Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
During a hormone replacement therapy (HRT) review, essential questions to ensure appropriate management and monitoring include:
- Symptom assessment: Ask about the persistence, severity, frequency, and any changes in menopausal symptoms such as hot flushes, night sweats, mood changes, sleep disturbances, and genitourinary symptoms. Evaluate the impact of symptoms on quality of life to determine HRT efficacy and tolerability.
- Side effects and adverse events: Inquire about any new or ongoing side effects, including vaginal bleeding. Confirm whether vaginal bleeding has occurred beyond the initial 3 months of treatment and advise prompt medical evaluation if so.
- Medication adherence and dosage: Check if the patient is taking the lowest effective dose as prescribed and whether adjustments are needed.
- Screening and risk factors: Confirm up-to-date participation in nationally recommended health screening programs such as breast, cervical, and bowel screening to monitor overall health during HRT.
- Medical history updates: Review any new diagnoses or changes in health status that might affect HRT safety, including cardiovascular disease, hypertension, thromboembolism, hormone-sensitive cancers, and bone health concerns.
- Contraception and fertility status: Assess current contraception use and discuss ongoing fertility considerations if relevant.
- Psychosocial aspects: Explore mental health symptoms, such as depressive symptoms or sleep problems related to menopause.
- Patient preferences and treatment goals: Reassess their goals regarding HRT and willingness or plans to continue, reduce, or stop therapy, including discussion of gradual dose reduction versus immediate cessation.
- Referral considerations: Identify if specialist referral is appropriate, especially if symptoms are not adequately controlled or side effects occur.
A review is recommended at 3 months after starting HRT and then annually unless earlier review is clinically indicated (e.g., side effects or ineffectiveness) NICE NG23.