HRT Flashcards
(56 cards)
Women may experience some irregular bleeding following a switch to an alternative preparation. When should this settle?
3-6months
What is the conversion from oral oestradiol to oestradiol patch
x25 and mcg rather than mg
E.g. 1mg oral oestradiol = 25mcg
Oestradiol gel is stronger than spray True or False
True
2 pumps of oestrogel= 3 sprays
What does evorel contain and how often is it applied?
Twice weekly
Contains norethisterone
What does femseven contain and how often is it applied?
Contains levonorgesterol, applied weekly
What is a low risk alternative to continuous combined HRT
Tibolone
In general the continuous dose is lower than the sequential dose of progesterone in HRT True or false
True
E.g. micronised progesterone
200mg daily sequential
100mg continuous
What are common symptoms of menopause due to falling estrogen levels?
- Hot flushes
- Night sweats
- Menstrual irregularities
- Sleep disturbance
- Vaginal dryness
- Urinary problems
- Joint and muscle pains
- Loss of libido
- Mood changes
- Cognitive disturbance
These symptoms can significantly impact quality of life for women undergoing menopause.
How is menopause diagnosed?
Diagnosis is made from a clinical history of typical symptoms in a woman ≥45y.
Investigations for abnormal bleeding should be conducted first.
What should be arranged if a woman under 45 has symptoms suggestive of menopause?
Arrange FSH if:
* 2 results >30 IU/L 4 weeks apart suggest early menopause
* If <40y, it indicates premature menopause
FSH stands for Follicle Stimulating Hormone.
What lifestyle changes are recommended for managing menopause symptoms?
- Regular exercise
- Healthy diet and BMI
- Stop smoking
- Reduce alcohol
- Avoid symptom triggers (e.g., spicy food)
- Reduce stress
- Relaxation exercises
- Sleep hygiene
These changes can help alleviate some symptoms associated with menopause.
What is the first-line treatment for vasomotor symptoms and low mood in menopause?
Hormone replacement therapy (HRT)
HRT is beneficial for sexual function and urogenital atrophy as well.
What alternatives to HRT are available for managing menopause symptoms?
- CBT for low mood and anxiety
- Isoflavones (soy) and black cohosh for flushes
- SSRIs and SNRIs for women who can’t have/don’t want HRT
Counseling regarding side effects is necessary for SSRI and SNRI use.
What are some contraindications to HRT?
- History of breast cancer or estrogen-dependent tumor
- Untreated endometrial hyperplasia
- Undiagnosed vaginal bleeding
- Uncontrolled hypertension
- Arterial thromboembolic disease
- Current or recurrent VTE (unless anticoagulated)
- Thrombophilic disorder
- Liver disease (with abnormal LFTs)
Note: Migraine is not a contraindication to HRT but transdermal use is recommended.
True or False: HRT increases the risk of breast cancer in women under 50.
False
HRT is unlikely to increase breast cancer risk in women <50y.
What factors may have a greater impact on breast cancer risk than HRT?
Lifestyle factors such as obesity and excess alcohol
These factors should be considered when assessing breast cancer risk.
What is the risk associated with HRT and venous thromboembolism (VTE)?
HRT increases VTE risk, but individual risk depends on other factors, generally low in early post-menopause years
Oral preparations carry higher risk; transdermal estrogen appears safer.
What is the commonest cause of death in postmenopausal women?
Cardiovascular disease (CVD)
HRT does not increase CVD risk in women <65y.
What is the relationship between HRT and stroke risk?
Oral HRT increases stroke risk; transdermal preparations appear safer
The risk of stroke depends on other cardiovascular risk factors.
What is the suggested risk of ovarian cancer associated with HRT?
Slight increased risk according to epidemiological studies
However, causation cannot be inferred from these studies.
What should be the starting dose for HRT?
Start with a low-dose regime (e.g. 50mcg patch) and titrate up according to symptoms
Who is eligible for oestrogen-only HRT?
Women who have had a TOTAL hysterectomy or those with an IUS
What must women with a uterus have when using HRT?
Progestogen to stop endometrial proliferation
What is sequential combined HRT used for?
For perimenopausal women with some endogenous hormone production
