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Menopause - Management
How should I manage peri-menopausal women with HRT (intact uterus)?
- Offer lifestyle advice.
- Advise about the risks and benefits of hormone replacement therapy (HRT) and record in the notes.
- For urogenital symptoms (e.g. vaginal dryness, dyspareunia) offer treatment with low-dose vaginal oestrogen (cream, pessary, tablet, or ring) or combined, systemic (oral or transdermal), cyclical HRT:
- Low-dose vaginal oestrogen may be preferred if the woman does not wish to take systemic HRT or cannot tolerate systemic HRT.
- For women with infrequent periods or who cannot tolerate progestogens, a systemic 3-monthly regimen may be preferred.
- For vasomotor symptoms (e.g. hot flushes, night sweats), with or without urogenital symptoms offer systemic (oral or transdermal) cyclical combined HRT:
- For women with infrequent periods or who cannot tolerate progestogens, a 3-monthly regimen may be preferred.
- Advise the woman that she may still get pregnant if contraception is not used:
- A suitable method of contraception should be used for 1 year after the last menstrual period if the woman is more than 50 years of age, or for 2 years after the last menstrual period if the woman is less than 50 years of age.
- See the CKS topic on Contraception for more information on contraception in perimenopausal women.
In depth
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