ENDOCRINE - SEX HORMONE RESPONSIVE CONDITIONS

Question 1

What is HRT?

Answer 1

• hormone replacement therapy

- replaces oestrogen with or without progesterone to relieve symptoms of menopause associated with low hormone levels

Question 2

What are some examples of natural oestrogens?

Answer 2

• estrone
• estradiol
• estriol

Question 3

What are some examples of synthetic oestrogens?

Answer 3

• ethinylestradiol

- mestranol

Question 4

What is the choice of HRT for women without a uterus?

Answer 4

• Oestrogen HRT - oestrogen alone continuously

Question 5

What is the choice of HRT for women with a uterus?

Answer 5

• Combined HRT
• Oestrogen and progesterone cyclically
• continuously to avoid withdrawal bleeding

Question 6

Who is continuous combined HRT unsuitable in?

Answer 6

• pre-menopause or <12 months after last period = irregular bleeding
• rule out endometrial cancer if irregular bleeding continues after stopping continuous combined HRT

Question 7

Before ELECTIVE surgery, when would you stop HRT?

Answer 7

• 4 to 6 weeks before due to risk of VTE

Question 8

If you are under 50 and require HRT how long after your period are you still fertile for?

Answer 8

2 years after last period

Use low-oestrogen COC

Question 9

If you are over 50, how long after your last period are you fertile for?

Answer 9

1 year after last period

Use barrier method only

Question 10

What are the side effects of using HRT?

Answer 10

• Cancers - ovarian, breast, cervical, endometrial (Add progesterone)
• CHD

Question 11

What would be reasons to stop HRT?

Answer 11

• VTE - sudden severe chest pain, sudden breathlessness or cough with blood stained sputum (PE) Unexplained swelling or severe pain in calf of one leg (DVT)
• Stroke - serious neurological effects
• Liver dysfunction
• Blood pressure - above systolic 160 or diastolic 95

Question 12

What are the risk factors that contraindicate HRT?

Answer 12

• prolonged immobility
• thrombophlebitis
• angina/MI
• VTE
• thromophilic disorder
• liver disease
• untreated endometrial hyyperplasia
• undiagnosed vaginal bleeding
• oestrogen-dependent cancer
• history of breast cancer

Question 13

What can be used for vaginal atrophy (dryness)?

Answer 13

• Topical oestrogens - creams, tablets, rings

Question 14

What can be used for vasomotor symptoms (hot flushes, night sweats)?

Answer 14

• systemic oestrogens - tabs or patches
• apply batch below waistline away from waistband or breast
• if contraindicated - give clonidine

Question 15

What do anti-oestrogens such as clomifene (ovulation stimulant) used for?

Answer 15

• infertility in women
• secondary amenorrhoea eg. PCOS
• use for 6 cycles only - increased risk of ovarian cancer