Endocrine sex hormone

Question 1

2 TYPES OF OESTROGENS?

Answer 1

NATURAL- estradiol, estrone & estriol
smaller names

SYNTHETIC- ethinylestradiol & mestranol

Question 2

PROGESTOGENS? 3 examples LND

Answer 2

LEVONORGESTREL
NORETHISTERONE
DESOGESTREL

Question 3

TIBOLONE ACTIVITY?

Answer 3

both
OESTROGENIC
PROGESTOGENIC
WEAKLY ANDROGENIC

Question 4

HORMONE REPLACEMENT THERAPY

What menopausal symptoms can oestrogen alleviate?

Answer 4

vaginal atrophy (topical)
vasomotor instability (systemic)

itching, flushing, burning

can reduce postmenopausal osteoporosis

Question 5

HORMONE REPLACEMENT THERAPY

Issue with Clonidine?

Answer 5

Can be used for vasomotor symptoms, BUT

large side-effect profile

Question 6

lots of risks associated with HRT (BEO) benefits should always outweigh risk, esp in pts under X

Answer 6

60

Question 7

HORMONE REPLACEMENT THERAPY- RISKS

BREAST CANCER?

Answer 7

Increased risk after 1 year
Risk higher in combined HRT over oestrogen-only (combined has more drug, more risk)
Excess risk persists for >10 years after stopping
but risk lowers after stopping

Question 8

HORMONE REPLACEMENT THERAPY- RISKS

ENDOMETRIAL CANCER?

Answer 8

Women with uterus-
Lower risk in combined HRT than oestrogen-only: adding progesterone greatly reduces risk

Tibolone also increases risk

Question 9

HORMONE REPLACEMENT THERAPY- RISKS

OVARIAN CANCER?

Answer 9

Small increase which disappears a few years after stopping

Question 10

HORMONE REPLACEMENT THERAPY- RISKS

VTE? increased risk with what

Answer 10

Increased risk of DVT with both oestrogen-only & combined HRT

Increased risk with prolonged bed rest, obesity, trauma & family history

Question 11

HORMONE REPLACEMENT THERAPY- RISKS

STROKE?

Answer 11

Slight increase w/ both oestrogen-only & combined HRT

Tibolone increases risk by x2.2 in first year of treatment

Question 12

HORMONE REPLACEMENT THERAPY- RISKS

CORONARY HEART DISEASE?

Answer 12

Increased risk in combined HRT when started >10 years after menopause

Question 13

CHOOSING HRT

WOMEN W/ UTERUS?

Answer 13

Oestrogen w/ cyclical progestogen for last 12-14 days of the cycle
OR
Continuous administration of an oestrogen+progestogen (from day 1)

NOTE: Continuous combined+tibolone, avoid in perimenopausal phase(just before menopause)/within 12months of last menstrual period

// baso oestrogen given thruout tx and progesterone given in last 12-14 days of cycle

Question 14

CHOOSING HRT

WOMEN WITHOUT UTERUS?

WHAT DO YOU DO IF ENDOMETRIOSIS OCCURS?

Answer 14

CONTINUOUS OESTROGEN USE

Endometriosis? Add progesterone
- where tissue similar to lining of womb grows in other places such as ovaries or fallopian tibes

Question 15

HRT- SURGERY

ELECTIVE
When do you stop HRT?
When do you reinitiate?

Answer 15

STOP HRT 4-6 WEEKS BEFORE SURGERY

REINITIATE WHEN FULLY MOBILE

reduced risk of cloths. elective meaning scheduled and pt is aware of it taking place

Question 16

HRT- SURGERY

NON-ELECTIVE?
emergency surgery

Answer 16

PROPHYLACTIC HEPARIN

GRADUATED COMPRESSION STOCKINGS

Question 17

REASONS TO STOP HRT?

Answer 17

SUDDEN CHEST PAIN/BREATHLESSNESS (pe?)
SWELLING/SEVERE PAIN IN CALF (dvt)
SEVERE STOMACH PAIN (hepatoxicity)
NEUROLOGICAL: prolonged headache, fainting, seizures
HEPATITIS/JAUNDICE
BP> 160mmHg systolic OR 95mmHg diastolic
PROLONGED IMMOBILITY

• symptoms similar to use of CHC due to them both containing same API

Question 18

double check https://bnf.nice.org.uk/treatment-summaries/sex-hormones/#hormone-replacement-therapy
after and incCHOICE section