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Estradiol/Norethisterone Acetate

Trisequens is a cyclical pill used in hormone replacement therapy, developed by Novo Nordisk. It is administered to treat symptoms of the menopause.

To buy Trisequens online through our prescription renewal service, take our doctor-reviewed questionnaire. Once your order is approved, you can expect to receive it by tracked courier in one working day.

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Trisequens is a cyclical pill used in hormone replacement therapy, developed by Novo Nordisk. It is administered to treat symptoms of the menopause.

To buy Trisequens online through our prescription renewal service, take our doctor-reviewed questionnaire. Once your order is approved, you can expect to receive it by tracked courier in one working day.

This content was reviewed by a clinician on

13 April 2021
dr daniel

Dr Daniel Atkinson

(GP Clinical Lead - GMC No. 4624794) 13 April 2021
Product information

Trisequens is a hormone replacement therapy made by Novo Nordisk. Employed in the treatment of menopausal symptoms, it is a sequential pill, which is dispensed from a calendar pack. This tablet is taken every day, and is intended for those who have had a period of at least six months since their last menstrual bleed.

The menopause is a completely natural process, and one which all women will undergo at some point as they get older. The average age at which someone experiences it is 51, although it can affect people as early as their 30s. It marks the end of menstruation; ovulation comes to a stop, and the layering up and breaking down of the endometrial wall becomes less frequent, before also ceasing altogether.

The amount of hormones the body naturally produces also decreases during this time. Oestrogen levels can drop, and this can lead to a variety of other physical or emotional symptoms. These can include vaginal dryness, flushing, and night sweats, making sleeping difficult. Headaches and mood swings may also occur. Additionally, after the menopause bones can become weaker, presenting an increased risk of osteoporosis.

Not everyone will get menopausal symptoms to a degree which proves problematic. Many people will only experience them to a mild extent, and not require treatment. However, others may find that the effects of the menopause present a significant distraction in their daily lives; and in these cases, medicinal help may prove beneficial.

Hormone replacement therapy is available in a range of forms. Some are oestrogen-only products; these are typically used in instances where a person has had a section of their womb surgically removed as part of a hysterectomy. They function by supplementing oestrogen levels in the body, and decreasing the presence of symptoms. Others are combined hormonal treatments, containing progesterone as well as oestrogen. These are issued in most instances where a person has not had their uterus removed, to lower the risk of oestrogen-induced endometrial cancer.

Trisequens is a sequential form of combined HRT. This means that a one-month cycle of treatment will consist of more than one type of tablet; in the case of Trisequens, three. Two of these will contain estradiol (a synthetic form of oestrogen) only, one being a standard dose and the other being a low dose; and the other will contain both estradiol and norethisterone (a progesterone).

Our hassle-free service enables you to renew your prescription and buy Trisequens online from a registered pharmacy, based in the UK. All you need to do is complete our consultation form, and your answers will be assessed by one of our practising doctors.

If they deem your order suitable, a prescription will be drawn up and sent to our dispensing pharmacy on your behalf. Delivery on all orders is made by tracked 24-hour courier, so that you don’t have to wait more than one working day to start using your treatment.

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Page last reviewed:  13/04/2021


Adhere to the instructions provided by your doctor when using this medication, and make sure you read the instructions in the patient information leaflet fully. This will help you to get the best out of your treatment, while also limiting the risk of side effects.

  1. Take as directed.
  2. The standard dose is one pill per day. 
  3. You should schedule a set time to take your pill each day and try to stick to this as closely as possible.
  4. The tablets are contained in a device called a calendar pack, which is designed to help you keep track of your treatment programme.
  5. Detailed instructions on how to use this can be located in the leaflet provided.
  6. As these tablets are a sequential form of HRT, it is vitally important that you take them in the correct order.
  7. If you miss your scheduled dose, try to take it as soon as you remember. However, you should not compensate for a missed dose with a double administration. If 12 hours or more have elapsed since your missed dose, skip the one you have not taken and carry on taking the treatment as normal.
  8. Treatment with Trisequens can begin at any time providing you are not switching from another form of HRT. If you are, consult your doctor for advice on when to begin taking it.

The above is only a summary of the guidelines you will need to follow when taking this medication. For further information, consult the leaflet provided.

