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Management of side effects


In all patients allow 3 months on treatment before making any changes as frequently side effects subside. Should side effects persist consider the following:

Estrogenic

Breast Tenderness/  
Enlargement
Leg Cramps
Bloating
Nausea
Headache
. » Breast Symptoms » Try Evening Primrose Oil
Reduce estrogen dose, particularly in older patients.
(Remember bone protection doses)
» GI Symptoms » Take with food

Change route of administration
Change type of oral estrogen

Progestogenic

PMS type symptoms
Breast Tenderness
Lower abdominal pain
Backache
Depressed mood
Acne/Greasy skin
. » Change progestogen » Testosterone derived:
Norethisterone/Norgestrel/Levonorgestrel
Progesterone derived:
Medroxyprogesterone/Dydrogesterone/Drospirenone
» Change route of administration  
» Offer tailor-made combination » Remember recommended dose & duration for endometrial protection.
» If post menopausal, consider change to continuous combined or tibolone. » Avoids symptoms related to progestogen fluctuation.

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