Discontinue use if VTE develops after initiating therapy; jaundice or deterioration in liver function, significant increase in BP & new onset of migraine-type headache occurs. Temporarily discontinue HRT for 4-6 wk earlier if prolonged immobilization is to follow elective surgery. Not recommended to add progestogen. Not to prescribed oestrogen replacement therapy for >1 yr w/o another physical, including gynaecological exam. Leiomyoma (uterine fibroids) or endometriosis; HTN; DM w/ or w/o vascular involvement; migraine or severe headache; SLE; epilepsy; asthma; otosclerosis; cardiac or renal dysfunction. Risk factors for thromboembolic disorders; oestrogen-dependent tumours, eg, 1st degree heredity for breast cancer. May cause minor local trauma in women w/ serious vag atrophy. Women w/ intact uterus w/ abnormal bleeding of unknown aetiology or who have previously been treated w/ unopposed oestrogens; pre-existing hypertriglyceridaemia; who undergone hysterectomy; on chronic anticoagulant treatment. Increased risk of VTE & HRT in patients w/ known thrombophilic; ischaemic stroke w/ systemic oestrogen-only therapy; probable dementia in women who start using continuous combined or oestrogen-only HRT after 65 yr. Increased circulating total thyroid, T4 or T3 levels; corticosteroids & sex steroids. Increased plasma proteins eg, angiotensinogen/renin substrate, α-1-antitrypsin, ceruloplasmin. Perform screening in women w/o personal history of VTE but w/ 1st degree relative w/ history of thrombosis at young age. Woman should consult a doctor if bleeding or spotting occurs during therapy. Liver disorders; cholelithiasis. Not indicated during pregnancy & lactation.
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