Poor symptom control

PARTIAL SYMPTOM IMPROVEMENT

• If symptoms have improved but are not fully controlled, consider increasing the oestrogen dose.
• Doses should not be increased too quickly and time given to allow the HRT to work (for example, 3 months).
• Response to treatment with HRT should be based on symptom control and estradiol blood tests should not be routinely undertaken because they are prone to error.
• Most women will respond to licensed HRT doses.

NO SYMPTOM IMPROVEMENT

• Where there has been no symptom improvement, this might suggest poor absorption, consider trying an alternative preparation.

Other reasons for partial or no symptom improvement might include:

1. Poor patch adhesion. Transdermal patches are more likely to detach in hot and wet climates. Patches may be less suitable for women living in tropical regions.
2. The release rate of some patches may be affected by temperature. Patches should not be applied in a location where they would be exposed to direct sunlight.
3. Drug interactions (particularly liver enzyme inducers).
4. An alternative underlying cause being the reason for symptoms (consideration should be made for other tests).
5. Unrealistic patient expectations. It is important to make women aware that some symptoms, such as low mood and anxiety, may have other causes and may require other additional treatments.