11
Table 6. Clinical Caveats During Treatment With MHT
Symptom/Condition
When MHT Started Approach to Resolution
Persistent, intolerable
VMS
Switch mode of administration or adjust dose of estrogen
and/or progestogen.
Hot flashes that persist
aer treatment adjustment
Consider another etiolog y of flashes (Table 2).
Ensure absorption: if transdermal, consider serum estradiol
determination.
Bleeding : approach
depends on time since
menopause, MHT
regimen, duration of
therapy, duration and
character of bleeding
Sequential regimen may be more appropriate for recently
menopausal (<2 y), because unscheduled bleeding with
continuous combined MHT can be problematic.
Persistent irregular bleeding (>6 mo) should be evaluated
for endometrial patholog y. If obese, diabetic, or having
family history for endometrial cancer, evaluate sooner.
Atrophic endometrium in women more remote from
menopause may respond to increased estrogen dose if
otherwise appropriate.
Breast tenderness Usually responds to a reduction in estrogen dose or change
in progestogen preparation.
CEE/BZA may improve symptoms.
Changing to tibolone may be helpful in women who
develop mastalgia on conventional MHT.
Baseline TG level
>200 mg/dL
Review family history and seek contributing factors.
Transdermal ET is preferred.
If oral estrogen is selected, monitor serum triglycerides (TG)
levels 2 wk aer starting therapy.
Hypothyroid on thyroid
replacement
Monitor thyroid stimulating hormone (TSH) 6–12 wk aer
starting oral MHT. yroxine (T4) dose may need to be
increased.
