Menopause and Perimenopausal Syndrome
Referral ICD-10 code: N95.0-3/N95.8-9 For primary management with hormone therapy (HT), refer to the PHC STGs and EML, Hormone therapy (HT) . If HT is contra-indicated, poorly tolerated or ineffective: Fluoxetine, oral Initiate at 20 mg on alternate days. If there is no response after 12 weeks, increase the dose to 20 mg daily. LoE:IIIb xxxix If on tamoxifen: Citalopram, oral, 10 mg d
ICD-10 code: N95.0-3/N95.8-9
For primary management with hormone therapy (HT), refer to the PHC STGs and EML, Hormone therapy (HT).
If HT is contra-indicated, poorly tolerated or ineffective:
- Fluoxetine, oral
- Initiate at 20 mg on alternate days.
- If there is no response after 12 weeks, increase the dose to 20 mg daily.
If on tamoxifen:
- Citalopram, oral, 10 mg daily.
- If there is no response after 12 weeks, increase the dose to 20 mg daily.
Note:
Start at the lowest possible dose to alleviate symptoms. The need to continue therapy should be reviewed annually.
REFERRAL
- Premature menopause, i.e. < 40 years of age.
- Severe osteoporosis.
- Post-menopausal bleeding.
- Hormone-dependent cancers, thrombo-embolism, liver disease; and unacceptable side-effects to hormone replacement therapy e.g. exacerbation of depression, enlargement of uterine fibroids, exacerbation of endometrioses (see Endometriosis).
Standard Treatment Guidelines and Essential Medicines List for South Africa Adult Hospital _Chapter 5: Gynaecology; Version 1.0, 2020-4_June 2024