MEDICAMENT PACK AND AGENT FOR THE TREATMENT OF CLIMACTERIC DEFICIENCY SYMPTOMS

MEDICAMENTS CONDITIONNES POUR LE TRAITEMENT DES SYMPTOMES DU CLIMATERE

English Abstract

ABSTRACT OF THE DISCLOSURE
A medicament pack and agent for the treatment of
climacteric deficiency symptoms. The pack comprises a
pharmaceutical treatment pack for the treatment of climacteric
deficiency symptoms, which comprises in or on a support member,
unit dosage forms of an E2 oestrogen, an E3 oestrogen and a gestagen,
which provided (I) (a) a first set of 10 - 12 daily dosages of an
E2 oestrogen and
(b) a first set of 10 - 12 daily of an
E3 oestrogen,
the ratio of the daily average dosage of E2
oestrogen to the average daily dosage of E3 oestrogen being from
2:1 to 1:8,
(II)(a) a second set of 9 - 11 daily dosages of E2
oestrogen, to complete 20 - 22 daily dosages,
and
(b) a second set of 9 - 11 daily dosages of E3
oestrogen, to complete 20 - 22 daily dosages,
the ratio of the average daily dosage of E2
oestrogen to the average daily dosage of E3
oestrogen being from 2:1 to 1:8, and
(c) a set of 9 - 11 daily dosages of a gestagen,
and if desired,
(III) a third set of 6 - 8 daily dosages of E3
oestrogen or of hormone-free preparations, to
complete 28 daily dosages, or of objects
indicating 6 - 8 days of no hormone treatment,
the sets being located in a particular order, together with
indications and/or instructions to indicate and facilitate a
treatment consisting of the administration to a human female on
each of 10 - 12 successive days of one of the daily dosages Ia
and one of the daily dosages Ib, on each of the immediately
following 9 - 11 successive days, to complete 20 - 22 days,

one of daily dosages IIa, one of the daily dosages IIb and one
of the daily dosages IIc, and on each of the immediately following
6 - 8 successive days, to complete 28 days, one of the E3 oestrogen
or hormone-free daily dosages III or no administration of hormone.

Claims

THE EMBODIMENTS OF THE INVENTION IN WHICH AN EXCLUSIVE
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. A pharmaceutical treatment pack for the treatment
of clinacteric deficiency symptoms, which comprises in or on a
support member, unit dosage forms of an E2 oestrogen, an E3
oestrogen and a gestagen, which provide (I) (a) a first set of
10-12 daily dosages of an E2 oestrogen and (b) a first set of 10-
12 daily dosages of an E3 oestrogen, the ratio of the average
daily dosage of E2 oestrogen to the average daily dosage of E3
oestrogen being from 2:1 to 1:8, and (II) (a) a second set of
9-11 daily dosages of E2 oestrogen, to complete 20-22 daily dos-
ages, and (b) a second set of 9-11 daily dosages of E3 oestrogen,
to complete 20-22 daily dosages, the ratio of the average daily
dosage of E2 oestrogen to the average daily dosage of E3 oestro-
gen being from 2:1 to 1:8, and (c) a set of 9-11 daily dosages of
a gestagen, the sets being located in a particular order, together
with indications and/or instructions to indicate and facilitate a
treatment consisting of the administration to a human female on
each of 10-12 successive days of one of the daily dosages Ia and
one of the daily dosages Ib, on each of the immediately following
9-11 successive days, to complete 20-22 days, one of the daily
dosages IIa, one of the daily dosages IIb and one of the daily
dosages IIc, and on each of the immediately following 6-8 succes-
sive days, to complete 28 days no administration of hormone.
2. A pack as claimed in claim 1 which additionally pro-
vides III a third set of 6-8 daily dosages of E3 oestrogen or of
hormone-free preparations, to complete 28 daily dosages, or of
objects indicating 6-8 days of no hormone treatment and in which
the indications and/or instructions indicate and facilitate the
treatment which includes on each of the final 6-8 successive days
to complete 28 days; one of the E3 oestrogen or hormone free
daily dosages III or no administration of hormone.
19

