When to refer
- SIDE EFFECTS
- POOR SYMPTOM CONTROL
- BLEEDING PROBLEMS
- COMPLEX MEDICAL HISTORY
- PAST HISTORY OF HORMONE DEPENDENT CANCER
- PATIENT REQUEST
Persistent side effects following logical therapy changes as per Side effect management.
Inadequate control despite logical changes in HRT as per Poor symptom control.
Sequential therapy - change in pattern of bleeding including increased duration, frequency and/or heaviness, and irregular bleeding.
Continuous combined therapy or tibolone - if still bleeding after 6 months of therapy or if bleeding occurs after a spell of amenorrhoea.
SERMS - any bleeding whilst on therapy should be treated as a post menopausal bleed.