HRT masterclass Flashcards
(20 cards)
A 52-year-old woman recently started treatment with oral combined HRT and visits
your community pharmacy for advice as she has developed a red, swollen and painful
calf in her left leg.
What action would you recommend for this patient?
A. advise the patient to continue taking the medication and contact their GP for a
routine appointment
B. advise the patient to continue taking the medication and sell ibuprofen for the
pain
C. advise the patient to stop taking the medication and contact their GP for a
routine appointment
D. advise the patient to stop taking the medication and sell ibuprofen for the pain
E. advise the patient to stop taking the medication and urgently refer to the
emergency department
F. offer to phone their GP and advise changing to a transdermal preparation of their
hormone replacement therapy
G. offer to phone their GP and advise changing to a vaginal preparation of their
hormone replacement therapy
H. recommend that no specific treatment is needed and advise self-care measures
and rest
Stop taking and go to A+E
A 54-year-old woman has been treated for menopausal symptoms with transdermal combined
HRT for the past 8 months. On starting the HRT, she experienced irregular heavy bleeding and
painful abdominal cramps which is continuing.
What action would you recommend for this patient?
What action would you recommend for this patient?
A. advise the patient to continue taking the medication and contact their GP for a routine
appointment
B. advise the patient to continue taking the medication and sell ibuprofen for the pain
C. advise the patient to stop taking the medication and contact their GP for a routine
appointment
D. advise the patient to stop taking the medication and sell ibuprofen for the pain
E. advise the patient to stop taking the medication and urgently refer to the emergency
department
F. offer to phone their GP and advise changing to a transdermal preparation of their
hormone replacement therapy
G. offer to phone their GP and advise changing to a vaginal preparation of their hormone
replacement therapy
H. recommend that no specific treatment is needed and advise self-care measures and rest
Irregular bleeding should settle within 3-6 months of starting HRT and if it does not then a GP referral should be ma
de to rule out serious
gynaecological pathology. The situation does not require patients need to immediately stop treatment
When would you use Cylical (sequential) HRT
Perimenopausal or within 1 year of menopause – still menstruating or recently stopped
When would you use continuous combined hRT
Postmenopausal (no periods for 12 months or aged >54
When is oestrogen only HRT used
No uterus
Risks of HRT
- Increased breast cancer risk (especially combined HRT >5 years)
- Increased VTE risk ( especially oral HRT)
- Increased stroke risk (especially oral HRT)
- Increased endometrial cancer
Which HRT route has a lower risk of VTE
transdermal patch or gel
Can HRT be used as a contraceptive
No - contraception is still needed if >50 and < 2 years since menopause
Examples of oestrogen only HRT
Estradot
Elleste solo
Examples of combined cyclical HRT
Evorel Sequi
Examples of combined continuous HRT
Evorel Conti
Femoston
Examples of vaginal oestrogen
Vagifem
What should patients report when using HRT
Unexplained bleeding especially if on continuous combined HRT for >6 months- still continue to take HRT this is not a reason to stop
How often should HRT be reviewed
At 3 months after starting then annually
What are the absolute CI of HRT
- Current or past breast cancer
- Undiagnosed vaginal bleeding
- Active or recent thromboembolic disease (e.g. DVT, PE)
- Active liver disease
- Untreated endometrial hyperplasia or cance
What are some relative CI to HRT
- Migraine with aura (esp. for oral HRT – transdermal may be safer)
- History of cardiovascular disease or stroke
- High risk of VTE (consider transdermal route)
- Gallbladder disease
Why is undiagnosed vaginal bleeding a CI
t may be a sign of endometrial cancer or hyperplasia and must be investigated before starting HRT.
Can you give HRT to someone with a high risk of VTE
Oral HRT is not recommended; use transdermal oestrogen with progestogen cautiously if benefits outweigh risks
Reasons to stop HRT immediately
- Sudden chest pain
- Sudden breathlessness
- Unexplained swelling or severe pain in one leg
- Severe stomach pain
- Serious neurological effects (including vision loss)
- Hepatitis, jaundice or liver enlargement
- Uncontrolled HTN
- Prolonged immobility after surgery or leg injury
HRT and bone health
- Reduces risk of osteoporosis and fracturees
- preserves bone mineral density
