A 41 year old married woman without children had attained premature menopause 3 years back.
She is on Estradiol valerate 1 mg daily for 28 days and medroxyprogesterone acetate 2.5 mg (1/4 tablet of 10mg medroxyprogesterone acetate) daily for last 10 days of the cycle.
Now she complains of tiredeness and occasional hot flashes. She has to face multiple family problems, which she is not able to cope with because she is tired.
She gets periods with 1mg dose of estradiol valerate.
1. She has been given an increased dose of estradiol to 2mg. She has been asked to get a TVS done to get to know her endometrial thickness. How much should be the endometrial thickness in a woman on HRT?
2. It is progesterone which is supposed to make the patient tired. In this case only minimum dose of progesterone, 2.5mg medroxy progesterone is being tried. The patient has been asked to get her thyroid levels, and lipid profile and haematological profile to rule out other causes.
Is there an indication to put her on micronized progesterone or duphastone, which are less androgenic?

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