When to refer

1. SIDE EFFECTS

Persistent side effects following logical therapy changes as per Side effect management.

2. POOR SYMPTOM CONTROL

Inadequate control despite logical changes in HRT as per Poor symptom control.

3. BLEEDING PROBLEMS

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.

4. COMPLEX MEDICAL HISTORY
5. PAST HISTORY OF HORMONE DEPENDENT CANCER
6. PATIENT REQUEST