3. A pack as claimed in claim 1, wherein the ratio of
the average daily dosage of the first set of E2 oestrogen Ia to
the average daily dosage of the first set of E3 oestrogen Ib is
substantially 1:2.
4. A pack as claimed in claim 3, wherein the ratio of
the average daily dosage of the second set of E2 oestrogen IIa
to the average daily dosage of the second set of E3 oestrogen IIb
is substantially 1:2.
5. A pack as claimed in claim 1, wherein in each set,
Ia, Ib, IIa, IIb and IIc the daily dosages are of substantially
uniform dosage.
6. A pack as claimed in claim 4, wherein all the E2
oestrogen daily dosages Ia and IIa are of substantially uniform
dosage, and all the E3 oestrogen daily dosages Ib and IIb are of
substantially uniform dosage.
7. A pack as claimed in claim 5, which includes a
third set of 6-8 daily dosages of E3 oestrogen III and wherein
all the E2 oestrogen daily dosages Ia and IIa are of substantially
uniform dosage, all the E3 oestrogen daily dosages in the first
and second sets Ib and IIb are of substantially uniform dosage,
and each E3 oestrogen daily dosage in the third set III is no
more than half the E3 oestrogen daily dosage in the other two
sets.
8. A pack as claimed in claim 1, 2 or 3 which includes
a set of objects indicating no hormone treatment III, each object
being removable.
9. A pack as claimed in claim 2 which includes a set
of objects indicating no hormone treatment III, each object being
an empty destructable profiled receptacle.
10. A pack as claimed in claim 1, 2 or 3, wherein each
E2 oestrogen daily dosage contains an amount of E2 oestrogen which
produces the same oestrogenic effect as the administration of 0.5
t 4 mg of oestradiol valerate daily.

11. A pack as claimed in claim 1, 2 or 3 wherein each
E3 oestrogen daily dosage contains an amount of E3 oestrogen which
produces the same oestrogenic effect as the administration of 0.5
to 8 mg of oestriol daily.
12. A pack as claimed in claim 1, 2 or 3 wherein each
gestagen daily dosage contains an amount of gestagen which pro-
duces the same gestagenic effect as the administration of 0.1 to
0.5 mg of D-norgestrel daily.
13. A pack as claimed in claim 1, 2 or 3 wherein the or
one of the E2 oestrogens in the pack is oestradiol valerate.
14. A pack as claimed in claim 1, 2 or 3 wherein the
same oestrogen is present in each E2 oestrogen daily dosage.
15. A pack as claimed in claim 1, 2 or 3 wherein the
or one of the E3 oestrogens in the pack is oestriol.
16. A pack as claimed in claim 1, 2 or 3, wherein the
same oestrogen is present in each E3 oestrogen daily dosage.
17. A pack as claimed in claim 1, 2 or 3 wherein the
or one of the gestagens in the pack is D-norgestrel, norethisterone
acetate or cyproterone acetate.
18. A pack as claimed in claim 1, 2 or 3, wherein the
same gestagen is present in each gestagen daily dosage.
19. A pack as claimed in claim 1, wherein the unit
dosage forms provide any one of the dosage combinations A to H
given in the following Table.

<IMG>
22

20. A pack as claimed in claim 1 in which each daily
dosage of Ia and Ib is combined in a single unit dosage form, each
daily dosage of IIa, IIb and IIc is combined in a single unit
dosage form.
21. A pack as claimed in claim 2 wherein each daily
dosage of Ia and Ib is combined in a single unit dosage form, each
daily dosage of IIa, IIb and IIc is combined in a single unit
dosage form and each daily dosage of III is in a single dosage
unit.
22. A pack as claimed in claim 1 wherein each dosage
unit is in a form suitable for oral administration.
23. A pack as claimed in claim 22 wherein each dosage
unit is in the form of a tablet or dragee.
24. A pack as claimed in claim 1, 2 or 3 wherein each
dosage unit is in a form suitable for parenteral administration.
25. A pack as claimed in claim 1, wherein the first
and second sets Ia, Ib and IIa, IIb and IIc provide daily dosages
for 21 days.
26. A pack as claimed in claim 25, wherein the first
set Ia and Ib provides daily dosages for 11 days and the second
set IIa, IIb and IIc provides daily dosages for 10 days.
27. A pharmaceutical treatment agent for use in the
treatment of climacteric deficiency symptoms, which comprises an
E2 oestrogen and an E3 oestrogen in a ratio of from 2:1 to 1:8
and a gestagen, the E2 and E3 oestrogen being present in a first
set to provide for administration for 22 days and the gestagen
being only present in a second set which comprises 9 to 11 daily
doses of the E2 and E3 oestrogen.
28. An agent as claimed in claim 27 wherein the E2
oestrogen is oestradiol valerate.
29. An agent as claimed in claim 28 wherein the E3
oestrogen is oestriol.
23

