Endocrine - HRT Flashcards
What is more appropriate for HRT, Natural or Synthetic Oestrogen?
Natural
Examples of Natural Oestrogens (2)
Estradiol
Estriol
Examples of Synthetic Oestrogen (1)
Ethinylestradiol
What has Oestrogenic, Progestogenic and Weak Androgenic activity? (1)
Tibolone
What does HRT treat?
Alleviating menopausal symptoms such as vaginal atrophy or vasomotor instability.
Define Menopause
When menstruation stops permanently
What are the different types of menopause? (4)
Peri-menopause: the menopause transition = irregular cycles
Post-menopause: end of transition = no period for 12 months
Early menopause: 40-45 years
Premature menopause: <40 years
What are the symptoms of menopause (6)
VASOMOTOR = Hot flush + Night sweats
COGNITIVE = Mood swings + Sleep disorder
VAGINAL = Irritation + Dry + Itch
Altered Sexual Function
Joint + Muscular Pain
Fatigue
What is given to women with vasomotor symptoms who cannot take oestrogen?
Clonidine Hydrochloride BUT may cause unacceptable side-effects.
When can tibolone be used?
Postmenopausal period
Also, diminish postmenopausal osteoporosis
It is given continuously, without cyclical progestogen
BUT other drugs are preferred
Treatment for women WITHOUT uterus
Oestrogen ONLY
What is given to a menopausal woman WITH a uterus?
Oestrogen WITH Progestogen
- can combine in a tablet or patch
- or use TWO different formulation
progesterone –> prevent cystic hyperplasia
Example of two diferent formulations?
Peri-menopause:
- Sequential Combined
Post-menopause:
- Continuous Combined
What if Oestrogen + Progesterone is contraindicated / not tolerated?
Offer CBT + Antidepressant
Example of Sequential combined HRT treatment?
Oestrogen:
Patch e.g. Evorel Sequi; Gel; Spray; Cream
Progesterone (per cycle):
Mirena IUS
Micronised Progesterone (200mg for 12 days)
Medroxprogesterone (10mg for 14 days)
Example of Continuous combined HRT treatment?
Oestrogen:
Patch e.g. Evorel Conti; Gel; Spray; Cream
Progesterone (per cycle):
Mirena IUS
Micronised Progesterone (100mg) e.g. Utrogestan®
Medroxprogesterone (5mg)
What are the Risk of HRT (6)
Breast cancer
Endometrial cancer
Ovarian cancer
Venous thromboembolism
Stroke
Coronary heart disease
Key point between HRT and surgery (2)
STOP 4-6weeks before surgery and restart when fully mobilised
Can’t be stopped, use unfractionated or LMW heparin/Compression socks
Key point in elderly (2)
Be mindful of breast cancer history
and VTE history
Reasons to stop HRT (9)
- Sudden chest pain
- Breathlessness
- Unexplained calf swelling or severe pain
- Severe stomach pain
- Serious neurological affect
- Liver issues
- Either BP above 160 / 90
- Prolonged immobility after surgery
- Risk factor which contra-indicates treatment
When is synthetic oestrogen used in HRT?
Short-term treatment for the symptoms of oestrogen deficiency
2nd line for osteoporosis prophylaxis
Low sex drive (Hypogonadism)
Vaginal symptoms treatment?
Estradiol 10mcg
Replense (for dryness)
Altered sex drive treatment?
Testosterone
