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Menopause - Management
How do I manage progestogen-related adverse effects (other than bleeding)?
- Progestogen-related adverse effects (e.g. fluid retention, breast tenderness, headaches/migraine, mood swings, depression, acne, lower abdominal pain, and backache) tend to occur in a cyclical pattern during the progestogen phase of cyclical HRT.
- Advise the woman to persist with therapy for 3 months (adverse effects may resolve).
- For persistent symptoms, consider:
- Changing froma a more androgenic progestogen (e.g. norethisterone and norgestrel) to a less androgenic progestogen (e.g. medroxyprogesterone or dydrogesterone).
- Changing from oral to transdermal, vaginal, or intrauterine progestogen.
- Reducing the duration of progestogen administration: swap from a 14 day to a 12 day product.
- Changing to a product with a lower dose of progestogen (dosages are preparation dependent).
- Switching to a long-cycle regimen, where progestogen is given for 14 days every 3 months (only suitable for women without natural regular periods).
- Changing to continuous combined therapy or tibolone (only suitable if postmenopausal).
- Many of these strategies are the opposite of what may be needed to give better bleeding control.
In depth
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