Treatment
16
Figure 1. Approach to the Patient with VMS
Contemplating MHT
ASSESS PATIENT CRITERIA
• Symptomatic woman with
interest in MHT who is:
• Age <60 y or
• <10 y since menopause
YES
CONSIDER CIRCUMSTANCES WHERE
MHT SHOULD NOT BE USED (Table 9)
Avoid if:
• Unexplained vaginal bleeding
• Stroke, TIA, MI, PE, VTE
• Breast or endometrial cancer
• Active liver disease
Exercise caution in women with:
• Diabetes
• Hypertriglyceridemia
• Active gallbladder disease
• Increased risk of breast cancer or CVD
• Migraine with aura
CONSIDER
OTHER
OPTIONS
ABSENT
EVALUATE CARDIOVASCULAR RISK
ACCEPTABLE
EVALUATE BREAST CANCER RISK
ACCEPTABLE
UTERUS PRESENT?
If age >60 or
>10 y since
menopause
PRESENT
HIGH
HIGH to
MODERATE
• Estrogen plus
progestogen
• Estrogen plus
bazedoxifene
• Tibolone
(where available)
• Estrogen alone
NO
YES