30. An agent as claimed in claim 27, 28 or 29 where in
the gestagen is D-norgestrel, norethisterone acetate or cyproter-
one acetate.
31. An agent as claimed in claim 27, 28 or 29 wherein
the ratio of E2 oestrogen to E3 oestrogen is substantially 1:2.
32. A pharmaceutical preparation which comprises an
agent as claimed in claim 27, in admixture or conjunction with a
pharmaceutically suitable carrier.
33. A pharmaceutical preparation as claimed in claim
32, which is in unit dosage form.
34. A pharmaceutical preparation as claimed in claim
33, wherein each dosage unit contains an amount of E2 oestrogen
which produces the same oestrogenic effect as the administration
of 0.5 to 4 mg of oestradiol valerate.
35. A pharmaceutical preparation as claimed in claim
34, wherein each dosage unit contains an amount of E3 oestrogen
which produces the same oestrogenic effect as the administration
of 0.5 to 8 mg of oestriol.
36. A pharmaceutical preparation as claimed in claim 33,
34, or 35 wherein each dosage unit contains an amount of gestagen
which produces the same gestagenic effect as the administration of
0.1 to 0.5 mg of D-norgestrel.
37. A pharmaceutical preparation as claimed in claim
33 wherein each dosage unit contains any one of the agents indi-
cated for the second stage in A to H given in the following Table.

<IMG>

38. A pharmaceutical preparation as claimed in claim
33, which consists of 9-11 dosage units or a multiple thereof.
39. A pharmaceutical preparation as claimed in claim
38 which consists of 10 dosage units or a multiple thereof.
40. A pharmaceutical preparation as claimed in claim
38 wherein the dosages of E2 oestrogen, E3 oestrogen and gestagen
are of substantially uniform dosage in all dosage units.
41. A pharmaceutical preparation as claimed in claim
32, which is in a form suitable for oral administration.
42. A pharmaceutical preparation as claimed in claim
37 which is in the form of a tablet or dragee.
43. A pharmaceutical preparation as claimed in claim
32, 33 or 34 which is in a form suitable for parenteral adminis-
tration.
44. A pack which comprises an E2 oestrogen, an E3
oestrogen and a gestagen made up in discreet parts to provide
(i) 10-12 daily dosages of an E2 oestrogen and an E3 oestrogen in
a ratio of from 2:1 to 1:8, these daily dosages being free of
gestagen, (ii) 9-11 daily dosages, to complete 20-22 daily dosages
of E2 oestrogen and E3 oestrogen in a ratio of from 2:1 to 1:8,
and of gestagen, and (iii) 0 to 8 daily dosages, up to a maximum
of 28 daily dosages, of an E3 oestrogen free of E2 oestrogen and
free of gestagen, or of a hormone-free preparation, or a multiple
of these daily dosages.
45. A pack as claimed in claim 44 in which in (iii)
there are 6 to 8 daily dosages.
46. A pack as claimed in claim 44 which is made up in
discreet parts as follows: (i) 10-12 daily dosages of E2 oestrogen
and E3 oestrogen in a ratio of from 2:1 to 1:8, and (ii) 9-11
daily dosages, to complete 20-22 daily dosages, of E2 oestrogen
and E3 oestrogen in a ratio of from 2:1 to 1:8, and of gestagen,
or in each discreet part, a multiple of these daily dosages.
26

47. A pack as claimed in claim 46 in which there is
also present (iii) 6-8 daily dosages to complete 28 daily dosages of
E3 oestrogen.
48. A pack as claimed in claim 46 or 47 wherein the
E2 oestrogen and E3 oestrogen in part (i) are in a ratio of sub-
stantially 1:2.
49. A pack as claimed in claim 46 or 47 wherein the
E2 oestrogen and E3 oestrogen in part (ii) are in a ratio of sub-
stantially 1:2.
50. A pack as claimed in claim 44 which is made up in
discreet parts as follows:
(i) 20-22 daily dosages of E2 oestrogen,
(ii) 20-22 daily dosages of E3 oestrogen, and
(iii) 9-11 daily dosages of gestagen.
or in each part, a multiple of these daily dosages.
51. A pack as claimed in claim 50 in which in part
(ii) or as an additional discreet part, 6-8 daily dosages, to
complete 28 daily dosages, of E3 oestrogen.
52. A pack as claimed in claim 50 or 51 wherein the
E2 oestrogen and E3 oestrogen in parts (i) and ( i) are in a
ratio of substantially 1:2.
53. A pack as claimed in claim 44 made up in discreet
parts as follows:
(i) 20-22 daily dosages of E2 oestrogen and E3 oestrogen in
a ratio of from 2:1 to 1:8,
(ii) 9-11 daily dosages of gestagen and if desired
(iii) 6-8 daily dosages of E3 oestrogen to complete 28 daily
dosages,
or in each part, a multiple of these daily dosages.
54. A pack as claimed in claim 53 wherein the E2
oestrogen and E3 oestrogen in part (i) are in a ratio of substan-
tially 1:2.
27

