Managing other adverse effects of systemic MHT

Evidence to guide the management of other adverse effects of systemic MHT is limited. A suggested approach is given in Suggested approach to managing adverse effects of systemic menopausal hormone therapy.

Table 1. Suggested approach to managing adverse effects of systemic menopausal hormone therapy
Symptom	Action
breast tenderness	reduce estrogen or progestogen dose [NB1] change route or type of progestogen change to tibolone or conjugated estrogens+bazedoxifene
nausea	reduce estrogen dose change from oral to transdermal therapy consider other causes
progestogen intolerance [NB2]	observe for 3 months (spontaneous symptom resolution may occur) change the route or type of progestogen reduce progestogen dose [NB1] change to tibolone or conjugated estrogens+bazedoxifene
Note: MHT = menopausal hormone therapy NB1: When reducing the dose of progestogen in continuous combined MHT regimens, ensure the dose is adequate for endometrial protection. NB2: Abdominal bloating and flatus, irritability, depression, headaches and breast tenderness may indicate progestogen intolerance, but causation has not been proven and other causes may need to be considered (eg breast tenderness may reflect that the estrogen dose is too high).