Endocrine - HRT

Question 1

HRT increases risks of what?

Answer 1

Increased risk of breast cancer
Increased risk of ovarian cancer
Increased risk of VTE
Increased risk of Stroke
Increased risk of Coronary heart disease

Question 2

HRT decreases risks of what?

Answer 2

Endometrial Cancer

Question 3

If there is an elective surgery with HRT?

Answer 3

Stop HRT 4-6 weeks before surgery

To be reinitiated when fully mobile

Question 4

If there is a non elective surgery whilst having HRT, pt must use what?

Answer 4

Prophylactic Heparin
&
Compression stockings

Question 5

HRT Referral Criteria for pt’s

Answer 5

See Google

Question 6

Vasomotor symptoms?

Answer 6

Hot flashes
Sweating (night)
Increase heart rate
Chills

Question 7

Vaginal Atrophy meaning?

Answer 7

Thinning, drying and inflammation of vaginal walls

Question 8

What to give for Vaginal Atrophy?

Answer 8

Topical Oestrogen like oestrogel pump
Oestrogen Tablets/ Rings/ Patches
With/without progesterone

If pt has uterus give combined

Question 9

Vaginal Atrophy or Vasomotor instability 2nd line? Specifically to give for Vasomotor symptoms?

Answer 9

Clonidine - but lots of side effects

Question 10

If vaginal walls are dry aka Vaginal atrophy - what to give?

Answer 10

Topical Oestrogen

Question 11

If Vasomotor symptoms what formulation should be given?
*Think internal

Answer 11

Systemic - tablet, patches, sprays and gels

Question 12

Non elective surgery precautions HRT?

Answer 12

Use Heparin prophylactically

Compression stockings

Question 13

When to Stop HRT?

Answer 13

Severe stomach pain - Hepatotoxic

SOB - PE

Calf swelling - VTE

IMMOBILE

BP over 160mmHG or 95 diastolic

Serious neurological

Question 14

HRT apply patch where?

Answer 14

Below waistline

Question 15

HRT Risks?

Answer 15

Ovarian cancer
Breast cancer - combined high risk
Endometrial cancer - oestrogen high risk
VTE/PE -
STROKE - Tibolone higher risk
CVD - specifically combined HRT >10yrs after menopause