Initial Review

It is recommended that an initial review following a three-month trial of HRT (which is usually needed to achieve maximum effect) should be carried out. This is to assess the following;

Has there been any improvement of the symptoms that she presented with before starting HRT?

Has she experienced any side effects from the HRT?

I still have the same symptoms as I had before!

In this case where a woman remains symptomatic, consider;

  • poor absorption – for example, due to bowel disorder, gastric surgery, persistent diarrhea/vomiting
  • some drugs can reduce bio-available oestrogen – for example, Carbamazepine and Phenytoin
  • ensure that if the women has been prescribed patches that there is good adhesion
  • check if there are any differential diagnoses that have not been picked up see section one of this module
  • patient expectations may also need to be discussed
  • the dose of oestrogen may be too low. The Oestrogen dose may need to be increased. Vaginal Oestrogen cream can be added if urogenital symptoms are poorly controlled
Now I feel better!