The patients should be educated about the start-up symptoms of HRT.

These inclede:

-Breast tenderness

-Nipple sensitivity

-Rise in appetite

-Weight gain

-Cramps in the calf

Patients should be informed that during starting the HRT symptoms similar to early pregnancy will be common.These symptoms usually remit at about 12 to 14 weeks of gestation.

Patients receiving HRT should ideally be reviewed Annually

Blood pressure:

Blood pressure should be checked.

Breast:

Patients should be taught how to self examine her breast. Should should also have regular mammography.

Pelvic examination:

This is especially very useful for unscheduled bleeding, especially if it is prolonged,heavy or recurrent. In cases of bleeding that is unscheduled a specialist consultation with a view to hysteroscopy and biopsy if indicated.

Ultrasound examination either transabdominally or vaginal (preferable) is also very useful as fibroids and endometrial polyps may be identified.

Use of local estrogens:

Symptoms originating in the lower genital tract (Bladder and urethra) may be treated with locally-applied estrogens.

Locally applied estrogens may be in the form of cream, pessary or vaginal tablet.It should be inserted/applied to the upper vagina where it will disperse to nearby local estrogen receptors.

Even patients who have had a past history of breast cancer can receive local vaginal estrogens for genitourinary symptoms.

References:

Pages 2209 to 2212.Chapter 327. The menopause transition and postmenopausal hormone therapy.Harrisons Principles of Internal Medicine. Volume II.16th edition. Kasper,Braunwald,Fauci,Hauser,Longo and Jameson.

Pages 227 to 229. Chapter 19. Menopause. Gynaecology by ten teachers. Seventeenth edition. Edited by Stuart Campbell and Ash Monga.

Pages 760 to 762. Chapter 17. Menopausal syndrome.Gynaecology. CMDT 2006. Current Medical Diagnosis and Treatment 2006.45 th Edition. Edited by Lawrence M. Tierney,Jr. Stephen J McPhee, Maxine A. Papadakis.

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