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Menopause - Management
How do I manage oestrogen-related adverse effects?
- Oestrogen-related adverse effects include fluid retention, bloating, breast tenderness or enlargement, nausea, headaches, leg cramps, and dyspepsia. They may occur continuously or randomly throughout the cycle.
- Encourage the woman to persist with therapy for about 3 months to await resolution, as most adverse effects resolve with increased duration of use:
- Leg cramps can improve with lifestyle changes, including exercise and regular stretching of the calf muscles.
- Nausea/gastric upset may be helped by adjusting the timing of the oestrogen dosage or taking with food.
- Breast tenderness may be alleviated by a low-fat, high-carbohydrate diet. Gamolenic acid (evening primrose oil) is no longer available as a licensed medicinal product because of lack of efficacy.
- Migraine triggered by fluctuating oestrogen levels may respond to transdermal therapy, as this produces more stable oestrogen levels.
- For persistent adverse effects, consider:
- Reducing the dosage or
- Changing the oestrogen type (e.g. swap between the two main forms of oestrogen, that is, estradiol and conjugated oestrogens) or
- Changing the route of delivery (e.g. tablets may cause nausea, but patches and gels generally do not).
Basis for recommendation
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