55. A pack as claimed in claim 54 wherein each dis-
creet part is in the form of one or more pharmaceutical prepara-
tions comprising the active ingredient(s) in admixture or conjunc-
tion with a pharmaceutically suitable carrier.
56. A pack as claimed in claim 55 wherein each phar-
maceutical preparation is in dosage unit form.
57. A pack as claimed in claim 56 wherein in each dis-
creet part each daily dosage of the active ingredient(s) is in a
single dosage unit.
58. A pack as claimed in claim 57 wherein in each dis-
creet part the daily dosages are of substantially uniform dosage.
59. A pack as claimed in claim 58 wherein all the E2
oestrogen daily dosages are of substantially uniform dosage and
all the E3 oestrogen daily dosages are of substantially uniform
dosage.
60. A pack as claimed in claim 58 which includes 6-8
daily dosages of E3 oestrogen to complete the 28 daily dosages,
wherein the other E3 oestrogen daily dosages are of substantially
uniform dosage, each of the 6-8 daily dosages of E3 oestrogen is
no more than half this daily dosage, and wherein all the E2 oestro-
gen daily dosages are of substantially uniform dosage.
61. A pack as claimed in claim 44, 45 or 46 wherein
each E2 oestrogen daily dosage provided produces the same oestro-
genic activity as the administration of 0.5 to 4 mg of oestradiol
valerate daily.
62. A pack as claimed in claim 44, 45 or 46 wherein
each E3 oestrogen daily dosage provided produces the same oestro-
genic activity as the administration of 0.5 to 8 mg of oestriol
daily.
63. A pack as claimed in claim 44, 45 or 46 wherein
each gestagen daily dosage provided produces the same gestagenic
activity as the administration of 0.1 to 0.5 mg of D-norgestrel
daily.
28

64. A pack as claimed in claim 44, 45 or 46 wherein
the or one of the E2 oestrogens in the pack is oestradiol valerate.
65. A pack as claimed in claim 44, 45 or 46 wherein
the same oestrogen is present in each E2 oestrogen daily dosage.
66. A pack as claimed in claim 44, 45 or 46 wherein
the or one of the E3 oestrogens in the pack is oestriol.
67. A pack as claimed in claim 44, 45 or 46 wherein
the same oestrogen is present in each E3 oestrogen daily dosage.
68. A pack as claimed in claim 44, 45 or 46 wherein
the or one of the gestagens in the pack is D-norgestrel, norethis-
terone acetate or cyproterone acetate.
69. A pack as claimed in claim 44, 45 or 46 wherein
the same gestagen is present in each gestagen daily dosage.
70. A pack as claimed in claim 44, 45 or 46 wherein
the unit dosage forms provide any one of the dosage combinations
A to H given in the following Table.

<IMG>

71. A pack as claimed in claim 44 wherein the daily
dosages are in a form suitable for oral administration.
72. A pack as claimed in claim 71 wherein the daily
dosages are in the form of tablets or dragees.
73. A pack as claimed in claim 44, 45 or 46 wherein
the daily dosages are in a form suitable for parenteral adminis-
tration.
74. A pack as claimed in claim 44 which provides a
total of 21 daily dosages of E2 oestrogen and E3 oestrogen free
of gestagen and of E2 oestrogen, E3 oestrogen and gestagen.
75. A pack as claimed in claim 74 which provides 11
daily dosages of E2 oestrogen and E3 oestrogen free of gestagen.
31

Description

1~ 56
This invention relates to the treatment of climacteric
deficiency symptoms.
It is already known to treat climacteric complaints
with various types of oestrogens. Thus, for example, the daily
administration of oestradiol valerate for 21 days followed by a
7-day hormone-free phase eliminates the typical climacteric com-
plaints such as hot flushes, outbreaks of sweating, insomnia,
cardiovascular disturbances and dizziness.
Oestradiol valerate can also overcome pyschological
changes that are ~anifeste~ by mental unbalance. However, a dis-
advantage of oestradiol valerate is -that, during treatment,
relatively severe proliferation of the endometrium results,
which in turn leads to undesired uterine bleeding. The result
of the strong action on the upper genital tract is that oestra-
; diol valerate has a liminted indication.
In addition, the treatment of climacteric disorderswith oestriol is known. Oestriol has a favourable effect on the
lower genital tract (Cervix uteri, vagina and vulva) but it has
the disadvantage that the typical hormone deficiency symptoms
and psychologlcal changes are not overcome satisfactorily.
The ef~ects on the deficiency symptoms can be increased
and the effect on the uterus can be largely eliminated by a suit-
able combination of natural oestrogens. Since a considerable
synergistic action in the desired direction, and simultaneously,
an antagonistic effect in an undesired direction occur, the fact
that the oestrogens can be used in a relatively low dosage is a
further advantage.
Suitable natural oestrogens having a strong effect on
the deficiency symptoms and the upper genital tract are oestra-
diol and its derivatives. These are known as E2 oestrogens. Theterm `'derivatives" indicates compounds that are formed by the
esterification or etherification of oestradiol. Esters of
- 2 - `~

