TREATMENT PLAN, PROGNOSIS

TREATMENT PLAN

Lifestyle measures:

• Exercise
• Weight loss
• Healthy eating
• Smoking cessation Non-HRT options:
• Vasomotor symptoms: SSRIs, clonidine, gabapentin, CBT
• Mood symptoms: self-help, CBT
• Urogenital symptoms: vaginal moisturisers, lubricants HRT options:
• With uterus: oestrogen-progesterone preparations
• Without uterus: oestrogen-only preparations
• Routes: oral or transdermal patch
• Start low dose with a shorter duration Review at 3 months, then annually • Specific indications:  o          Mood disorders: oral/transdermal HRT o       Urogenital sx’s:
  • 1^st line: low-dose vaginal oestrogen
  • 2^nd line: Oral ospemifene o Altered sexual function: Seek advice about testosterone supplementation o     Vasomotor sx’s
  • w/ uterus: E+P oral/patch
  • without uterus: E only oral/patch o   <50 with vasomotor sx’s
  • HRT/CHC (both are helpful in bone protection) Contraindications to HRT:
• Current/past breast cancer
• Oestrogen-dependent cancers
• Undiagnosed vaginal bleeding
• Untreated endometrial hyperplasia
• Previous/recurrent VTE/ATE
• Pregnancy
• Active liver disease
• Thrombophilia

PROGNOSIS

• The perimenopausal state typically lasts 5-7 years
• Vasomotor symptoms may persist for 2-5 years