HRT Flashcards
(28 cards)
What is HRT and what is it used for?
Hormone replacement therapy
Use of oestrogens and progesterones to alleviate symptoms of menopause
Symptoms
Hot flushes
Vaginal atrophy
Accelerated skin aging
Vaginal dryness
Decreased muscle mass
Sexual dysfunction
Bone loss
Early menopause and natural menopause?
Early menopause is less than 45 years old
Natural menopause is 50 years old+
Sex hormones - oestrogens
They are important in the development of females secondary characteristics
- we have natural vs synthetic oestrogens
- natural oestrogens ( estradiol,estriol) are better for HRT than synthetic oestrogens (ethinylestradiol and mestranol)
- tibolone has oestrogenic, progestogenic and weak androgenic activity
- oestrogens can be given cyclically and continuously
- oestrogens can cause thromboembolism’s
- give progesterone to women with a uterus on long term therapy to reduce the risk if cancer and cycstic hyperplasia
Combinations of HRT
Progesterones are specifically added to oestrogen regimens when the uterus is still present
Tibolone - combines oestrogenic and progestrogenic activity, given continuously without cyclical progestogens
Clonidine may be used to reduce menopausal symptoms in women who can not take oestrogen but may cause unacceptable side effects
What are the risks with HRT? Obeeeeee
-Breast cancer
-Endometrial cancer (risk reduced with progesterone)- progestrogens will only reduce risk of endometrial cancers not the others
-Ovarian cancer
-Stroke
-CHD
The moment you stop the HRT
Risk goes away
More into risks
Increases the risk of CHD in women who start combined HRT more than 10 years after menopause
Use the minimum effective dose of HRT for shortest duration of time
- always review the treatment annually and consider alternatives for osteoporosis
- benefits of short term HRT for the treatment of menopausal symptoms outweigh the risks in majority of women, especially those over 60 y/o
The risk of breast cancer
Using all types of HRT including tibolone will increase the risk of breast cancer within 1-2 years of initiating treatment
- increased risk is related to the duration of HRT
- This risk disappears within 5 years of stopping HRT
The risk of endometrial Cancer
-depends on dose and duration of oestrogen only HRT
- In women with a uterus, additional of a progestrogen cyclically (10 days per 28 day cycle) reduces risk of endometrial cancers
- risk is eliminated if progestrogen is given continuously but higher risk of breast cancer
Risk of ovarian cancer
Long term use if combined HRT or oestrogen only hRT is associated with a small increased risk of ovarian cancer
This risk disappears a few years after stopping
Risk of a venous thromboembolism
Women using combined or oestrogen only HRT are at risk of DVT and Pe especially in the first year of use
Women that have predisposing factors (family/peronal history or DVT/PE, severe varicose veins, obesity and trauma) - may need to be reviews for their need of HRT as in some cases HRT risks may exceed benefits
- prolonged immobility further increases risk of DVT
Risk of Stroke
Increases with age, older women have a greater risk of stroke
Combined HRT or oestrogen only HRT increases the risk of stroke slight;y
Tibolone increases risk of stroke, 2.2 times in the first year of treatment
Risk of coronary heart disease
HRT dose not prevent CHD and should not prescribed for this purpose
Increased risk of CHD for women that have started combined HRT for greater than 10 years
The choices of HRT: When do we give oestrogen alone?When do we give oestrogen with progestogen?
- women with a uterus we give cyclical progesterone( combined) for last 12-14 dats of cycle or a preparation which involves continuous administration of oestrogen and progestogen
Oestrogen alone- for continuous used in women without a uterus (except endometriosis add progesterone)
Surgery
Major surgeries - its a predisposing factors to VTE so stop HRT 4-6 weeks before surgery and start after full mobilisation is gained
-if can’t stop HRT (eg.Non elective) - give prophylaxis with unfractionated or LMWH heparin and graduated compression hosiery
What symptoms will prompt stopping HRT
Sudden severe chest pain (even if nor radiating to left arm)
Sudden breathlessness(cough with blood stained sputum)
Unexplained swelling or severe pain in one leg
Severe stomach pain
Serious neurological effects(eg. Severe headaches, loss of vision, hearing disturbance, dysphagia,epileptic seizures,numbness on one side of body or fainting)
-Heapatitis, Jaundice, liver enlargement
- prolonged immobility after surgery
Sex Hormones - Ethinylestradiol
- licensed for short term symptoms of oestrogen deficiency
- osteoporosis prophylaxis
- female hypogonadism and menstrual disorders
Sex hormones - raloxifene
Treatment and prevention of post menopausal osteoporosis
Unlike HRT, does not reduce menopausal vasomotor symptoms eg. Hot flushes
Progestogens and progesterone receptor modulators
There are 2 main groups of progestogen-
1) progesterone and its analogues (dydrogesterone and medroxyprogesterone acetate)
2) Testostrone analogues (eg. Norethisterone and norgestrel)
New progestrogens (desogesterel, norgestimate and gestodene) all derivatives of norgestrel
Levongestrel is an active isomer of norgestrel and has twice its potency
Just remember that in women with a uterus…
Add progestrogens to oestrogens to prevent cystic hyperplasia of the endometrium which can possibly transform into cancer
This can be added on a cyclically or continuous basis
Male Sex Hormones - Androgens
- cause masculinisation
- used as a replacement therapy in castrated adults and those who are hypogonadal
- they inhibit the pituitary gonadotrophin secretion and depress spermatogenis in normal males
- they have anabolic action - led to the development of anabolic steroids
- not effective to treat impotence and impaired spermatogenisis, unless there is associated hypogonadism
Eg. Testostrone (testrogen,testin and tostran )
Anti Androgens
Cyproterone acetate and dutasteride and finasteride
Cyproterone - uses = treatment of sever hypersexualty and sexual deviations in men