5:~2~
oestradiol, for example oestradiol valerate, are preferred.
Suitable natural oestrogens with a negligible effect
on deficiency symptoms and a strong effect on the lower genital
tract are oestriol and its derivatives. These are ]cnown as E3
oestrogens. The term "derivatives" is used here to include, in
particular, ethers and esters of oestriol. Oestriol and oestriol
succinate, for example, are very suitableO
Reliable action is achieved if a combination of a
natural oestrogen of type 1 (an E2 oestrogen, that is oestradiol
or a derivative of oestradiol) and a natural oestrogen of type 2
(an E3 oestrogen, that is oestriol or a derivative of oestriol)
is administered in the ratio of approximately 2:1 to 1:8 for 21
days and then only a natural oestrogen of type 2 (E3) or no
hormones for 7 days. Adjustment to the normal female cycle is
achieved with dosage over a period of 28 days.
A disadvantage of pure oestrogen therapy is the danger
of an unphysiological proliferation of the endometrium and mammary
tissue. We have now found that the residual action of oestrogens
on the uterus and mammae can be rendered harmless by the addi-
tional administration of a gestagen in the second half of thecycle for ~-11 days. The addition of gestagen brings about a
transformation of theendometrium and cyclic bleeding.
The present in~ention thus provides a pharmaceutical
treatment agent or composition for use in the treatment of
climacteric deficiency symptoms, which comprises an E2 oestrogen
and an E3 oestrogen in a ratio of from 2:1 to 1:8, and a gestagen.
The agent may be made up in the form of a pharmaceuti-
cal preparation, which comprises the three components in admix-
ture or conjunction with a pharmaceutically suitable carrier.
The preparation is suitably in dosage unit form.
The present invention further provides a pack which
comprises an E2 oestrogen, an E3 oestrogen and a gestagen made
-- 3 --

s~;
up in discreet parts to provide
(i) 10-12 daily dosages of an E2 oestrogen and an E3
oestrogen in a ratio of from 2:1 to 1:8, these daily
dosages being free of gestagen,
(ii) 9-11 daily dosages, to make up 20-22 daily dosages,
of E2 oestrogen and E3 oestrogen in a ratio of from
2:1 to 1:8, and of gestagen,
and, if desired,
(iii) up to 8, especially 6-8 daily dosages up to a maximum
of 28 daily dosages, of an E3 oestrogen free of E~
oestrogen and free of gestagen or of placebo.
If desired, ihere maybe an exact multiple of these daily dosages
in the pack.
Suitably the components (i), (ii) and (iii) are in the
form of pharmaceutical preparations comprising the active ingred-
ient(s) in admixture or conjunction with a pharmaceutically suit-
able carrier.
The pack may be made up in three discreet parts as
follows: the E2 oestrogen, the E3 oestrogen and the gestagen;
or the 10-12 daily dosages (i), the 9-11 daily dosages (ii) and
if desired, the remaining daily dosayes (iii). Also, for example
the E2 and E3 oestrogens could be made up in one part, the gesta-
gen in another part, and-the E3 oestrogen free of E2 oestrogen
and gestagen in another part.
The present invention also provides a pharmaceutical
treatment pack for the treatment of climacteric deficiency
symptoms, which comprises in or on a container, card or other
support member, unit dosage forms of an E2 oestrogen, an E3
oestrogen and a gestagen, which provide
(I) (a) a first set of 10-12 daily dosages of an E2 oestrogen
and
(b) a first set of 10-12 daily dosages of an E3 oestrogen,
-- 4 ~

