HRT

Question 1

what are proven risks of HRT?

Answer 1

1. increased incidence of VTE
2. increased incidence of endometrial cancer/breast cancer (unopposed oestrogen therapy)

Question 2

what are some contraindications to oestrogen therapy:

Answer 2

undiagnosed vaginal bleeding, severe liver disease, pregnancy, venous thrombosis, and personal history of breast cancer

-Well-differentiated and early endometrial cancer, once treatment for the malignancy is complete, is no longer an absolute contraindication.

-A family history of breast cancer is not an absolute contraindication.

Question 3

what is not a recognised route of administration of oestrogens?

Answer 3

intramascular

Question 4

what symptoms can bromocriptine therapy cause?

Answer 4

hypotension

-Bromocriptine is a dopamine agonist that induces postural hypotension and can be used as an antihypertensive. The drug inhibits release of norepinephrine (NE) from an isolated artery by stimulating presynaptic receptors.

also: constipation, drowsiness, headache, nasal congestion, nausea

Question 5

what are some SEs of progestogen therapy:

Answer 5

– Bloating, constipation, irritability; also: alopecia, breast abnormalities, depression, dizziness, fluid retention, insomnia, menstrual cycle irregularities, nausea, sexual dysfunction, skin reactions, weight changes

Question 6

what are some SEs of Levonorgestrel-releasing IUD

Answer 6

Amenorrhoea (1/3 of pts); also: gastrointestinal discomfort, headaches, nausea, skin reactions

Question 7

what does combined HRT reduce the risk of?

Answer 7

osteoporosis

Question 8

what does combined HRT increaser the risk of?

Answer 8

-breast cancer
-endometrial cancer (usually unopposed oestrogen)
-venous thromboembolism
-cardiovascular disease (However, oestrogen-only HRT may reduce the risk of cardiovascular disease.)

Question 9

benefits of HRT:

Answer 9

1. Symptomatic relief of vasomotor symptoms such as flushing, insomnia, headaches, vaginal atrophy and dryness
2. Decreases the risk of osteoporosis and colorectal cancer
3. In premature ovarian insufficiency, HRT should be continued until the age of 50. This is to help prevent the development of osteoporosis

Question 10

Contraindications of HRT:

Answer 10

-Undiagnosed vaginal bleeding
-Pregnancy
-Breastfeeding
-Oestrogen receptor-positive breast cancer
-Acute liver disease
-Uncontrolled hypertension
-History of breast cancer or venous thromboembolism (VTE)
-Recent stroke, myocardial infarction or angina

Question 11

SEs of HRT:

Answer 11

1. Oestrogen: breast tenderness, leg cramps, bloating, nausea, headaches
2. Progestogen: premenstrual syndrome-like symptoms, mood swings, breast tenderness, backache, depression, pelvic pain, fluid retention, weight gain
3. Increased risk of breast cancer, endometrial cancer, VTE, stroke and ischaemic heart disease