DETAIL HISTORY SHOULD BE OBTAINED ABOUT HER SYMPTOMS AND IMPACT ON QUALITY OF LIFE.DETAIL MEDICAL HX TO RULE OUT CONTRAINDICATIONS FOR HRT ,HX OF BREAST CA,OVARIAN CA ,FOCAL MIGRAINE PERSONAL HX OF VTE,AND TO ASSESS HER RISK OF VTE SUCH AS SICKLE CELL ANAEMIA, INFLAMMATORY BOWEL DISEASE,NEPHROTIC SYNDROME AND CARDIAC DISEASE.ALSO ENQUIRE ABOUT FAMILY HX OF VTE.DRUG HX TOBE CHECKED IF SHE IS ONANY DRUGS WHICH AFFECT THE LEVELS OF HER HORMONES IN HER BLOOD LIKE ENZYME INDUCERS. SOCIAL HX OF ALCOHOL SMOKING,DRUG ABUSE INCREASES RISK OF VTE.IN GYNE HX PREVIOUS HX OF CONTRACEPTION AND ANY PROBLEMS WITH CONTRACEPTION. EXAMN - HEIGHT WEIGHT ,BMI ,CVS ,BP ASSESMENT, ABDOMEN AND PELVIC EXAMN, TO ASSESS HER FITNESS FOR HRT AND TO R/O ANY CONTRAINDICATION. IF FOUND TO HAVE ANY CONTRAINDICATION ,OFFER ALTERNATIVES AS CLONIDINE , SSRI SNRI, PHYTOESTROGENS ETC.ANS (b)IN PATIENTS W UTERUS ENDOMETRIAL PROTECTION PROVIDE BY THE USE OF CYCLICAL PROGESTERONES FOR 7-10 DAYS PER CYCLE.LNG IUS IS AGOOD OPTION FOR THE SAME IN VIEW OF LESS SYSTEMIC SIDE EFFECTS.ALL PATIENTS SHOUL BE COUNSELLED ABOUT PROGESTOGENIC SIDE EFFECTS LIKE BLOATIG LEG CRAMPS FLUID RETENTION ETC.AND ALSO DISCUSS LIFE STYLE MODIFICATION BEFORE COMMENCING ON HRT.
