrogen replacement that corrects the declining estrogen driving vasomotor symptoms (hot flashes, night sweats) of menopause; needs an added progestogen whenever the uterus is intact, per the cautions.

Cautions

Do not start if there is postmenopausal bleeding - refer to exclude endometrial cancer first.
Unopposed estrogen increases endometrial cancer risk; must add progestogen if uterus present.
Contraindicated in active/past VTE, breast cancer, or severe active liver disease.
Use lowest effective dose for shortest duration necessary.
Estradiol valerate, not ethinyl estradiol. The register carries a pack labelled ETHINYL OESTRADIOL 50 MCG whose scientific name in the source data is simply 'estradiol', and that is the only product it returns. Ethinyl estradiol is a synthetic oestrogen of far higher hepatic and thrombotic potency and is not an HRT agent - 50 mcg of it is a contraceptive dose, not a replacement one.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ESTRAVODOSE 1 MG 28 F.C. TABS.	TECHNOPHARM	33.00 EGP (1.18/unit)

TIBOLONE

2nd line

Strength2.5 mg

Formoral.solid

Adult dose and duration

2.5 mg once daily - long-term (review annually)

Paediatric dose

Adult-only condition - paediatric section not applicable

Dose source

Livial (tibolone) 2.5 mg tablets SmPC sections 4.1-4.4 (eMC product 1597)

Why

Synthetic steroid with combined estrogenic, progestogenic, and androgenic activity, used as an alternative hormone therapy for vasomotor symptoms in women who are clearly postmenopausal.

Cautions

Increases stroke risk in women aged >60 years.
Combines estrogenic, progestogenic, and androgenic properties.
Only suitable for postmenopausal women (>12 months after last period).
Not started until at least twelve months after the last period.
Ischaemic stroke risk rises from the first year. The relative rise is the same at any age, but the baseline climbs steeply with age, so in an older woman the actual added risk is much larger.
Breast cancer risk up to doubled beyond five years of use, showing from about three years, and it does not fall away immediately on stopping.
Bleeding or spotting still happening after six months needs investigating properly, biopsy included - it is not the drug settling in.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
LIVIAL 2.5MG 28 TAB.	ORGANON > MULTIPHARMA	205.00 EGP (7.32/unit)

PROGESTERONE

add-on - not a substitute

Strength200 mg

Formoral.solid

Adult dose and duration

Micronised progesterone 200 mg at bedtime for 12 days, from day 15 to day 26 of each cycle; alternatively 100 mg at bedtime from day 1 to day 25, which causes less withdrawal bleeding - For as long as systemic oestrogen is continued

Paediatric dose

Adult-only condition - paediatric section not applicable

Dose source

Egyptian National Drug Formulary - Endocrine System 2024 (progesterone monograph)

Why

21 live products. The formulary's oral indication is adjunctive use with an oestrogen in post-menopausal women with an intact uterus. The condition currently offers estradiol valerate with no progestogen, which is unopposed oestrogen - a real endometrial cancer risk in any woman who still has a uterus.

Cautions

This is endometrial protection, not treatment for hot flushes. It is given ONLY alongside the systemic oestrogen, and only to a woman who still has a uterus.
The tibolone already listed does not need an added progestogen - it is a single agent.
Take at bedtime; micronised progesterone is sedating.
Contraindicated in undiagnosed vaginal bleeding, active or recent venous thromboembolism, severe hepatic disease, and hormone-dependent cancer.
Investigate any unscheduled bleeding that starts after the first 6 months of therapy, or that persists beyond it.
Check the excipients - some soft capsules are formulated in peanut or soya oil.
A woman who has had a hysterectomy does not need this and should not be given it.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
UTROCARE 200 MG 30 S.G. CAPS.	SAFE PHARMA > OCTOBER PHARMA	204.00 EGP
PROGEST 200MG 30 ORAL/VAGINAL CAPS.	PHARCO	246.00 EGP
HYSTROGEST 200 MG 30 S.G.CAPS.	SAFE PHARMA > GLOBE INTERNATIONAL PHARMACEUTICALS	264.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.