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Ask an Expert: Q&A

Ask An Expert: Q&A | For health professionals 15 Nov 2021
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'Ask an Expert: Q&A' is a place for health professionals to ask our team of experts about cases seen in work and/or clinical practice.

Questions can cover a wide range of women’s health topics and will be answered by an expert in the multidisciplinary Jean Hailes health professional team. Read more about this series or learn how to ask a question here.

If you are not a health professional but have your own health question, visit our 'Ask Dr Jean' pages.

Answering your questions for this edition of 'Ask an Expert: Q&A' is Dr Sonia Davison, Jean Hailes endocrinologist and president of the Australasian Menopause Society.

Question 1

Is it safe to continue with Tibolone 2.5mg daily in a 70 year-old? She has been on it since the age of 45 and had reduced to 1 tablet every second day but is having terrible hot flushes since stopping it 3 months ago. I cannot find an alternative explanation for her hot flushes. Would there be a safer/better alternative than Tibolone?

Jean Hailes endocrinologist Dr Sonia Davison

Answer

From Jean Hailes endocrinologist Dr Sonia Davison

This information page on Tibolone on the Australasian Menopause Society website goes through the benefits and risks of Tibolone in detail.

There is a slightly higher risk of stroke from the 60s, and an increased risk of breast cancer that increases with duration of use. My preference would be to try a non-hormonal treatment for controlling the flushes (see this information page), and trying to avoid a return to hormone therapy if possible.

Question 1

51 year-old female using progesterone-only pill (POP) for contraception; amenorrhea on this for last 3 years; wishing to start menopausal hormone therapy (MHT) for vasomotor symptoms. As on POP, I cannot confirm if amenorrhea secondary to pill or now postmenopausal, hence difficult to advise on stopping contraception.

Would it be best to use continuous MHT, oestrogen patch + micronised progesterone PLUS continue the POP for contraception, as I understand POP not approved for endometrial protection. Or is the combined progesterone use not advisable? Patient does not wish to have IUD.

Answer

From Jean Hailes endocrinologist Dr Sonia Davison

Please also refer to the answer and resources for Q2 on the October edition of Ask an Expert: Q&A.

The probability of pregnancy is very slim but not zero. She still has the options of barrier contraception, vasectomy and tubal ligation if she doesn’t want to pursue a levonorgestrel IUD for contraception, whilst on combined MHT (of any type). My preference would be to combine any form of oestradiol with the levonorgestrel IUD in this situation; the risk of bleeding is minimised, contraception is provided, and the ‘set and forget’ convenience of the IUD means that there will be less worry for all concerned.

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