How do we decide which will be the most appropriate HRT for me?

 


Figure 28.1

Figure 28.1 is a flowchart indicating the salient questions to be addressed when considering the HRT options. There are three main questions leading to the appropriate options:

First, have you had a hysterectomy (hysterectomy)?

If your womb has been removed (hysterectomy), oestrogen replacement can be prescribed alone; there is generally no need for progestogens. If the womb has not been removed and oestrogen were prescribed unopposed, there would be a chance of the endometrium (womb lining) becoming unduly thickened with a risk of bleeding problems and on rare occasions malignancy ( HRT and progestogen).?

Secondly, if your womb is still present, are you still seeing your periods?

If periods are occurring spontaneously HRT would be supplementing the natural hormone cycle. In addition to the oestrogen replacement your doctor would suggest a progestogen for 10 to 12 days each month to ensure a regular withdrawal bleed. This prevents your endometrium (lining of the womb)becomingtoo thick. If you have not reached your menopause and a non-bleed variety of HRT were prescribed you would almost certainly have irregular bleeding.

Finally, if your womb is still present and the menopause has already occurred, do you wish to have a regular withdrawal bleed?

There is a choice of prescribing the progestogen se quentially to produce a regular withdrawal bleed or prescribing the progestogen on a daily (non-cyclical) regimen: This continuous combined HRT provides the benefits of HRT without “periods”. A blood hormone test can be arranged to provide a guide as to whether you have reached your menopause ( Q 26.14).



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