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Hormone Replacement Therapy Councelling
Hormone Replacement Therapy Councelling
Introduction
Introduce yourself and confirm the patient’s name, age (Patient Demographics)
Privacy: Insure patient’s Privacy
Permission: Gain consent with explaining what you are going to do.
First ask a few questions "First, I need to ask a few questions about you to check HRT is appropriate for you" ...
Age (menopause age is 45-55 years), GP, Preg.
SOCRATES
Discuss their symptoms (and their effect on quality of life)
o Vasomotor instability
Are there any associated night sweats, nausea, or palpitations?
Any difficulty falling and staying asleep?
Any history of Migraine or a particularly excessive headache?
o Urogenital atrophy:
Are you experiencing itching, vaginal dryness or painful sexual intercourse" dyspareunia?"
Any history of recurrent UTI?
Any history of vaginal bleeding or discharges, decreased libido?
Have you been passing urine more frequently? Any discomfort when passing urine.
Do you feel any leakage of urine when you cough or sneeze? (stress incontinence)
Do you worry that you cannot get to the bathroom in time? (urgency)
Mesntrual Hx:
o Confirm menopause if possible (since when was your last period?)
o PV (per vaginal) bleeding (Undiagnosed PV bleeding is a CI, = Contraindication)
Still having periods: ask COMPONENTS of Menst. Hx (see menstruation history in gyne
guide)
No longer having periods: last menstrual period, any post -menopausal/post -coital bleeding
Currently breastfeeding/pregnant (this is a CI)
Relevant past medical history and family history
o PE/stroke/MI/angina/ Venous thromboembolism (CI)
o Estrogen dependent cancer (if currentlyCI) (breast/ endometrial/other), (Hx of breast cancer is CI)
o Do they have a uterus (i.e. no previous hysterectomy)?
o Other Contraindications: current Uncontrolled HT or Acute liver disease
Past Meds./ Allergies
Lifestyle
Smoking cessation
Eat sensibly and try to avoid excessive weight gain
Regular physical activity
Stay in cold atmosphere and wear cotton clothes.
Ending
Summarize
Let patient think about it and plan follow up
Offer leaflets/website links