Hormone Replacement Therapy (HRT) Flashcards
(36 cards)
What is HRT and what is it used for?
It is the use of oestrogens and progesterones to alleviate symptoms of menopause.
What are the symptoms of menopause?
- Hot flushes
- Vaginal atrophy
- Vaginal dryness
- Sexual dysfunction
- Bone loss
- Decreased muscle mass
- Accelerated skin aging
What age is early menopause? What age is natural menopause?
Early is when period stops before the age of 45. Before 40 is premature menopause.
Natural is between 45-55
What are examples of natural oestrogens? And examples of synthetic?
Natural:
1. Estradiol
2. Estrone
3. Estriol
Synthetic:
1. Ethinylestradiol
2. Mestranol
What are the side effect of Oestrogens?
Thromboembolism
What is the nature of Tibolone?
It has oestrogenic, progestogenic & weak androgenic activity
And it is given continuously without cyclical progestogen
Which patients should receive Progestogen?
Women with a uterus on long term therapy to reduce risk of cancer and cystic hyperplasia.
It is added to oestrogen regimens
What can be given as an alternative to oestrogen for menopausal symptoms?
Clonidine but can cause difficult side effects
What are the risks of HRT?
- Endometrial cancer (risk reduced by progestogen
- Venous thromboembolism
- Stroke
- Breast cancer
- Ovarian cancer
- Coronary heart disease
- CHD in women who started combined HRT more than 10 years after menopause
Which HRT medications increase the risk of breast cancer?
All types of HRT, including tibolone.
Increase in cancer within 1-2 years of initiating treatment
Increase risk is related to duration of HRT.
The risk disappears within 5 years of stopping
What does the risk of Endometrial cancer depend on?
It depends on the dose and duration of oestrogen-only HRT
What can reduce the risk of Endometrial cancer?
The addition of a progestogen cyclically (10 days per 28 day cycle).
Risk is eliminated if progestogen is given continuously but higher risk of breast cancer
Which HRT regime increases the risk of ovarian cancer and Venous Thromboembolism?
Long term use of combined HRT or oestrogen-only HRT.
Which HRT drugs and regimens increase the risk of stroke?
Combined HRT or Oestrogen only HRT increases stroke slightly. But more with older women, as risk increases with age.
Tibolone increases risk 2.2 times from the 1st year of treatment
When is Oestrogen given alone?
For continuous use in women without a uterus (except endometriosis, then add progesterone)
When is Oestrogen & Progesterone used together?
Only for women with uterus
Cyclical progesterone is given for the last 12-14 days of cycle or can be given continuously
What should happen to HRT for surgeries?
Stop HRT 4-6 weeks before surgery and restart after full patient mobilisation.
If HRT cannot be stopped (like due to non-elective surgery), give prophylaxis with unfractionated or LMWH heparin & graduated compression hosiery
When must HRT be stopped?
- Sudden severe chest pain (even if not radiating to left arm)
- Sudden breathlessness (or cough with blood stained sputum)
- Unexplained swelling or severe pain in calf of one leg
- Severe stomach pain
- Prolonged immobility after surgery or leg injury
- Hepatitis, jaundice, liver enlargement
- Severe neurological effects like severe headaches, hearing disturbances, loss of vision, epileptic seizures, fainting etc
Examples of sex hormones?
- Ethinylestradiol
- Raloxifene
Learning points for Ethinylestradiol?
- Licensed for short term symptoms of oestrogen deficiency
- Osteoporosis prophylaxis
- Female hypogonadism & menstrual disorders
Learning points for Raloxifene?
- Treatment & prevention of postmenopausal osteoporosis
- Unlike HRT, it does not reduce menopausal vasomotor symptoms like hot flushes
What are the two main groups of progestogens
- Progesterone & its analogues (e.g. dydrogesterone & medroxyprogesterone acetate
- Testosterone analogues (e.g. noretgisterone & norgestrel)
What are examples of derivatives of norgestrel?
- Desogesterel
- Norgestimate
- Gestodene
Levonorgestrel is an active isomer of norgestrel and has twice its potency
Why must progestogen be added to oestrogen for women with a uterus?
To prevent cystic hyperplasia of the endometrium and possibly transform into cancer
Can be added on cyclically or continuous basis
