7. Menopause and HRT Flashcards
What is the menopause?
permanent cessation of menses (no periods) following loss of ovarian activity
loss of oestrogen significantly impacts on women in this time of life
proportion of average female lifespan spent in menopause years: 1/3 to 1/2
Peri-menopause
transition from reproductive cycles to post menopause
typical age at start 45-50 y, median 47.5 y
mean duration: 3.8 y
few ova remain – less responsive to hormones
irregular menstrual cycles
occasional heavy bleeding
hot flushes
nervousness, irritability
Primary symptoms of menopause
Menstrual cycle changes - oligomenorrhea, amenorrhea
Vasomotor symptoms - hot flushes, night sweats
Vaginal dryness
Secondary symptoms of menopause
urinary stress/urge incontinence cystitis-like symptoms depression/irritability changes musculoskeletal pains (joint aches & osteoporosis) dry skin, hair thinning, nail changes decreased concentration decreased libido
What are the components of HRT and what do they do?
Oestrogen required for symptoms
Progestagens required to prevent endometrial cancer
Alternatives to HRT to reduce osteoperosis?
biphosphonates
• Aldronate
• Risedronate
Alternatives to HRT to reduce vasomotor symptoms
- Progesterone
- SERMS - raloxifene
- Beta-blocker
- Clonidine
Complementary and alternative therapies to HRT
• Phyto-oestrogens (soya bean) • Herbalism ○ Black cohost ○ St John's Wort ○ Ginseng ○ Oil of Evening Primrose • Progesterone cream • Homeopathy • Acupuncture • Reflexology
Options in HRT
Choice of route:
- oral
- patches
- implants
- vaginal rings
- transdermal gel
- nasal
Choice of dose and type of drug
Choice of regimen
How is HRT given?
Continous oestrogen:
no tablet break
No bleeding as no uterus
Continuous sequential HRT:
Oestrogen then progestogen on day 14. Sequential therapy without a tablet break. Regular bleeding at end of cycle (there is a uterus).
Continuous combined HRT:
Oestrogen and progestogen combined and given continuously, without bleeding at the end of cycle
No uterus HRT
Only oestrogen
Oestradiol 1 mg
Has to be taken continuously as symptoms return once treatment is stopped
HRT with a uterus
Oestradiol every day (white tablets)
Oestrogen plus progestagen (norgestrol) for 11 days (brown tablets)
Packet taken one after the other or with a 7 day break
Withdrawal bleeding during the brown tablets
Absolute contraindications to HRT
Pregnancy Active venous thromboembolism Severe active liver disease Endometrial carcinoma with recurrence Breast cancer with recurrence
Relative contraindications to HRT
Abnormal bleeding Breast lump (prior to investigation) Previous endometrial cancer Previous breast cancer Strong family history breast cancer Family history of thromboembolism
Side effects of HRT
Tender or painful breasts Fluid retention causing bloating and weight gain Nausea Headaches Leg cramps Mood swings/low mood Acne Backache Lower abdominal ache Bleeding Stomach upset (indigestion)
