Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction Y3 > Hormone replacement therapy (HRT) > Flashcards

Hormone replacement therapy (HRT) Flashcards

1
Q

What is the use of HRT?

A

Used in perimenopausal and postmenopausal women to alleviate symptoms associated with menopause.

These symptoms are associated with a declined in the level of oestrogen. Exogenous oestrogen is given to alleviate the symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

For HRT, why is progesterone given in addition to oestrogen for women who have a uterus?

A

Purpose of adding progesterone is to prevent endometrial hyperplasia and endometrial cancer secondary to “unopposed” oestrogen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Women with a uterus require endometrial protection with progesterone. True/false?

A

True

This is due to unopposed oestrogen causing risk of endometrial cancer.

Whereas women without a uterus can have oestrogen-only HRT.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the difference in HRT regime for women that still have periods compared to postmenopausal?

A

Women that still have periods should go on cyclical HRT, with cyclical progesterone and regular breakthrough bleeds.

Postmenopausal women with a uterus and more than 12 months without periods should go on continuous combined HRT.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are non-hormonal treatments for menopausal symptoms?

A

Lifestyle changes such as improving the diet, exercise, weight loss, smoking cessation, reducing alcohol, reducing caffeine and reducing stress

Cognitive behavioural therapy (CBT)

Clonidine, which is an agonist of alpha-adrenergic and imidazoline receptors

SSRI antidepressants (e.g. fluoxetine)

Venlafaxine, which is a selective serotonin-norepinephrine reuptake
inhibitor (SNRI)

Gabapentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is clonidine?

A

An agonist of alpha-2 adrenergic receptors and imidazoline receptors in the brain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Uses for clonidine?

A

Lowers blood pressure and reduces the heart rate, and is also used as an antihypertensive medication.

Can be helpful for vasomotor symptoms and hot flushes, particularly where there are contraindications to using HRT.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are common side-effects of clonidine?

A

Dry mouth, headaches, dizziness and fatigue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the effects of sudden withdrawal from clonidine?

A

Can result in rapid increases in blood pressure and agitation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the indications for HRT use?

A

Replacing hormones in premature ovarian insufficiency, even without symptoms

Reducing vasomotor symptoms such as hot flushes and night sweats

Improving symptoms such as low mood, decreased libido, poor sleep and joint pain

Reducing risk of osteoporosis in women under 60 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In women under 60 years old, the benefits of HRT generally outweigh the risks. True/false?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the main benefits of HRT?

A

Improved vasomotor and other symptoms of menopause (including mood, urogenital and joint symptoms)

Improved quality of life

Reduced the risk of osteoporosis and fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

The risks of HRT are less significant in older women and decrease with a longer duration of treatment. True/false?

A

False

HRT risks are more significant in older women and increase with longer duration of treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the main risks of HRT?

A

Increased risk of breast cancer (particularly combined HRT – oestrogen-only HRT has a lower risk)

Increased risk of endometrial cancer

Increased risk of venous thromboembolism (2 – 3 times the background risk)

Increased risk of stroke and coronary artery disease with long term use in older women

The evidence is inconclusive about
ovarian cancer, and if there is an
increase in risk, it is minimal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Do the main risks of HRT apply to all women?

A

No

The risks are not increased in women under 50 years compared with other women their age

There is no risk of endometrial cancer in women without a uterus

There is no increased risk of coronary artery disease with oestrogen-only HRT (the risk may even be lower with HRT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can the main risks of endometrial cancer and VTE be avoided in HRT?

A

The risk of endometrial cancer is greatly reduced by adding progesterone in women with a uterus

The risk of VTE is reduced by using patches rather than pills

17
Q

What are some major contraindications to HRT?

A
  • Undiagnosed abnormal bleeding
  • Endometrial hyperplasia or cancer
  • Breast cancer
  • Uncontrolled hypertension
  • Venous thromboembolism
  • Liver disease
  • Active angina or myocardial infarction
  • Pregnancy
18
Q

Before initiating HRT, what is important to check?

