sex hormone responsive conditions Flashcards
(6 cards)
types of oestrogens and progesterones and other hormones
oestrogens:
natural oestrogens - estradiol, estrone, estriol
synthetic oestrogens - ethinylestradiol, mestranol
progesterones:
norethisterone, levonorgestrel, desogestrel
tibolone - oestrogenic, progestogenic and weakly androgenic
HRT - what it contains- imp points
oestrogens (combined with progestogen if pt has uterus)
- alleviates menopausal symptoms
vaginal atrophy - topical
vasomotor instability - systemic
can also reduce postmenopausal osteoporosis
clonidine - also used for vaosmotor symptoms - large SE profile
risks of HRT
benefits should always outweigh risks esp < 60
breast cancer:
- increased risk after 1 year
- risk higher in combined HRT over oestrogen only
- excess risk persists > 10 years
endometrial cancer:
- women with uterus - risk is lower with combined than oestrogen only
- tibolone increases risk
ovarian cancer:
- small increase but disappears few years after stopping
VTE:
- increased risk with combined + oestrogen only
- increased risk with obesity, rest, family history
STROKE:
- increase with both HRTs
- tibolone increases risk 2.2x in first year
CORONARY HEART DISEASE:
- increased risk in combined HRT when started > 10 years after menopause
choosing type of HRT
women with uterus:
- oestrogen with cyclical progestogen for last 12-14 days of cycle
- continuous administration of oestrogen and progestogen
- combined & tibolone avoided in perimenopausal period
women without uterus:
- continuous oestrogen use
- if endometriosis occurs - add progestogen
HRT and surgery - imp points
elective surgery:
- stop HRT 4-6 weeks before surgery
- reinitiate when fully mobile
non-elective surgery:
- prophylactic heparin
- graduated compression stockings
reasons to stop HRT
severe chest pain/breathlessness
swelling/pain in calf in leg (DVT)
severe abdominal/stomach pain
serious neurological effects: prolonged headache, epileptic seizure, motor disturbance numbness
hepatitis/jaundice
BP > 160 systolic, 95 diastolic
prolonged immobility - increased risk of VTE