Z5~
the ratio of the average daily dosage of E2 oestroyen
to the average daily dosage of E3 oestro~en being from
2:1 to 1:8,
(II) (a) a second set of 9-11 daily dosages of E2 oestrogen, to
complete 20-22 daily dosages, and
(b) a second set of 9-11 daily dosages of E3 oestrogen, to
complete 20-22 daily dosages,
the ratio of the average daily dosage of E2 oestrogen
to the average daily dosage of E3 oestrogen being from
2:1 to 1:8, and
(c) a set of 9~11 daily dosages of a gesta~en, and if,
desired,
(III) a third set of 6-8 daily dosages of E3 oestrogen or
of hormone-free preparations or objects indicating no
hormone treatment, to complete 28 daily dosages,
the sets being located in a particular order, together with
indications and/or instructions to indicate and facilitate a
treatment consisting of the administration to a human female on
; each of 10-12 successive days of one of the daily dosages Ia
and one of the daily dosages Ib, on each of the immediately
following 9-11 successive days, to complete 20-22 days, one of
the daily dosages IIa, one of the daily dosages IIb and one of
the daily dosages IIc, and on each of the immediately following
6-8 success;ve days to complete 28 days, one of the E3 oestrogen
or placebo daily dosages III or no administration of hormone.
The total number of days in the first, second and third
stages should always be 28. If desired, there may be additional
sets of dosage units in the pack so that the 28-day rhythm can
be repeated. The administration of E2 oestrogen and gestagen are
terminated on the same day.
The third set may be free from intake, or placebos, E3
oestrogen and/or other active substances may be administered
-- 5 --

5~
during the 6-8 day perioa.
~ en no dosage unit is to be administered, the pack
may contain objects indicating no hormone treatment. Each object
may take the form of a gap, space, mark(s), relief or packing
on or in the card or tube or other support member. It may be,
for example, a representation of a dosage unit preparation or of
a receptacle therefor, for example an empty profiled receptacle.
Each object is preferably removablel destructable or otherwise
alterable, so that a check on the treatment may be kept easily.
For example, it may be an empty destructable profiled receptacle.
However, in order to avoid inadvertent omission of
medication, the pack may contain E3 oestrogen preparations or
placebos.
Indication of the method by which treatment is to be
carried out may comprise the arrangement in the pack of the sets
of preparations and, if present, objects indicating no hormone
treatment. The appearance of the preparations may also provide
guidance for the treatment; for example, the different prepara-
tions may be of different colours. Two or more preparations may
be taken per day, but generally one per day is taken. Thus, each
daily dosage Ia and Ib is combined in a-single unit dosage form
and each daily dosage IIa, IIb and IIc is combined in a single
unit dosage form. Thus the pack may contain 28 dosage units pre-
ferably for oral administration in a co-ordinated, fixed sequence,
the sequence corresponding to the stages of the daily administra-
tion. The pack may, among other things, be in the form of a
transparent pack with for example 11 dosage units for the first
stage, 10 dosage units for the second stage and 7 dosage units for
the third stage, from which 1 dosage unit daily may be taken for
28 days. Generally, written or printed instructions are also
given.
Suitably, the dosage of the oestrogens corresponds to
- 6 -

~ 3~ 5~
the usual dosage known in oestrogen therapyO
Suitable E2 oestrogens are, especially oestradiol and
esters of oestradiol, e.g. oestradiol valerate and oestradiol
benzoate. Preferably the quantity of E2 oestrogen used is such
that it produces the same oestrogenic activity as the administration
of 0.5 to 4 mg of oestradiol valerate daily. The E2 daily dosages
can,of course,vary from day to day within a stage and from stage
to stage, although they are preferably substantially uniform.
Especially suitable E3 oestrogens are oestriol and
esters of oestriol, e.g. oestriol succinate. Preferably the
quantity of E3 oestrogen used is such that it produces the same
oestrogenic activity as the administration of 0.5 to 8 mg of
oestriol daily. The E3 daily dosages can, of course vary from
day to day within a stage and from stage to stage. Preferably
the E3 daily dosage in stages I and II is substantially uniform.
The daily dosage in stage III is preferably substantially uniform
and may be the same as or different from the daily dosage in the
other stages, for example the daily dosage in stage III may be
half the daily dosage in each of the other two stages.
The ratio of E2 to E3 administered can vary from day
to day and from stage to stage, although it is also preferably
substantially uniform. Usually the ratio of E2 to E3 administered
each day is from 2:1 to 1:8, although it can vary slightly from
this provided the average daily dosage ratio is in this range.
The preferred ratio of E2 to E3 is substantially 1:2.
It should be understood that the ratios of E2 oestrogen
to E3 oestrogen mentioned herein are ratios by weight.
The gestagenic constituent present in the agent of the
present invention and administered in stage II may be any
gestagenically-active su~stance. Preferably the quantity used
is such that it produces the same gestagenic activity as the
administration of 0.1~0.5 mg of D-norgestrel daily. The gestagen
~ 7 -

