OGCO-E10 Protocol for follow up of patients on hormonal replacement therapy

Question 1

What is the follow up for HRT and what needs to be asssessed?

Answer 1

FU visit 2-4 months after initiation of HRT and subsequent visits made every 6 months-1 year for repeat prescriptions and monitoring.

Assessment includes patients acceptance, compliance, symptom control and side effects, and the bleeding pattern of those on combined regimens

Question 2

What are the indications for prescribing HRT as a special drug from the hospital pharmacy?

Answer 2

• Premature ovarian insufficiency
• Symptomatic menopausal patient
• Menopausal patient with established osteoporosis
• Hypopituitarism and other endocrine disease.

Pharmacy has
* premarin 0.3mg/0.625mg
* Estrofem 2mg
* Kliogest
* Activelle
* Provera/Duphaston (dyhydrogesterone)
* Femoston 2/10 (estradiol +dydrogesterone)

Question 3

Use of local vaginal estrogen for treating atrophic symptoms

Answer 3

• Conjugated equine estrogen (premarin) cream can be absorbed from the vagina and cause endometrial stimulatio nwith prolonged use. Therefore, if long term use is indicated, progestogen should be added for endometrial aspiration
• Alternatively, an estradiol vaginal tablet (Vagifem) can be option if prolonged use is indicated. It has low systemic absorption and hormone levels remain within post menopausal range. Regime: vagifem 25mg (1 tablet) daily for 2 weeks then 2 times per week