Treat vag infections before starting therapy. HRT should only be initiated for postmenopausal symptoms that adversely affect quality of life. Careful appraisal of risks & benefits should be undertaken at least annually. Limited evidence regarding risks associated w/ HRT in the treatment of premature menopause. Before initiating or reinstituting HRT, a complete personal & family medical history should be taken. During treatment, periodic check-ups are recommended of a frequency & nature adapted to the individual woman. Caution in patients w/ leiomyoma (uterine fibroids) or endometriosis; risk factors for thromboembolic disorders; risk factors for oestrogen-dependent tumours (eg, 1st degree heredity for breast cancer); HTN; liver disorders (eg, liver adenoma); DM w/ or w/o vascular involvement; cholelithiasis; migraine or (severe) headache; SLE; history of endometrial hyperplasia; epilepsy; asthma; otosclerosis. Immediate treatment discontinuation in case of jaundice or deterioration in liver function; significant increase in BP; new onset of migraine-type headache; pregnancy. Risk of endometrial hyperplasia & carcinoma; breast cancer; ovarian cancer; ischaemic stroke. Associated w/ risk of developing VTE, more likely in the 1st yr of HRT. Temporarily stopping HRT 4-6 wk earlier is recommended if prolonged immobilisation is to follow elective surgery. May cause fluid retention. Closely monitor women w/ pre-existing hypertriglyceridaemia during HRT. Increased thyroid-binding globulin, other binding proteins (ie, corticoid-binding globulin, sex-hormone-binding globulin), & other plasma proteins (angiotensin/renin substrate, α-1-antitrypsin & ceruloplasmin). HRT use does not improve cognitive function. Intravaginal applicators may cause minor local trauma, especially in women w/ serious vag atrophy. Not indicated during pregnancy & lactation. Women >65 yr.
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