A

Take a full history to ensure there are no contraindications

Take a family history to assess the risk of oestrogen dependent cancers (e.g. breast cancer) and VTE

Check the body mass index (BMI) and blood pressure

Ensure cervical and breast screening is up to date

Encourage lifestyle changes that are likely to improve symptoms and reduce risks

19
Q

When choosing the correct HRT formulation, what steps are checked through?

A

3 main things are checked:

Step 1: Do they have local or systemic symptoms?
Step 2: Does the woman have a uterus?
Step 3: Have they had a period in the past 12 months (perimenopause or postmenopause)?

20
Q

Step 1 HRT formulation for local and systemic symptoms?

A

Local symptoms: use topical treatments such as topical oestrogen cream or tablets

Systemic symptoms: use systemic treatment – go to step 2

21
Q

Step 2 HRT formulation for women with and without uterus?

A

No uterus: use continuous oestrogen-only HRT

Has uterus: add progesterone (combined HRT) – go to step 3

22
Q

Step 3 HRT formation for if woman has or hasn’t had period in last 12 months?

A

Perimenopausal: give cyclical combined HRT

Postmenopausal (more than 12 months since last period): give continuous combined HRT

23
Q

2 main methods for delivering systemic oestrogen in HRT?

A

Oral (tablets)

Transdermal (patches or gels)

24
Q

When are patches more suitable than tablets for systemic oestrogen delivery?

A

More suitable for women with poor control on oral treatment, higher risk of venous thromboembolism, cardiovascular disease and headaches.

25
Q

In what cases is cyclical progesterone given in HRT and what is the pattern?

A

Given to perimenopausal women (had period in last 12 months)

Given for 10 – 14 days per month. Cycling the progesterone allows patients to have a monthly breakthrough bleed during the oestrogen-only part of the cycle, similar to a period.

26
Q

When is continuous progesterone given in HRT?

A

Continuous progesterone is used when the woman has not had a period in the past:

24 months if under 50 years
12 months if over 50 years

27
Q

Continuous HRT has better endometrial protection than cyclical HRT. True/false?

A

True

28
Q

What are the 3 methods of administering progesterone for endometrial protection in HRT?

A

Oral (tablets)

Transdermal (patches)

Intrauterine system (e.g. Mirena coil)

29
Q

How long can mirena coil be used for endometrial protection before being replaced?

A

4 years

30
Q

What are progestogens?

A

Refer to any chemicals that target and stimulate progesterone receptors

31
Q

What is progesterone?

A

Hormone produced naturally in the body

32
Q

What are progestins?

A

Synthetic progestogens

33
Q

2 main types of progestogens?

A

C19 and C21 progestogens

34
Q

What are C19 progestogens?

A

C19 progestogens are derived from testosterone, and are more “male” in their effects.

Examples are norethisterone, levonorgestrel and desogestrel. These may be helpful for women with reduced libido.

35
Q

What are C21 progestogens?

A

C21 progestogens are derived from progesterone, and are more “female” in their effects.

Examples are progesterone, dydrogesterone and medroxyprogesterone. These may be helpful for women with side effects such as depressed mood or acne.

36
Q

In menopause, there is an increase in the male hormone known as testosterone. True/false?

A

False

Testosterone is naturally low in females.

In menopause, there can be reduced testosterone, resulting in low energy and reduced libido (sex drive).

Treatment with testosterone is usually initiated and monitored by a specialist.

37
Q

What are the side-effects of the oestrogen components of HRT?

A
  • Nausea and bloating
  • Breast swelling
  • Breast tenderness
  • Headaches
  • Leg cramps
38
Q

What are the side-effects of the progesterone components of HRT?

A
  • Mood swings
  • Bloating
  • Fluid retention
  • Weight gain
  • Acne and greasy skin

Reproduction Y3 (78 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions