Sex hormone responsive conditions

Question 1

Oestrogens most appropriate for HRT?

Answer 1

Natural oestrogens (estradiol, estrone, estriol)

Question 2

Name the synthetic oestrogen hormones

Answer 2

Ethinylestradiol, Mestranol

Question 3

Hormonal profile of tibolone

Answer 3

Oestrogenic, progestogenic, androgenic (Weak)

Question 4

Why is progesterone used in HRT?

Answer 4

To reduce risk of endometrial hyperplasia and endometrial cancer

Question 5

Aim of systemic HRT

Answer 5

To treat vasomotor symptoms of menopause

Question 6

Aim of topical HRT

Answer 6

To treat vaginal atrophy/ dryness

Question 7

In which patient group is the evidence for HRT limited?

Answer 7

> 65 years old

Question 8

Which drug can be used to treat vasomotor symptoms if unsuitable for oestrogen?

Answer 8

Clonidine

Question 9

Choice of treatments for HRT in patients WITHOUT a uterus

Answer 9

Continuous oestrogen

Question 10

Choice of treatments for HRT in patients WITH a uterus

Answer 10

Oestrogen + Progesterone either cyclically or continuously

Question 11

For which patients would combined continuous therapy (including tibolone) not be suitable for?

Answer 11

Those in peri-menopause and those who have not been amenorrhoea >12 months

Question 12

How long after use with systemic HRT does the risk of breast cancer increase?

Answer 12

After 1 year

Question 13

Are local HRT preparations associated with an increased risk of breast cancer?

Answer 13

No

Question 14

Which cancer risk disappears a few years after stopping HRT?

Answer 14

Risk of ovarian cancer

Question 15

Which cancer risk persists despite stopping HRT?

Answer 15

Risk of breast cancer

Question 16

When is there an increased risk of coronary artery disease in HRT use?

Answer 16

If combined HRT started >10 years after menopause onset

Question 17

Which HRT preparation may be more appropriate in patients considered a higher risk of VTE?

Answer 17

Transdermal- lower risk of VTE

Question 18

What cancers is there an increased risk of with systemic HRT?

Answer 18

Ovarian, breast, endometrial, and cervical

Question 19

CI of HRT

Answer 19

Liver disease
MI or angina
Prolonged Immobility after surgery or leg injury
Oestrogen-dependent cancers
History/ family history of breast cancer
Previous VTE
Undiagnosed vaginal bleeding
Thrombophlebitis

Question 20

What BP reading is HRT CI in?

Answer 20

Systolic >160 or diastolic >95

Question 21

How long before elective surgery should HRT be stopped?

Answer 21

4- 6 weeks (if major surgery under general anaesthesia)- re-start after full mobilisation.

Question 22

Management of HRT in a non-elective surgery?

Answer 22

If HRT not stopped- heparin should be used as prophylaxis and graduated compression stockings used

Question 23

What is raloxifene licensed for?

Answer 23

Post-menopausal osteoporosis

Question 24

Does raloxifene reduce vasomotor symptoms associated with menopause?

Answer 24

No

Question 25

Which progesterone receptor modulator is used to treat moderate- severe uterine fibroids when surgery has failed?

Answer 25

Ulipristal acetate

Question 26

Name 2 progesterone analogues

Answer 26

Medroxyprogesterone and dydrogesterone

Question 27

Name 2 testosterone analogues

Answer 27

Norgestrel and Norehisterone

Question 28

First-line pain management for those with endometriosis?

Answer 28

NSAID and patracetamol in combination

Question 29

When to refer to a gynaecologist in endometriosis?

Answer 29

When pain is not controlled with combined oral oestrogen or progesterone

Question 30

What is required before surgery for deep endometriosis in the bladder, ureter or bowel?

Answer 30

3 months of gonadotrophin releasing hormones first

Question 31

Meaning of mennorhagia

Answer 31

Excessive menstrual blood loss of >80ml over 7 days

Question 32

1st line for mennorhagia if pathology unknown, fibroids <3cm, or adenomyosis suspected

Answer 32

Levonorgestrel IUD

Question 33

Treatment options for menorrhagia if levonorgestrel unsuitable?

Answer 33

Tranexamic acid, an NSAID, combined hormonal contraceptive, or cyclical oral progestogen.

Question 34

What is cyproterone used for?

Answer 34

Hypersexuality and deviancy in males, metastatic prostate cancer resistant to analogue therapy