Women who are starting HRT for the first time some years after their menopause (whether it occurs naturally or as a result of medical treatment) should always be prescribed natural forms of oestrogen, and the dose should be low initially and increased slowly if necessary. Start low and go slow is a wise motto for any hormone therapy. Examples of widely used natural and synthetic oestrogens, and the typical dosage range, are listed on page 175.
Lydia was sixty-two when she went onto HRT with a view to halting a worrying deterioration in bone density. This had been diagnosed by comparing the results of bone density scans performed when she was fifty-nine and then three years later. She was prescribed a dose of oestrogen usually given to women immediately after the menopause and developed sore breasts, excessive nipple sensitivity and nausea. Her doctor should have started her on a lower dose and slowly increased it over a period of three to six months. When Lydia was prescribed a natural oestrogen at a low dose, she experienced no worrying side effects, and for her this was a sufficient dose to stabilise bone density.
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