HRT Benefits And Risks W3

Question 1

How long should HRT be taken for

Answer 1

usually used for 2-3 years

initial review at 3 months t

Annual review recommended because of increased risk of side effects

Question 2

side effects shown in trials

Answer 2

Stroke

Breast cancer

Endometrial cancer

Venous thromboembolism

Question 3

HRT in women over 60

Answer 3

Prescribed before 60 Has a favourable benefit/risk profile in healthy women

Start on Lower doses

preferably with a trqansdermal route of estradiol administration

Question 4

Oestrogen side effects of HRT

Answer 4

Nausea and vomiting

Abdominal cramps and bloating

Weight changes (gain)

Breast tenderness and enlargement

Question 5

Progesterone side effects of HRT

Answer 5

More androgenic drugs:
- Cause greasy skin + hair

Less androgenic drugs:
- Abdominal bloating
- Mood changes such as irritability, depression
- Breast tenderness

Question 6

Why do women stop taking HRT

Answer 6

Non-compliance with HRT is most commonly due to:
- Side effects of the progestogen
- Regular monthly bleed induced by combination therapy when periods had been in the process of stopping
- Weight gain §

Question 7

Short term benefits of HRT

Answer 7

Control symptoms of the peri/post meno including hot sweats, headaches, mood changes, loss of libido and thinning of hair

Question 8

Long term benefits of HRT

Answer 8

Reduce risk of osteoporosis

Reduce risk of coronary heart disease

Improve mood, sleep and quality of life

Reduce UTIs

Question 9

Risks of HRT

Answer 9

Breast cancer

Blood clots

Stroke

Endometrial cancer

Ovarian cancer

Question 10

Risks of breast cancer

Answer 10

Combined HRT (estrogen + progestogen) = Increased risk, especially after 5+ years of use

Estrogen-only HRT (for women without a uterus) = Little or no increased risk; possibly lower with short-term use

After stopping HRT, the increased risk gradually declines and may return to normal within a few years

Question 11

Risks of endometrial cancer

Answer 11

Oestrogen-only HRT (with uterus) = High risk – not recommended without a progestogen

Combined HRT (estrogen + progestogen = No increased risk, protective effect

Oestrogen-only HRT (after hysterectomy) = Safe; no endometrium to stimulate

Question 12

Risks of ovarian cancer

Answer 12

Both estrogen-only and combined HRT are linked to a slightly increased risk

The risk appears after ~5 years of use

The risk drops back to baseline after stopping HRT

Question 13

Risks of stroke

Answer 13

Oral HRT (estrogen) = Small increase in ischaemic stroke risk

Transdermal HRT = Minimal or no increased risk

Starting HRT > age 60 = Higher risk

Question 14

Coronary heart disease and HRT

Answer 14

Not conclusive!!

Before menopause, the incidence of CHD in women is lower than in men

CHD is the leading cause of death in post- menopausal women

Oestrogen alone = no reduced, risk of CHD

Oestrogen + progesterone = neutral or slight increased risk of CHD

Question 15

Tibolone

Answer 15

Synthetic steroid that mimics the effect of oestrogen, progesterone and androgens

Helps with menopausal symptoms, preventing osteoporosis and vaginal dryness

Evidence of slight increase in breast cancer risk after a long term use

Increase stroke risk in over 60-year-olds

Question 16

Clonidine

Answer 16

Mostly for night sweats and hot flushes

Question 17

What else could women use for menopausal symptoms?

Answer 17

SSRis - venalafaxine

Gabapentin

Plant based oestrogen – red clover

Acupuncture

St John’s wort