Before starting or re-appointing HRT, you must collect a complete personal and family history, and conduct a thorough general and gynecological examination to identify possible contraindications and observe the necessary precautions when taking the drug. During the treatment it is also recommended to conduct additional examinations. The frequency of examinations and the methods used are determined for each individual patient individually. Breast examination and / or mammography are conducted in accordance with accepted standards.
The use of estrogens can affect the results of the following laboratory tests: determination of glucose tolerance, examination of the functions of the thyroid and liver.
For women receiving HRT, it is necessary to periodically carefully assess the relationship between risk and benefit from such treatment.
Particular care must be taken to weigh the benefits of treatment and the possible risk from it, if present, have ever occurred before and / or occurred during pregnancy or previous courses of hormone therapy states described in "With caution."
Patients with heart failure and impaired renal function should be under special control; Estrogens can cause fluid retention. Patients in the terminal stage of kidney disease need special attention, since an increase in the levels of active substances in the blood should be expected.
Some patients receiving estrogen / progestogen therapy may experience changes in glucose tolerance. Patients with diabetes should closely monitor blood glucose levels in the first months of HRT.
Data from epidemiological studies suggest that substitution hormone therapy is associated with a relatively high risk of developing deep vein thrombosis in the lower limbs or thromboembolism of pulmonary vessels.Risk factors for the development of thromboembolic diseases are: their presence in a personal and family anamnesis, pronounced obesity (body mass index> 30 kg / m2) and systemic lupus erythematosus. There is no consensus on the possible role of varicose veins.
The appointment of HRT to patients with recurrent or with established deep vein thrombosis in the lower extremities in history, receiving anticoagulant therapy, requires a careful assessment of the relationship of risk and benefit from HRT. To exclude a predisposition to thrombosis, a history of recurrent thrombosis or recurrent spontaneous abortions should be carefully studied. Prior to the formulation of the above diagnosis or the initiation of anticoagulant therapy, the appointment of HRT should be considered contraindicated.
The risk of developing deep vein thrombosis in the lower extremities may temporarily increase with prolonged immobilization, extensive injuries or extensive surgical operations. In all postoperative patients, increased attention should be paid to preventive measures aimed at preventing thromboembolic complications after surgical interventions.In cases where prolonged immobilization is necessary after surgical operations, in particular after abdominal surgery and orthopedic operations on the lower limbs, consideration should be given to the temporary discontinuation of HRT 4 to 6 weeks before surgery. The decision to resume HRT is taken individually for each specific case.
If thrombosis develops after the onset of HRT, the individual should be discarded. Patients should be instructed about the need to seek immediate medical attention if the following symptoms occur: pain and swelling of the lower extremities, sudden pain in the chest, indigestion. The data of epidemiological studies show a slight increase in the likelihood of developing breast cancer in women who received or are currently receiving HRT. The detection of breast cancer may be associated with early diagnosis, the biological effects of HRT, or a combination of both. The likelihood of diagnosing breast cancer increases with the duration of treatment and returns to normal five years after discontinuation of HRT.
In postmenopausal women receiving estrogen, the risk of cholelithiasis increases.
Also, when taking HRT, the risk of developing systemic lupus erythematosus increases. The use of estrogens can affect the results of certain laboratory indicators (activity of hepatic transaminases ALT and ACT, alkaline phosphatase, gamma-glutamyltransferase).
Breakthrough uterine bleeding and unexpressed menstrual bleeding can occur during the first months of treatment. If, despite the adjustment of the dose, such bleeding does not stop, the drug should be discontinued until the cause of bleeding is established. If bleeding recurs after a period of amenorrhea or continues after withdrawal of treatment, its etiology should be established. This may require an endometrial biopsy.
The experience of treating women over 65 is limited.