5~i
daily dosage can of course, vary from day to day although it is
preferably substantially uniform. Suitable gestagenic constitu-
ents are, inter alia progesterone, 17-hydroxyprogesterone esters,
l9-nor-17-hydroxyprogesterone esters, 17 ~-ethynyltestosterone,
17c~ethynyl-19-nor-testosteron (norethisterone) and 17~-ethynyl-
18-methyl-19-nor-testosterone (D-norgestrel) and their derivatives.
The term "derivatives" includes compounds that are formed by the
introduction of double bonds, by substituents, esterification,
etherification, and ketalisation.
~dditional double bonds may be, inter alia in the 1,2-
6,7-, 15,16- or 16,17-positions. Substituents may be halogen
atoms, especially fluorine or bromine atoms, methyl, hydroxy,
methoxy and acetoxy groups in the 4,6,7,11- and/or 16-positions
and also methylene groups in the 1,2-, 6,7-, 15,16- and/or
16,17-positions. The 3-keto group of the gestagen may be
reduced or eliminated. The 4,5-double bond may be displaced
to the 5,6- or 5,10-position.
Suitable esters are those of acids that are normally
used in steroid chemistry to esteriEy steroid alcohols e.g.
alkanecarboxylic acids having especially 1 to 11 carbon atoms.
Examples of ethers are alkyl ethers and tetrahydropyranyl ethers
and examples of ketals are those of ethane diol and of propane
diols.
Preferred gestagens are D-norgestrel, norethisterone
acetate and cyproterone acetate ~17-acetoxy-6-chloro-1~,2c~-
methylene-4,6-pregnadiene-3,20-dione).
The E2 oestrogen, E3 oestrogen and the gestagen used
on different days may be the same or different, usually the same.
For example, there may be administered any of the
following dosage combinations A to H:

s~
Daily dosage for Daily dosage for Daily dosage for
each of 10 to 12 each of the immedi- each of the immediately
successive days ately following 9 following 6 to 8
(lst stage) to 11 successive successive days
days (2nd stage) to (3rd stage) to
complete 20-22 days complete 28 days
(Agent of the
invention)
1 mg oestradiol 1 mg oestradiol
valerate valerate
A 2 mg oestriol 2 mg oestriol 1 mg oest~iol
0.25 mg D-norgestrel
2 mg oestradiol 2 mg oestradiol
valerate valerate
2 mg oestriol 2 mg oestriol 1 mg oestriol
. 0.25 mg D-norgestrel
3 mg oestradiol 3 mg oestradiol
valerate valerate
C 2 mg oestriol 2 mg oestriol 1 mg oestriol
2 mg norethisterone
. acetate
4 mg oestradiol 4 mg oestradiol
valerate valerate
D 2 mg oestriol 2 mg oestriol 2 mg oestriol
. . 0~25 mg D~norgestrel
0.5 mg oestradiol 0.5 mg oestradiol
valerate val.erate
E 4 mg oestriol 4 mg oestriol 2 mg oestriol
1 mg cyproterone
: acetate
1 mg oestradiol 1 mg oestradiol
F valerate valerate
4 mg oestriol 4 mg oestriol 2 mg oestriol
.. 0.25 mg D-norgestrel
; 2 mg oestradiol 2 mg oestradiol
valerate valerate
G 1 mg oestriol I. mg oestriol 0.5 mg oestriol
0.25 mg D-norgestrel
1 mg oestradiol 1 mg oestradiol
valerate valerate
H 2 mg oestriol 2 mg oestriol No hormone
0.25 mg D-norgestrel

S~i
The active ingredients are preferably administered
together orally but they may also be administered separately or
parenterally. Each daily dosage of Ia and Ib may be combined
in a single dosage unit and each daily dosage of IIa, Ilb and
IIc may be similarly combined.
For formulating the dosage units, the active substances
may be processed with the additives, carrier substances and/or
taste correctives customary in galenical pharmacy according to
methods known per se to produce the normal forms of administra-
tion. Tablets, dragées, capsules, pills, suspensions or solu-
tions especially are suitable for the preferred oral administra-
tion and, for parenteral administration oily solutions, e.g.
sesame oil or castor oil solutions which may optionally also
contain a diluting agent, e.g. benzyl benzoate or benzyl alcohol
are especially preferred. ~or the preferred oral administration
the three-stage agents are preferably assembled in the form of
a pack.
The following Examples illustrate the invention.
Ex~nple 1
Cornposition of a dragee for each stage
1st Stage 1.000 mg oestradiol valerate
2.000 mg oestriol
43.500 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
11 successive days.
. ~
-- 10 --

~0~5~
2nd Stage 1.000 mg oestradiol valerate
2. ono mg oestriol
0.250 mg D-norgestrel
43.250 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to àpproxi-
mately 140 mg with a normal sugar mixture.
A single d~agee of this composition is administered on each of
the immediately following 10 successive days.
` 3rd Stage 1.000 mg oestriol
45.500 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
~0 the immediately following 7 successive days.Example 2
~ Composition of a dragee for each stage
1st Stage 2.000 mg oestradiol valerate
2.000 mg oestriol
42.500 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.600 mg talcum
0.100 mg magnesium stearate
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
11 successive days.
-- 11 -- ,

