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Question answered:29/04/08
The CKS guideline on the menopause [1] has a specific section, ‘What should I do if there is poor symptom control?’ [2], this states:
"Review the woman:
- Check that the hormone replacement therapy (HRT) has been used as recommended for at least 3 months to ensure full effect.
- Check that patches are adherent.
- Review the woman's expectations. Hormone replacement therapy can help symptoms due to oestrogen deficiency but is not an answer to all problems.
- Consider an alternative diagnosis. See Other causes of the symptoms
Treatment options include:
- Increasing the oestrogen dose.
- Adding vaginal oestrogen if urogenital symptoms are not controlled.
- Switching from oral to a non-oral route (e.g. if absorption is poor because of a bowel disorder or if a drug interaction is present).
- Switching delivery system if patch adhesion is poor.
Basis for recommendation
These recommendations are based on expert published opinion and pragmatic advice [Rees and Purdie, 2006a; Menopause Matters, 2007b]."
References
1) http://cks.library.nhs.uk/menopause/view_whole_guidance
2) http://cks.library.nhs.uk/menopause/management/detailed_answers/managing_symptoms_with_hrt/poor_symptom_control#
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