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MHT - Coggle Diagram

- - - - Brain fog
      - Mood disorder
    - - Bloating
      - cramps
      - Incontinence
  - - - MHT can also prevent bone loss and should be started soon after menopause for maximum benefit. Some studies have shown that MHT can increase bone density by around five per cent in two years. On average, MHT reduces the risk of spinal and hip fractures by 40%.
      - Treatment - Tibolone he LIFT study showed that women using tibolone 1.25mg (standard dose 2.5mg) reduced the risk of both vertebral and non-vertebral fracture compared to placebo (9)
    - - Risk reduction shown at 10 year mortality but not primary prevention recommended. No harm (Cochrane)
- - - - Weight loss reduces hot flushes
    - - Hypnotherapy
  - - - Oestrogen
        
        PV
        
        Oestrogen
        
        PrasteroNE (dhea) oestrogen and androgenic
        
        Patch
        
        Dot
        
        Oral
      - Progesterone/ Progestogen or Dyhydrogesterone
        
        Oral
        
        IUD
      - Bleeding post HRT
        
        Settle a few cycles
        
        Adjust
        
        6 months ix
      - Non hormonal treatment
        
        SSRI/ SNRI
        
        No fluoxetine or paroxetine on tamoxifen- metabolim
        
        Gabapentin
        
        Clonidine- no due to side effects
        
        NK3 Antag fezolinetant - hot flushes
        
        Oxybutynin- hot flushes
        
        Stellate ganglion block
    - - Oestrogen only
    - - Modest effect on libido only
      - Bloods required prior and during