General health / risk assessment

  • cervical smear

  • ?PV

  • breast exam

  • CVRA

Symptomatic

HRT contraindicated

  • Hot flushes

    • venlafaxine 37.5mg-75mg/ od

    • paroxetine

    • clonidine 50-100mcg/day

    • Gabapentin 300-900mg/day

HRT

  • lowest dose

  • trial off every 1-2 years to assess need

  • short term where possible

  • QoL issues considered in HRT

  • CI

    • hormone sensitive tumpours

Asymptomatic

  • Asses sBMD

  • Osteoporosis

    • T score \< -2.5

    • exclude other causes

    • Calcium

    • weight bearing

    • vit D

    • bisphosphonate

  • osteopenia

  • NOrmal