Management of poor symptom control

• Check compliance
• Allow 3 to 6 months on therapy to ensure full effect
• Inadequate estrogen dosage - increase dose or change from oral to non-oral route
• Poor absorption due to bowel disorder - change to non-oral route
• Drug interactions eg. barbiturates, phenytoin, carbamazepine - increase oral dose or change to non-oral route
• Poor patch adhesion - change delivery system
• Incorrect diagnosis - review indications
• Unrealistic expectations - counsel