advice to prescribers

Last reviewed 01/2018

• benefits of short-term HRT and/or tibolone for treating menopausal symptoms are considered to outweigh the risks in the majority of women
• good practice to use the lowest effective dose for the shortest possible time and to review the need to continue treatment at least annually
• for women without a uterus, oestrogen-only therapy is appropriate
• in women with an intact uterus, the risks of endometrial cancer and breast cancer for each woman should be carefully assessed, taking into account her individual risk factors and bearing in mind the frequency and characteristics of both cancers, in terms of their response to treatment, morbidity and mortality
• tibolone (and continuous combined HRT preparations) should only be used in women who have not had a natural menstrual bleed for at least 1 year
• tibolone, like all HRT, is contraindicated in women with undiagnosed vaginal bleeding except breakthrough bleeding occurring during the first 6 months of treatment. All unexplained bleeding should be investigated, including bleeding after treatment has stopped, to exclude endometrial malignancy
• the increased risk of endometrial cancer associated with increased BMI is greater than the increased risk due to HRT and/or tibolone

Reference:

1. Current Problems in pharmacovigilance 2006;31:1-12.