2nd stage 2.000 mg oestradiol valerate
2.000 mg oestriol
0.250 mg D-norgestrel
42.250 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.600 mg talcum
0.100 mg magnesium stearate
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
- A single dragee of this composition is administered on each of
; the immediately following lO successive days.
3rd Stage l.000 mg oestriol
45.500 mg lactose
26.800 mg maize starch
3~000 mg polyvinyl pyrrolidone 25
3.600 mg talcum
0.100 mg magnesium stearate
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
the immediately following 7 successive days.
Example 3
Composition of a dragee for each stage
1st Stage 3.000 mg oestradiol valerate
2.000 mg oestriol
; 41.500 mg lactose
26.800 mg maize starch
; 3nO00 mg polyvinyl pyxrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
- 12 -

~q,~1,3~5~
A single dragee of this composition is administered on each of
11 successive days.
2nd Stage 3.000 mg oestradiol valerate
2.000 mg oestriol
2.000 mg norethisterone acetate
39.500 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
the immediately following 10 successive days.
3rd Stage 1.000 mg oestriol
45.500 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
the immediately following 7 successive days.
Example 4
Composition of a dragee for each stage
1st Stage 4.000 mg oestradiol valerate
2.000 mg oestriol
40.500 mg lactose
26.800 mg maize starch
3.000 mgpolyvinyl pyrrolidone 25
3.550 mg talcum
0.150 mg magnesium stearate
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
- 13 -

3;256
A single dragee of this composition is administered on each of
11 successive days.
2nd Stage 4.000 mg oestradiol valerate
2.000 mg oestriol
0.250 mg D-norgestrel
40.250 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.550 mg talcum
0.150 mg magnesium stearate
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
the immediately following 10 successive days.
3rd Stage 2.000 mg oestriol
44.500 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.550 mg talcum
0.150 mg magnesium stearate
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of the
immediately following 7 successive days.
Example 5
Composition of a dragee for each ;stage
1st Stage 0.500 mg oestradiol valerate
4.000 mg oestriol
~ 42.000 mg lactose
; 30 26.800 mg maize starch
- - 14 -

s~;
3,000 mg polyvinyl pyrrolidone 25
3 . 7 00 mg talcum
80.000 mg total weiyht which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
11 successive days.
2nd Stage 0.500 mg oestradiol valerate
4.000 mg oestriol
1.000 mg cyproterone acetate
41.000 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
the immediately following 10 successive days.
3rd Stage 2.000 mg oestriol
44.500 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
8G.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
the immediately following 7 successive days.
Example 6
.
Composition of a dragee for each stage
1st Stage 1.000 mg oestradiol valerate
4.000 mg oestriol
41.500 mg lactose
26.800 mg maize starch
- 15 -

3.000 m~ polyvinyl pyrrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
11 successive days.
2nd Stage 1.000 mg oestradiol valerate
4.000 mg oestriol
0.~50 mg D-norgestrel
41.250 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
the immediately following 10 successive days.
3rd Stage 2.000 mg oestriol
44.500 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
the immediately following 7 successive days.
Example 7
; Composition of a dragee for each stage
1st Stage 2.000 mg oestradiol valerate
1.000 mg oestriol
43.500 mg lactose
26.800 mg maize starch
- 16 -

5~"
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
___
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
11 successive days.
2nd Stage 2.000 mg oestradiol valerate
1.000 mg oestriol
0.250 mg D-norgestrel
43.250 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
the immediately following 10 successive days.
3rd Stage 0.500 mg oestriol
46.000 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A singlt dragee of this composition is administered on each of
the immediately following 7 successive days.
Example 8
Composition of a dragee for each stage
_
1st Stage 1.000 mg oestradiol valerate
2.000 mg oestriol
43.500 mg lactose
26.800 mg maize starch
- 17 -

5~j
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
11 successive days.
2nd Stage 1.000 mg oestradiol valerate
2.000 mg oestriol
0.250 mg D-norgestrel
43.250 mg lactose
26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
8~000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
the immediately following 10 successive days.
3rd Stage 46.500 mg lactose
- 26.800 mg maize starch
3.000 mg polyvinyl pyrrolidone 25
3.700 mg talcum
80.000 mg total weight which is made up to approxi-
mately 140 mg with a normal sugar mixture.
A single dragee of this composition is administered on each of
the immediately following 7 successive days.
; ~ 18 -