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.

Pregnancy Undiagnosed abnormal bleeding Breast or endometrial cancer Severe liver disease PMH Thrombosis Migraine 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