How should I monitor a patient on HRT for potential side effects and complications?

Monitoring a patient on hormone replacement therapy (HRT) for potential side effects and complications involves:

• Arranging a review 3 months after starting or changing HRT to assess efficacy, tolerability, and any adverse effects, then at least annually thereafter unless earlier review is clinically indicated (e.g., treatment ineffectiveness or side effects) ¹.
• At each review, reinforce information and lifestyle advice, assess symptom control, and check for bothersome adverse effects or persistent symptoms ¹.
• If adverse effects or symptoms persist, consider adjusting the HRT dose, type of progestogen, or route of administration (e.g., switching from oral to transdermal), or switching to combined oestrogen/bazedoxifene acetate if progestogen is unsuitable ¹.
• Monitor for any abnormal bleeding patterns such as sudden changes in menstrual pattern, intermenstrual bleeding, postcoital bleeding, or postmenopausal bleeding, and arrange urgent referral if gynaecological cancer is suspected ¹.
• Review the duration of HRT treatment regularly, supporting the patient to make an informed decision on when and how to stop HRT, noting that treatment duration is individualized and may be longer than 2–5 years if benefits outweigh risks ¹.
• Ensure patients with hypothyroidism have serum thyroid-stimulating hormone (TSH) monitored after starting HRT, as HRT can affect thyroid hormone levels ¹.
• Manage cardiovascular risk factors and consider using transdermal rather than oral HRT in women at increased cardiovascular risk ¹.
• Encourage patients to keep up to date with nationally recommended health screening during HRT treatment ².
• Refer patients to a healthcare professional with expertise in menopause if symptoms persist despite treatment, if there are ongoing side effects, or if there is uncertainty about the most suitable treatment option ².