BMS-Menopause Flashcards
Talking about women age 50-59-how many extra cases of breast cancer will there be per 1000 women over 5 years in women taking combined HRT?
4
Talking about women age 50-59-how many extra cases of breast cancer will there be per 1000 women over 5 years in women with a BMI >30?
24
Talking about women age 50-59-how many fewer cases of breast cancer will there be per 1000 women over 5 years in women who take 2.5hrs moderate exercise a week?
7
Talking about women age 50-59-how many extra cases of breast cancer will there be per 1000 women over 5 years in women who drink 2+ units?
5
What’s the point in all those stats?
Consider HRT in context of other modifiable risk factors
In women with HIV what 2 things do you need to consider re HRT?
- Drug interactions with ART
- Use transdermal due to increased clot risk
Otherwise just treat as per guidelines
Can women with migraine with aura have HRT?
Yes-use transdermal and continuous (eg LNG-IUD) if possible to avoid fluctuating levels
How do you approach HRT post hysterectomy & BSO in people with endometriosis?
Give E and P-at least to start-little evidence but prevent theoretical risk of E alone activating any extrauterine deposits of endo/stimulating malignant transformation
Is CBT effective for hot sweats in menopause?
Yes
What should you tell women about applying Testosterone gel?
Lower abdo/thighs, let it dry, wash hands after (don’t touch kids etc), don’t wash off for 2-3 hours
What bloods/how often for T?
Total testosterone always:
Prior to starting
Approx 3-6 weeks after starting
At least annually
Rarely do SHBG (If high eg with oral E may explain lack of effect of T…if low may explain androgenic SE’s)
In women with low libido on oral HRT what should you do?
Consider transdermal (to decrease SHBG)
Women with breast cancer on tamoxifen what are the non hormonal alternatives to hrt to avoid?
Sertraline, paroxetine and fluoxetine-they render it less effective
Better is Citalopram.
Best is Venlafaxine (in terms metabolism of tamoxifen)
Apart from SSRI/SNRI what other non hormonal medications are there for hot sweats?
Gabapentin (900mg effective in 50 % hot flushes)
Pregabalin (50-300mg) better tolerated same effect as above
Clonidine (start 25-50mcg bd) only licensed option-poor sleep
How many days of progestogen are needed in a sequential HRT regime for endometrial protection?
12-14 (at least same as natural luteal phase)
What is the risk that favours switch to continuous HRT after 5+ years of sequential HRT?
Possible increased risk of endometrial hyperplasia and cancer with sequential > 5 years (but not before)
In who should you start sequential HRT?
Women with a uterus who have had a period in last year (or in POI in last 2 years)
What do you need to remember about HRT and subtotal hysterectomy?
trial sequential combined to start with -switch to E only if no bleeding ie no residual endometrium in stump
What are the usual doses of micronised progesterone? Uterogestan
Sequential 200mg 12-14 days
Conti 100mg daily
Can increase both by 100mg eg if taking high dose E or if unscheduled bleeding a problem
When do you worry about unscheduled bleeding on HRT?
After 4-6 months and tried changing progestogen if persists then investigate (or ‘if concerned’ before then)
What % of women are menopausal by 54?
80%
What are the 3 potential benefits of HRT?
Symptom control
Bone health
If < 60/< 10 years after LMP cardiac benefits too
In who do you diagnose POI?
under 40
FSH x2 > 30 4-6 weeks apart
ammen/oligo >3/12
Who cannot have paroextine or fluoxetine?
Prescribed tamoxifen-reduces efficacy
When do you use clonidine?
Vasomotor can’t have hrt
50-75mcg BD
Dry mouth sedation dizziness nausea
