Sex hormones responsive conditions

Question 1

what are the two types of oestrogens?

Answer 1

Natural
Synthetic

Question 2

examples of natural oestrogens

Answer 2

estradiol, estrone, estriol

Question 3

examples of synthetic oestrogens

Answer 3

ethinylestradiol + menstranol

Question 4

examples of progestrones used in tx of HRT

Answer 4

norethisterone, levonorgestrel, desogestrel

Question 5

examples of tibolone used in tx of HRT

Answer 5

oestrogenic
progestogenic
weakly adrongenic

Question 6

why is oestrogen given as tx in HRT?

Answer 6

-It helps to alleviate menopausal symptoms
-can also reduce postmenopausal osteoporosis

Question 7

when is progestrone given with oestrogen

Answer 7

if pt has uterus

Question 8

topical + systemic

what are the menopausal symptoms?

Answer 8

-vaginal atropy (topical)
-vasomotor instability (systemic)

Question 9

pro and con of clonidine

Answer 9

-pro= can be used for vasomotor symptoms
-con = large s/e profile

Question 10

when should HRT be used

Answer 10

only when benefit outweighs risk especially in under 60

Question 12

what are the risks of HRT

Answer 12

-Breast cancer
-endometrial cancer
-ovarian cancer
-venous thromboembolism
-stroke
-coronary heart disease

Question 13

how long is breast cancer a risk in HRT

Answer 13

-increased risk after 1 yr
-longer use = higher risk
-risk higher in combined HRT than oestrogen alone
-excess risk persists for 10+yr

Question 14

when is is endometrial cancer a risk in HRT

Answer 14

-women with uterus lower risk with combined than oestogren alone
-tibolone also increases risk

Question 15

how long is ovarian cancer a risk in HRT

Answer 15

small increase which disappers a few years after stopping

Question 16

what increases risk of VTE in HRT

Answer 16

-increase risk of DVT with both oestrogen-only and combined HRT
-increased risk with prolonged bed rest, obesity, trauma, family history

Question 17

oestogen-only or combined HRT

which drugs increases risk of stroke in HRT

Answer 17

-slight increase with both oestogen-only and combined HRT
-tibolone increases risk by 2.2x in 1st yr of tx

Question 18

what increases risk of coronary heart disease in HRT

Answer 18

-increased risk in combined HRT when started 10yr+ after menopause

Question 19

choosing HRT women with uterus

Answer 19

-oestrogen + cyclical progestogen for last 12-14 DY of cycle
-continous admin of oestrogen + progestogen
-avoid continous admin of combined + tibolone in perimenopausal phase or within 12MT of last menstrual period

Question 20

choosing HRT women without uterus

Answer 20

-continous oestrogen use
-if endometriosis occurs consider + progestrone

Question 21

HRT and elective surgery

Answer 21

stop HRT 4-6wk before surgery + restart when fully mobile

Question 22

what is given in non-elective surgery when taking HRT

Answer 22

-prophylactic heparin
-graduated compression stockings

Question 23

reasons to stop HRT

Answer 23

-stopped pending investigation + tx
-sudden severe chest painand breathlessness
-unexplained swelling/severe pain =calf one leg = DVT
-severe stomach pain
-serious neurological effects (unusual severe, prolonged headache, fainting 1st unexplained epileptic seizure, motor disturbances, numbness
-hepatitis and jaundice
-BP >60 sys 95 diast
-prolonged immobility