Treatment Guideline Chart

Menopause is associated with decreased estrogen production which leads to vasomotor symptoms and vulvovaginal atrophy. The woman may experience hot flushes, night sweats, dyspareunia or vaginal dryness. Spontaneous or natural menopause occurs when the final menstrual period is confirmed after 12 consecutive months of amenorrhea with no pathological cause. Induced menopause is the permanent cessation of menstruation after bilateral oophorectomy (ie surgical menopause) or iatrogenic ablation of ovarian function (eg pelvic radiation therapy, chemotherapy).


Menopause%20-and-%20hormone%20therapy Management

Follow Up

  • Schedule follow-up visit within a few months (eg 3 months) of starting MHT
    • Monitor compliance, response and side effects especially bleeding
    • Counsel on expected bleeding patterns and need for regular breast self-examination
    • Adjust MHT if required
  • An earlier follow-up is advised in patients with persistent symptoms or serious side effects
  • Patient should be evaluated yearly thereafter
    • Check for treatment side effects and new symptoms
    • Review risks versus benefits
    • BP, pulse rate, BMI
    • Breast evaluation
    • Cervical smears for all women with uterus
    • Perform bone mineral density as required
    • Every 2 years: Perform physical exam, lipid profile, LFTs, fasting glucose and mammogram if indicated
  • If women experience recurrence of hot flushes after stopping ET, non-hormonal agents may be tried; if symptoms persist, MHT may be resumed at the lowest effective dose or transdermal therapy may be considered in select patients with periodic reevaluation 
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