Deciding the best treatment?

Menopausal symptoms derive from oestrogen deficiency so if the flushes are tolerable but urogenital symptoms are significant, then low dose vaginal oestrogens will often be more effective as an initial strategy.

What is the name of an example of vaginal oestrogen. How often would you advise it’s use at what dose? (You can check the BNF or with your GP/Pharmacist) – THIS IS AN INTERACTIVE SECTION NEEDS A FREE TEXT BOX. – this can go in quiz at end

If sex drive is a problem discuss with the GP you work with whether testosterone is appropriate (NICE 2019)[; a supplementation for menopausal women with low sexual desire if HRT alone is not effective.

Has she got a uterus? Or has she got any remaining endometrium?

 If so, then she will need oestrogen and progesterone.

This will help to prevent hypertrophy and malignant change.

NB; Oestrogen and Progestogen to women with a uterus, Oestrogen alone to women without a uterus. (NICE 2019)

Has she had a period

If she has, and she has not got the Mirena ® LNG IUS, then a cyclical regimen can be offered.

If she has a Mirena ® LNG IUS only oestrogen is needed.

 If she has not had a period in the last year she will need either continuous Progestogen and Oestrogen, or Tibolone.