The newest developments in HRT

Written By Clinic51

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What you need to know…..

For many years, there’s been very little innovation and choice in HRT, which has been frustrating for patients who need alternatives. But things are changing…..

Pharmaceutical companies are finally investing again in developing HRT medications, and we now have some promising new progesterone products to consider.

Why Do We Need Progesterone as part of HRT treatment?

Let’s start with the basics. The oestrogen in HRT is what improves symptoms like hot flushes, brain fog, and sleep disturbances. It also supports long-term health—protecting bones and the heart.

But if you still have a womb, oestrogen alone isn’t enough. Think of oestrogen as fertiliser on a lawn—it thickens and grows the womb lining, and if left unchecked, this increases the risk of womb cancer. Progesterone is like the lawnmower! It protects the lining of the womb by stopping it from getting too thick.

If you don’t have a womb (or endometriosis), you don’t need progesterone at all.

Progesterone vs. Progestogens: What’s the Difference?

This is where it gets a little jargon-heavy.

  • Progesterone is the hormone your body naturally makes.

  • Micronised progesterone (sometimes known by brand names like Utrogestan) is the version most similar to what your body produces.

  • Progestogens are synthetic versions. They’re slightly different in structure, and some people tolerate them worse—or better—depending on their body.

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Traditionally, our first-line options have been:

  • Micronised progesterone (capsules, often made from yams)

  • Synthetic progestogens in combined patches, tablets like Provera, or the hormone coil

But for some, these don’t work well—either because of side effects (bloating, mood changes, PMS-type symptoms) or bleeding issues.

The traditional synthetic progesterones medroxyprogesterone acetate (Provera) and Norethisterone are also associated with a higher breast cancer risk (as widely reported in a WHI study)

Enter the Newcomers: Slynd and Nalvee

We now have two new progestogen options that broaden the toolkit for managing menopause symptoms. These progestogens have been around for a while in combination products but have not been available as standalone tablets.

1. Nalvee (Dydrogesterone)

  • This is not actually a newcomer but an old friend-it was last available in the UK in 2008 branded as Duphaston but was taken off the market for commercial reasons-it was much missed.

  • It has been around for 60 years, so there is lots of safety data.

  • Licensed specifically for HRT.

  • Very similar to your body’s own progesterone, which makes it one of the most “body-friendly” progestogens.

  • It has already been used widely in the combination HRT tablets - Femoston Sequi and Conti, so it isn’t an unknown drug—it’s just now available on its own.

  • Benefits:

    • Lower breast cancer risk, similar to micronised progesterone (E3N study)

    • Excellent for bleeding, its 8x more bioavailable than micronised progesterone

    • Well tolerated

    • Neutral for libido and skin (neither strongly anti-androgenic nor androgenic)

  • Things to consider:

    • Only comes in one fixed dose (so less flexibility)

    • Licensed for sequential use only (Clinicians may consider for continuous use, off-license)

2. Slynd (Drospirenone)

  • Slynd is a progesterone only contraceptive pill, but it can be used off-license in HRT as per British Menopause Society guidance

  • It’s the same progestogen found in the combined contraceptive pill Yasmin, Yas and Eloine, which many women like for their positive effects on skin and mood.

  • Benefits:

    • May be better tolerated by women sensitive to progesterone

    • Can help with hormonal acne

    • Slight diuretic effect (useful if you get fluid retention)

    • Good bleeding control

  • Things to consider:

    • It has an “anti-androgenic” effect. Great for skin, but could reduce libido in some women.

    • It’s not licensed for HRT and needs to be taken continuously, ignoring the placebo pills.

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Tried and Tested Options Still Matter

Even with these exciting new choices, the tried-and-tested options remain important:

  • Oestrogen through the skin (gel, spray, patch) with

    • micronised progesterone

    • Hormone coil (great if you also need contraception or have heavy bleeding)

  • Combined patches

  • Combined oral tablets

For most women starting HRT, these will still be the first line. But if you’re struggling—particularly with bleeding, side effects, or tolerance—it’s great to have alternatives like Nalvee and Slynd

Moving Beyond “Good” vs. “Bad” HRT

One thing that it is important to stress: there’s no such thing as “good” HRT and “bad” HRT.

  • Natural doesn’t automatically mean better.

  • Synthetic doesn’t automatically mean harmful.

The best HRT is the one that works for you. What’s important is balancing benefits, risks, and side effects in a way that fits your individual needs.

Final Thoughts

We’re in a much better place than we were even a couple of years ago. More options mean more chances of finding the right fit for each person.

  • If you’re struggling with bleeding: Nalvee might help.

  • If you’re sensitive to progesterone: Slynd could be a game-changer.

  • If your current HRT is working fine: there’s no need to change.

Every woman’s experience is unique, and sometimes it’s a matter of trial and error—much like choosing the right contraceptive pill. The key is to work closely with your doctor or menopause specialist to tailor treatment to you.

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