Contraception + HRT Flashcards
(20 cards)
What are contraindications of the COC?
Current past history of VTE, stroke, or heart disease
Active liver disease
Breast feeding
Surgery
Family history of VTE
Obesity (avoid if >35)
Long term immobilisation
Smoking
>35 years (avoid in over 50)
DM (avoid if any complications)
Hypertension
Migraine without aura (avoid with aura)
What are the steps involved when taking COCs and surgery?
Surgery increases VTE
Stop COC’s 4 weeks before major surgery, surgery to legs or which involves prolongued immobilisation
Restart at first menuses at least 2 weeks after full mobilisation
Depot progesterone only injection as alternative
Doesnt apply to minor surgery
If emergency surgery, use compression hosiery and thromboprophylaxis (heparin)
What are the advantages of the POP?
Reliable and reversible without the oestrogen
Can be used while breast feeding
Can be used by women with cautions with the oestrogen e.g older women, heavy smokers, dm, migraine, major surgery
What is post menopause?
Time after the menopause
Occurs after 12 months of spontaneous amenorrhoea
Difficult to recognise in women who have started HRT
When would oestrogen with progesterone be given as a HRT and why?
Women with an intact uterus
To stop over stimulation of the endometrium by unopposed oestrogen, as oestrogen can increase risk of endometrial cancer
When would oestrogen only be given as a HRT and why?
Women without a uterus e.g who’s had a hysterectomy
If the uterus has been removed there is no endometrium to stimulate
When is a woman considered potentially fertile while around the menopause age?
For 2 years after last period if under 50
For 1 year after the last period if over 50
What should be given to women under 50 if they are also experiencing menopausal symptoms and potentially fertile?
Low dose COC
What should be given to women over 50 if they are experiencing menopausal symptoms and potentially fertile?
Non-hormonal contraceptives and HRT
How much progesterone is needed in HRT and give examples:
Is needed for a minimum of 10 days per 28 day cycle
Usually use less androgenic (synthetic) e.g dydrogesterone, medroxyprogesterone acetate
Rather than more androgenic such as norethisterone, levonorgestrel
When would the transdermal HRT be used first line?
There is a lower rate of VTE
So first line if increased risk of VTE, BMI is larger than 30, previous/ family history of VTE
Describe VTE as a side effect of HRT:
VTE increases in both types of HRT especially in the first year
Risk of VTE greater in oral vs transdermal
Describe breast cancer as a side effect of HRT:
All systemic HRT increases risk after 1 year
Combined HRT particularly continuous increases risk rather than oestrogen only
No increased risk for vaginal oestrogen
Risk decreases after stopping but excess risk remains for over 10 years compared to those who have never used HRT
Describe endometrial cancer as a side effect of HRT:
Associated with oestrogen only HRT if used in women with a uterus
Risk eliminated if progesterone used continuously
Describe ovarian cancer as a side effect of HRT:
Small increased risk in both types of HRT
Excess risk disappears after stopping for a few years
Describe stroke as a side effect of HRT:
Risk of stroke increases with age regardless of HRT or not
Both HRTs slightly increase risk
Describe Coronary Heart Disease as a side effect of HRT:
Not conclusive
Before menopause, CHD increased in men
After menopause, CHD similar in both men and women
Oestrogen possibly no difference or reduced risk
O+P possible little or no increased risk
Describe CVD as a side effect of HRT:
HRT doesn’t increase risk of CVD if started in women under 60
Describe Tibilone as a second line treatment for menopausal symptoms:
2.5mg OD
Gonadomimetic- stimulates oestrogen receptors
Synthetic steroid derivative of norethisterone
Mixed oestrogenic and progestrogenic and androgenic activity
Licensed for short term treatment of symptoms and osteoporosis is prophylaxis
Describe Clonidine as a second line treatment for menopausal symptoms:
50mcg BD
Increased if required to 75mcg BD after 2 weeks
For vasomotor symptoms especially if hot flushes
Centrally acting a-adrenergic agonist, possible reduces noradrenergic activity of BVs
