Patient Care and Monitoring

1. Assess the patient for use of HT by evaluating for the presence of vasomotor symptoms. If the patient is experiencing bothersome vasomotor symptoms, consider the use of HT only after assessing for risk factors for heart disease and breast cancer. If vasomotor symptoms are tolerable and/or the patient has risk factors for heart disease and/or breast cancer, consider alternative, nonhormonal treatments for vasomotor symptoms.

2. Obtain a thorough medication history, including the use of over-the-counter and herbal products.

3. Educate the patient on lifestyle or behavioral interventions that may help to alleviate vasomotor symptoms.

4. Discuss methods of HT administration, and have the patient decide in conjunction with the health care provider which one she feels will work best for her.

5. Recommend the appropriate dose of HT, and use the lowest effective dose for the shortest duration possible.

6. Educate the patient regarding the proper administration, potential adverse effects, and expectations of HT.

7. Monitor the patient for a reduction in vasomotor symptoms, vaginal dryness, and improvement in sleep.

Also monitor for breakthrough bleeding and spotting, adverse effects of HT, and improvement in QOL.

8. Monitor the following objective parameters:

• Blood pressure at every outpatient visit

• Yearly lipoprotein panels

• Yearly fasting plasma glucose determinations

• Yearly breast examinations and mammograms

• Yearly TSH determinations, particularly for women with hypothyroidism on thyroid therapy

• Endometrial studies in women with undiagnosed vaginal bleeding

9. Educate the patient regarding the importance of adhering to the medication regimen.

10. Educate the patient regarding the importance of obtaining a yearly mammogram and Papanicolaou (Pap) smear (if applicable), as well as performing a monthly breast self-examination.

11. Assess patient symptoms every 6 to 12 months, and consider tapering the HT dose and discontinuing treatment after 1 year. If vasomotor symptoms return, determine if a longer tapering schedule is warranted or if long-term treatment is necessary.

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