Hormone replacement therapy Flashcards
(34 cards)
When is contraception needed during menopause?
12 months after last period in women >50
24 months after last period in women <50
Who does NICE say you can diagnose menopause clinically without performing investigations in?
Women >45 with typical symptoms
Who does NICE say need FSH blood test to diagnosis menopause in?
(Provided they are not taking hormonal contraception)
- women <40 with suspected premature menopause
- women >45 years with atypical symptoms
- women 40-45 with menopausal symptoms
What age is premature menopause?
What is the cause?
<40
Premature ovarian insufficiency
What is perimenopause?
What age
- The time leading up to last menstrual period + 12 months after
- where women experience vasomotor symptoms + irregular periods
- Typically in women >45
Vasomotor symptoms of perimenopause
Hot flushes
Night sweats
Insomnia
Headaches
Perimenopause symptoms
- hot flushes
- night sweats
- irregular periods
- emotional liability
- vaginal dryness
- urinary frequency
- reduced libdio
- joint pain
Lifestyle management of menopause
- hot flushes: regular exercise, weight loss, reduce stress, loose fitting thin clothing
- sleep disturbance: avoid late evening exercise + maintain good sleep hygiene
- mood: sleep, regular exercise, relaxation
- cognitive symptoms: regular exercise, good sleep hygiene
Non HRT management of menopause
- lifestyle changes: weight loss, smoking cessation, exercise, improve diet, reduced alcohol/stress/caffeine
- vasomotor symptoms: *fluoxetine, citalopram, clonidine
- vaginal dryness: vaginal lubricants
- psychological symptoms: self help groups, CBT, SSRIs
- lack of libido: testosterone cream
- vaginal atrophy: oestrogen creams of tablets
What is clonidine?
How is it used in HRT?
- Agonists of alpha 2 adrenergic receptors + imidazole receptors in the brain
- lower BP + reduced HR
- can he helpful for vasomotor symptoms + hot flushes
Why is combined HRT given?
When can oestrogen be used alone?
- To reduce the risk of endometrial cancer
- if a women does not have a uterus, oestrogen can be used alone
Indications of hormone replacement therapy
- replacing hormones in premature ovarian insufficiency +/- symptoms
- reducing vasomotor symptoms
- improving symptoms such as low mood, reduced libido, poor sleep
- reducing osteoporosis in women <60
Benefits of hormone replacement therapy
- Improved vasomotor + other symptoms of menopause
- Improve quality of life
- reduced risk of osteoporosis + fractures
Risk of HRT
- increased risk of breast cancer (especially combined HRT)
- increased risk of endometrial cancer (unopposed oestrogen in women with a uterus)
- increased risk of VTE
- increased risk of stroke + coronary artery disease
What type of HRT increases risk of breast cancer?
The addition of progesterone
What type of HRT increases risk of endometrial cancer?
Unopposed oestrogen
Must be given in combination to women with a womb
What type of HRT is preferred in women at risk of VTE?
Transdermal HRT
Side effects of HRT
Nausea
Breast tenderness
Fluid retention + weight gain
Contraindications of hormone replacement therapy
- current or past breast cancer
- any oestrogen sensitive cancer
- unexplained vaginal bleeding
- untreated endometrial hyperplasia or cancer
- uncontrolled hypertension
- pregnancy
- active angina or MI
What should be checked/considered before starting HRT?
- full history to ensure no contraindications
- family history to assess risk of VTE + oestrogen dependent cancers
- check BMI + BP
- ensure cervical + breast screening is up to date
- encourage lifestyle changes
Stepwise formulations when choosing HRT
1: do they have local or systemic symptoms?:
- local: topical treatments e..g oestrogen cream
- systemic: step 2
.
2: do they have a uterus?
- no: continuous oestrogen only HRT
- yes: add progesterone - combined HRT + step 3
.
3: have they had a period in last 12 months?
- yes/perimenopausal: cyclical combined HRT
- no/postmenopausal: continuous combined HRT
Choices of hormones in HRT
- ‘natural’ oestrogen
- synthetic progestogens
- tibilone - synthetic compound with oestrogenic, progestogenic + androgenic activity
Options for oestrogen HRT delivery
Oral (tablets)
Transdermal (patches or gels)
Options for progesterone HRT delivery
- cyclical: 10-14 days per month with breakthrough bleed
-
continuous in post menopause women
. - oral (tablets)
- transdermal (patches)
- IUS e.g. mirena coil
