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Year 4 Gynae > Hormone replacement therapy > Flashcards

Hormone replacement therapy Flashcards

1
Q

When does progesterone need to be given with oestrogen

A

When the women still have a uterus

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2
Q

Why is progesterone and oestrogen given

A

To reduce the risk of endometrial cancer

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3
Q

HRT for women who are still having periods

A

Cyclical HRT with cyclical progesterone and breakthrough bleeds to reduce the risk of endometrial cancer

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4
Q

Postmenopausal women with a uterus and more than 12 months without periods

A

Continuous combined HRT

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5
Q

Indications for HRT

A

Replacing hormones in premature ovarian insufficiency, even without symptoms

Reducing vasomotor symptoms such as hot flushes and night sweats

Improving symptoms such as low mood, decreased libido, poor sleep and joint pain

Reducing risk of osteoporosis in women under 60 years

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6
Q

Benefits of HRT

A

Improved vasomotor and other symptoms of menopause

Improved quality of life

Reduced the risk of osteoporosis and fractures

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7
Q

Risks of HRT

A

Increased risk of breast cancer (particularly combined HRT)

Increased risk of endometrial cancer

Increased risk of VTE (2 - 3 x )

Increased risk of stroke and coronary artery disease with long term use in older women

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8
Q

In which group do HRT benefits outweigh the risks

A

No increased risk in women under 50 years

No risk of endometrial cancer in women without a uterus

No increased risk of coronary artery disease with oestrogen-only HRT

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9
Q

Ways to reduce the risks of HRT

A

Reduced risk of endometrial cancer by adding progesterone

Reduced risk of VTE by using patches rather than pills

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10
Q

Contraindications to HRT

A

Undiagnosed abnormal bleeding

Endometrial hyperplasia or cancer

Breast cancer

Uncontrolled hypertension

VTE

Liver disease

Active angina or myocardial infarction

Pregnancy

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11
Q

Assessment Before HRT

A

Full history to exclude contraindications

FHx to assess the risk of oestrogen dependent cancers (e.g. breast cancer) and VTE

BMI and BP

Ensure cervical and breast screening is up to date

Encourage lifestyle changes that are likely to improve symptoms and reduce risks

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12
Q

How to choose a suitable HRT

A
  1. Do they have local or systemic symptoms? - topical vs systemic
  2. Does the woman have a uterus? (oestrogen only or combined)
  3. Have they had a period in the past 12 months?
    - Perimenopausal: give cyclical combined HRT
    - Postmenopausal: continuous combined HRT
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13
Q

Options for Oestrogen Delivery

A

Oral (tablets)

Transdermal (patches or gels)

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14
Q

When are transdermal oestrogen patches appropriate

A

Poor control on oral treatment

Higher risk of VTE, cardiovascular disease and headaches

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15
Q

Types of progesterone course

A

Cyclical progesterone

Continuous progesterone

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16
Q

Cyclical progesterone

A

Given for 10 – 14 days per month

17
Q

How long to use continuous progesterone for

A

24 months if under 50 years

12 months if over 50 years

18
Q

Using continuous combined HRT before postmenopause

A

Can lead to irregular breakthrough bleeding

19
Q

Types of progesterone delivery

A

Oral (tablets)

Transdermal (patches)

Intrauterine system (e.g. Mirena coil)

20
Q

Benefits of Mirena coil

A

Can treat menorrhagia

21
Q

Advice for Mirena coil

A

Can cause irregular bleeding and spotting in the first few months after insertion

22
Q

Follow up after HRT

A

Follow up three months after initiating HRT to review symptoms and signs

23
Q

When should HRT be stopped before surgery

A

Stop oestrogen-containing contraceptives or HRT 4 weeks before major surgery due to VTE risk

24
Q

Oestrogenic HRT side effects:

A

Nausea and bloating

Breast swelling

Breast tenderness

Headaches

Leg cramps

25
Q

Progestogenic HRT side effects:

A

Mood swings

Bloating

Fluid retention

Weight gain

Acne and greasy skin

Year 4 Gynae (35 decks)

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