Dr Sylvia Bond

16/9/09

1 point type and 1 point brand name

Cyclical( sequential) CCT ( Continuous Combined Therapy) Unopposed Oestrogen Topical Oestrogen Mirena ( IUS) + unopposed oestrogen

45years

Normal range of menopause 45-55 years

Menopause is last menstrual period Peri-menopause may last 10 years+

with symptoms

1 year if over 50 years 2 years if under 50 years

No

PMH cancer of ovary is also not contraindicated as not Oestrogen sensitive.

PregnancyUndiagnosed abnormal bleedingBreast or endometrial cancerSevere liver diseasePMH ThrombosisMigraine with aura

Osteoporosis Bowel cancer ? Alzheimer’s disease

Dixarit ( Clonidine) Black Cohosh Red Clover Kava Kava Angus castus Magnesium/Zinc

Phytoestrogens ( Soya /Yam)

Evening Primrose oil

SSRIs

32 iu

May need to repeat to confirm if basing advice on contraception on result, e.g. When amenorrhoea with IUS and deciding when safe to remove.

12 months after LMP or over 54 years

If using cyclical ( sequential) HRT offer swap at 54 years on review or repeat prescription and monthly withdrawal bleeds should stop.

A. Oestrodiol tablets = 1 mg

B. Oestrodiol patches = 50mcg

1 point type and 1 point brand name

Cyclical( sequential) CCT ( Continuous Combined Therapy) Unopposed Oestrogen Topical Oestrogen Mirena ( IUS) + unopposed oestrogen

Cyclical HRT Still perimenopausal Premique cycle MPA good for lipids and

CVD risk

IUS + Unopposed Oestrogen

Mirena + Premarin 0.625mg/ Oestrodiol 1mg

May consider HRT + barrier methods

Tibolone ( Livial ) CCT

Alternative Cyclical HRT Femoston 1/10mg

Unopposed Oestrogen

Double dose to 1.25mg Or try Oestrodiol 2mg or patch/gel Or add non hormonal remedy

CCT, lowest dose possible

Kliovance ( 1 mg Oestrodiol+ P) Premqiue low dose ( 0.325mg

premarin+ P)

Topical Oestrogen Premarin Oestrogel