CPTP 3.6 Menopause & HRT

Question 1

HRT for women without uterus

Answer 1

E only
(transdermal, oral, intra-vaginal)

Question 2

HRT for women with uterus, within <1 year of LMP (perimenopausal)

Answer 2

E + P (not everyday)

• E everyday
• P every 10-14 days OR 4x a year

Question 3

HRT for women with uterus, >1 year of LMP (postmenopausal)

Answer 3

E + P everyday

Question 4

Side effects of HRT

Answer 4

• unscheduled vaginal bleeding
• increased risk of cardiovascular disease (only increased for E+P pill, not E only pill)
• increased stroke, DVT/VTE risk
• increased risk breast Ca (only for E+P. Risk increases during tx duration, risk reduced after stopping HRT)
• increased risk ovarian Ca (insufficient evidence to prove if this is actually true)

Question 5

Benefits of HRT (short term, long term)

Answer 5

SHORT TERM

• relief of vasomotor symptoms
• relief of low mood
• relief of sexual difficulties
• relief of urogenital symptoms

LONG TERM
-reduced risk of fractures during tx (but reduced risk is removed once tx stopped)

Question 6

Modes of giving estrogen + why is oral not given in original form

Answer 6

Modes: oral, vaginal, transdermal

Oral: must be esterified
-Most oral Estradiol (E2) is converted to Estrone (E1) & Estriol (E3) in gut/liver –> not effective on receptors

Question 7

Name some progestogens

Answer 7

Noresthisterone
Levonorgestrel
Dydrogesterone
Micronised progesterone
Medroxy-progesterone acetate

Question 8

Things to note when stopping HRT

Answer 8

• Very variable: may take for 6 months or lifelong
• If no uterus, can take small amounts of oestrogen lifelong
• Osteoporosis protection is withdrawn very soon after stopping HRT

Question 9

What can be given to pts who need bone protection

Answer 9

Raloxifene (Evista)

Specific estrogen receptor modulator (no P action)

Does NOT reduce vasomotor symptoms (makes hot flushes worse)