Hormone Replacement therapy

Question 1

Name 3 complications of giving oestrogen-based HRT

Answer 1

Breast cancer (combined higher risk than oestrogen-only)
Endometrial cancer
VTE
Stroke risk

Question 2

You see a 54-year old lady in GP complaining of irregular breakthrough bleeding the last 2 weeks. She has been on continuous combined HRT for the last month. It is bothering her as it often soaks her underwear. What should your management plan be?

A. Reassure and safety net
B. 2-WW urgent referral to Gynae
C. Prescribe tranexamic acid
D. Switch her to an oestrogen only HRT
E. Switch her to a Mirena coil combined with transdermal oestrogen preparation

Answer 2

Answer: E

Continuous combined HRT is commonly associated with breakthrough bleeding, treating this is achieved by increasing or changing the type of progesterone.

Question 3

Name 4 contraindications for HRT in women

Answer 3

1. Active breast cancer
2. Unexplained endometrial bleeding
3. Previous idiopathic DVT
4. Active or recent arterial thromboembolic disease (i.e angina/MI)
5. Pregnancy
6. Thrombophilia
7. Active liver disease with abnormal LFTs

Question 4

What are some reasons to prescribe transdermal preparations?

Answer 4

Persistent troublesome symptoms with oral treatment
Cardiovascular risk factors
History or increased risk of VTE
History of migraine

Question 5

What preparations can be given to women without a uterus?

Answer 5

Oestrogen-only, combined HRT

Question 6

What preparation can be given to women with a uterus?

Answer 6

Combined HRT

Oestrogen-only is not allowed!

Question 7

3 adverse effects of oestrogen HRT?

Answer 7

Fluid retention
Breast pain
Headaches
Bloating

Question 8

3 adverse effects of progesterone HRT?

Answer 8

Fluid retention
Acne
Breast pain

Question 9

If a patient wanted to take contraception alongside HRT, which forms can she only have?

Answer 9

Progesterone-only pill
Progesterone-only implant

Injectable increases risk of osteoporosis in women older than 50

Question 10

Benefits of HRT

Answer 10

Gets rid of menopausal symptoms

Reduces CVS risk (although if existing risk factors, prescribe transdermal only)

Question 11

When would you take contraception alongside the mini-pill?

Answer 11

To prevent contraception while getting rid of hormonal symptoms

Take for 1 year after last period if >50 yrs old
Take for 2 years after last period if <50 yrs old