When should I refer a patient for specialist assessment regarding HRT management?

Refer a patient for specialist assessment regarding hormone replacement therapy (HRT) management if they have ongoing symptoms and lifestyle measures, hormonal, non-hormonal, or non-drug treatments are ineffective ¹.

Refer if the patient has persistent, troublesome adverse effects from treatment ¹.

Refer if there is uncertainty about the most suitable treatment option, for example if the woman has co-morbidities and/or contraindications to treatment ¹.

Refer if there is a sudden change in menstrual pattern, intermenstrual bleeding, postcoital bleeding, or postmenopausal bleeding, to assess appropriately and arrange an urgent 2-week referral if a gynaecological cancer is suspected ¹.

Refer women with premature ovarian insufficiency or if there is doubt about the diagnosis, to a specialist with expertise in menopause or reproductive medicine ².

Refer women with menopause-associated symptoms and a personal history, or high risk, of breast cancer for specialist advice ².

Refer women with menopause due to medical or surgical treatment to discuss menopause and fertility with a healthcare professional with expertise in menopause ².