Hormone Replacement Therapy

Question 1

What age to people typically go through the menopause?

Answer 1

45-55

Question 2

What initial questions should be asked when counselling for HRT?

Answer 2

• Confirm menopause if possible
• Discuss symptoms + effect on quality of life
• PV bleeding-> presence, regularity, LMP, post-menopausal + post-coital bleeding

Question 3

What past medical history and family history is important to ask about when counselling for HRT?

Answer 3

• PE
• Stroke
• MI
• Angina
• Oestrogen dependent cancer-> endometrial or breast
• Do they have a uterus (eg hysterectomy)

Question 4

How should a patient’s initial knowledge be checked when counselling for HRT?

Answer 4

• What they already know about HRT
• Anything they want to know
• Explain what would like to do-> discuss the risks and benefits, types, contraception etc

Question 5

What is the menopause?

Answer 5

• Periods cease and patient no longer able to get pregnant
• Ovaries stop producing hormones
• These hormones affect the reproductive system but also the body-> can affect mood + libido
• Lasts approximately 4 years but can be up to 12

Question 6

What are the short term benefits of HRT?

Answer 6

• Relieves vasomotor symptoms
• Helps with psychological symptoms eg anxiety
• Improves libido
• Helps with urogenital atrophy

Question 7

What are the long term benefits of HRT?

Answer 7

• Reduce osteoporosis risk

- Can help with CVD risk

Question 8

What are the risks of HRT?

Answer 8

• VTE-> not with transdermal
• Stroke
• Breast cancer-> with combined only
• Ovarian cancer-> when 5+ years of therapy
• Endometrial cancer-> with oestrogen only

Question 9

What are the side effects of HRT?

Answer 9

• Oestrogen-> breast tenderness, leg cramps, nausea bloating
• Progesterone-> PMS
• Cyclical HRT-> PV bleeding

Question 10

What are the potential routes of HRT?

Answer 10

• Oral
• Transdermal-> patches, gel
• Vaginal-> tablet, cream, pessary, ring

Question 11

When is oestrogen-only HRT used?

Answer 11

When the patient doesn’t have a uterus

Question 12

What type of HRT is used when someone is perimenopausal + has a uterus?

Answer 12

• Cyclical HRT
• Oestrogen every day
• Oestrogen + progesterone together-> for 12-14 days to cause bleed (if still have periods) OR every 13 weeks (if irregular periods)

Question 13

What type of HRT is used when someone is post-menopausal?

Answer 13

Continuous HRT-> oestrogen + progesterone without bleed

Question 14

When is someone post-menopausal?

Answer 14

• No periods or 1 year

- Cyclical HRT for 1 year

Question 15

What is the maximum duration that HRT should be used?

Answer 15

Is no limit but risk increases when age 65+

Question 16

How long post-menopause can someone be fertile for?

Answer 16

• 1 year after LMP

- 2 years if age <50

Question 17

What are the contraception options for someone on HRT?

Answer 17

• POP

- Mirena-> can use as progesterone component

Question 18

What are some alternatives to HRT when the patient has mood problems?

Answer 18

• CBT

- Antidepressants

Question 19

What are some alternatives to HRT when the patient has vasomotor symptoms?

Answer 19

• SSRIs
• SNRIs
• Clonidine

Question 20

What are some alternatives to HRT when the patient has vaginal dryness?

Answer 20

• Lubricants

- Moisturisers

Question 21

What are some alternatives to HRT when the patient has irregular periods?

Answer 21

Mirena coil

Question 22

How should a consultation about HRT be concluded?

Answer 22

• Let patient think about it
• Plan follow up
• Ask if have any questions
• Offer leaflets + website links