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 |
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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. |