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For the treatment of menopausal symptoms, HRT should only be initiated for symptoms that adversely affect quality of life. In all cases, a careful appraisal of the risks and benefits should be undertaken at least annually and HRT should only be continued as long as the benefit outweighs the risk. Ovarian cancer is much rarer than breast cancer. Epidemiological evidence from a large meta-analysis suggests a slightly increased risk in women taking oestrogen-only or combined oestrogen-progestogen HRT, which becomes apparent within 5 years of use and diminishes over time after stopping. Some other studies, including the WHI, trial suggest that the use of combined HRTs may be associated with a similar or slightly smaller risk (see Section 4.8). The active ingredient, synthetic estradiol, is chemically and biologically identical to endogenous human estradiol. It substitutes for the loss of oestrogen production in menopausal women, and alleviates menopausal symptoms. Parkinson’s features such as trembling of hands, muscle stiffness, falls or difficulty with walking. If any of the following conditions are present, have occurred previously, and/or have been aggravated during pregnancy or previous hormone treatment, the patient should be closely supervised. It should be taken into account that these conditions may recur or be aggravated during treatment with Evorel, in particular:

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National Institute for Health and Care Excellence. (2018) Dementia: assessment, management and support for people living with dementia and their carers. Nice guideline 97. [online] Available at: https://www.nice.org.uk/guidance/ng97/chapter/Recommendations#diagnosis [Accessed 4 Jul. 2019]. Standard 1.2.13.

Ritonavir and nelfinavir, although known as strong inhibitors, by contrast exhibit inducing properties when used concomitantly with steroid hormones. Herbal preparations containing St. John's Wort (Hypericum perforatum) may raise the metabolism of oestrogens (and progestogens). Women with pre-existing hypertriglyceridaemia should be followed closely during oestrogen replacement or hormone replacement therapy, since rare cases of large increases of plasma triglycerides leading to pancreatitis have been reported with oestrogen therapy in this condition.

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The National Dementia Helpline provides information, advice, and support through listening, guidance and appropriate signposting to anyone affected by dementia. Age UK A doctor will only prescribe rivastigmine if the patient has a caregiver available who can regularly make sure that the patient is taking the medicine. Alzheimer’s Research UK. (2018). Prevalence by age in the UK. [online] Available at: https://www.dementiastatistics.org/statistics/prevalence-by-age-in-the-uk/ [Accessed 4 Jul. 2019]. In women with no personal history of VTE but with a first degree relative with a history of thrombosis at young age, screening may be offered after careful counselling regarding its limitations (only a proportion of thrombophilic defects are identified by screening). If a thrombophilic defect is identified which segregates with thrombosis in family members or if the defect is 'severe' (e.g. antithrombin, protein S, or protein C deficiencies or a combination of defects) HRT is contraindicated. Note re: Enduring Power of Attorney (EPA): the LPA has now replaced the EPA. However, a valid EPA that was executed before 1 October 2007 will continue to be valid, even if it has not yet been registered.Office of the Public Guardian. (2019). Make, register or end a lasting power of attorney. Government Digital Service. [online] Available at: https://www.gov.uk/power-of-attorney [Accessed 4 Jul. 2019]. When the analysis was restricted to women who had not used HRT prior to the study there was no increased risk apparent during the first 5 years of treatment: after 5 years the risk was higher than in non-users. Women on a cyclic or continuous sequential regimen wishing to switch from a sequential combined HRT preparation to Evorel may do so at the end of a cycle of the current therapy or after a 7 day hormone free interval.

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The FDA recently approved a skin patch version of the drug donepezil to treat mild to severe Alzheimer’s-related dementia. Alzheimer’s Research UK. (2018). Genes and dementia. [online] Available at: https://www.alzheimersresearchuk.org/about-dementia/helpful-information/genes-and-dementia/ [Accessed 4 Jul. 2019].This is called a Lasting Power of Attorney (LPA). 24A solicitorcan help you arrange an LPA. There are 2 types of LPA - one for the management of ‘Property This service was developed by the National Institute for Health Research (NIHR) in partnership with Alzheimer Scotland, Alzheimer’s Research UK and Alzheimer’s Society to match interested volunteers with researchers. My husband is still quite capable of looking after his own personal hygiene and does the patches himself. I don't get too stressed out about it probably because he hasn't had any problems. He can occasionally get a little redness where the patches have been so it's easy to see where he has been putting them. In some families, ‘early onset dementia’ is more common, so here there does seem to be a stronger genetic cause. Also, people with Down’s syndrome are more likely to develop dementia early. 17 If there has been more than one person in

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This type of dementia mainly occurs in younger people. It affects the front of the brain more than other areas. It often starts in people in their 50s and 60s. 11

Keep using rivastigmine patch as you have been told by your doctor or other health care provider, even if you feel well. It is important to try to treat and manage these risk factors, particularly high blood pressure and diabetes. It may also help, in the mid-life years, to manage any problems with hearing loss, obesity, social isolation and depression. 14 Therapy should be started with Evorel 50. The dose may be adjusted depending on efficacy and signs of over-oestrogenisation (e.g. breast tenderness). Note, however, that the efficacy of Evorel 25 for the prevention of post- menopausal osteoporosis has not been demonstrated. For maintenance therapy, the lowest effective dose should be used. A dose of 100micrograms of estradiol/24 hours should not be exceeded.