Page last reviewed:  13/04/2021
Side effects & Warnings

Side effects

Some side effects may necessitate urgent medical attention, so it is important to be aware of the nature of these so that you can take the appropriate action if they occur. Speak to your doctor right away if you experience any indications of the following: an allergic reaction; liver disease; breast, cervical or ovarian cancer; heart attack; stroke; a blood clot; or the sudden appearance of a migraine, or one which is worse than normal. Detailed information relating to what form these indications may take can be found in the patient information leaflet.

Very common (1 in 10 people or more):

Breast pain or tenderness, or irregular menstrual bleeding.

Common (1 in 10 people or less):

Weight fluctuations, headache, inflammation or infection of the vagina, migraine, depression, feeling sick, back pain, cramps in the legs, swollen arms or legs, exacerbation of uterine fibroids, or stomach pain.

Uncommon (1 in 100 people or less):

Hair loss, itching, bloating, endometrial hyperplasia, anxiety, period pain, or acne.

Rare (1 in 1,000 people or less):

Blood clot or inflammation in a vein.

The side effects listed here are only a summary of those associated with this medicine. For a more detailed list, please consult the patient information leaflet.


Taking it with other medicines

Other drugs may cause this product to work less efficiently, or pose an increased risk of causing interactions. Let your doctor know if you are taking any other treatments, including those for: epilepsy, such as carbamazepine, phenobarbital, or phenytoin; tuberculosis, for instance rifampicin or rifabutin; HIV, such as ritonavir, efavirenz, nevirapine, or nelfinavir; fungal infections, like ketoconazole; or St John’s Wort.

Conditions to look out for

Some conditions may make this product unsuitable for use. Do not take Trisequens if you have or have ever had: liver disease from which you have not yet fully recovered; an untreated case of endometrial hyperplasia; breast, ovarian or cervical cancer; a blood clot or related condition; porphyria; lactose intolerance; heart attack; stroke; or an episode of vaginal bleeding which your doctor could not explain.

Certain medical factors may also require you to apply special precautionary measures when using this treatment. Refer to the leaflet supplied for a full list of these, and make sure you let your prescriber know if you have any medical conditions or have experienced any in the past.

Regular check-ups

You will need to have your HRT treatment reviewed in person on a regular basis with your GP, typically once a year at least, to make sure it is performing as it should.

HRT and cancer

Please read the information regarding HRT and cancer risk in the leaflet prior to use.

Pregnancy and breastfeeding

This medication must not be used during pregnancy or breastfeeding. Stop taking it right away and tell your doctor if you become pregnant.

Driving and using machines

Trisequens is not likely to affect your capacity to drive or operate machinery.

Lactose intolerance

Trisequens contains lactose monohydrate, so you will need to let your prescriber know if you have any intolerance to sugars.

Page last reviewed:  13/04/2021

Can I still drink alcohol?

Yes. It is not likely that alcohol will interfere with the function of this product.

Will I still be able to drive?

Yes. Your capacity to drive should not be affected. But, should you experience any side effects which could make driving unsafe, refrain from doing so and notify your doctor.

Can I take the medicine while pregnant?

No. It is not suitable for those who are pregnant, think they might be pregnant, or are breastfeeding.

How should I store it?

In a safe place, at room temperature.

Am I allergic to anything in the medicine?

Trisequens tablets contain the following: estradiol, norethisterone, lactose monohydrate, maize starch, hydroxypropylcellulose, talc, magnesium stearate, hypromellose, titanium dioxide (E171), indigo carmine (E132), macrogol 400, triacetin, red iron oxide (E172) and propylene glycol. Do not use this product if you are allergic to any of these ingredients.

Is it available over-the-counter?

You can only buy Trisequens in the UK if you have a prescription for it.

Our secure consultation facility enables you to have your prescription renewed by a doctor. After your item has been approved, an electronic prescription will be generated for your order.

Is it right for me?

See your GP if you think you are having menopausal symptoms, or are not currently using treatment. They will discuss your symptoms with you, and be able to issue a prescription for the most appropriate treatment where required.

Can I buy Trisequens online?

If you’re already using treatment, you can get a repeat prescription for it through our secure and reliable service. Place your order and complete our medical questionnaire. Once complete, our GMC-registered doctor will assess your responses. If your medication is suitable for you, our UK-based pharmacy will issue your medication, and our courier partners will ship it to your door by next-day parcel.

Page last reviewed:  13/04/2021
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