Referral indications in menopause

Consider referral for specialist advice if the patient has:

• factors that make the benefit-harm balance of menopausal hormone therapy (MHT) difficult to assess, such as:
  • complex medical conditions
  • age 60 years or older
  • increased risk of venous thromboembolism
  • high risk of familial breast cancer
  • endometriosis
• premature ovarian insufficiency or early menopause
• persistent symptoms despite systemic or intravaginal estrogen therapy
• persistent adverse effects of MHT.