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Indications For Specialist Referral : Unexplained vaginal bleeding, Personal/family (1st deg relative) history of VTE, Personal history of breast, endometrial or endometroid ovarian cancer, Otosclerosis, Undiagnosed breast lump, Active liver disease, Migraine with aura
Cautions: Fibroids, Hypertension, Migraines, Endometriosis, Family history of breast cancer (can give HRT, but monitor closely)
What To Do In a Review: @3m: discuss symptom control, bleeding pattern, side effects; check BP & adjust dose if needed; @6m: same as 3m; @ 12m: as 3m plus weight; mammography to be repeated according to NHS breast screening programme.
Treatment Duration: Symptom Relief: 3-5y then gradual withdrawal, continue Rx if symptoms recur; Osteoporosis: 5-10y; Premature Menopause: treat to age 51, then review and discuss benefits vs risks with patient (increased risk of breast Ca applies only after average age of menopause (ie 51)
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** change to continuous combined regime if therapy required for more than 2 years
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Contraception
HRT is not a contraceptive
50y: continue contraception for 1y after menopause
If HRT is started premenopausally, the last period is masked, and fertility status is therefore unclear. Contraception is advised until age 54, when 80% women will be post menopausal
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