Hormone Replacement Therapy

Question 1

What is the definition for monopause?

Answer 1

Monopause is the permanent cessation of menstration resulting from loss of activity of the ovarian follicles.

Question 2

What is diagnosed as menopause?

Answer 2

After 12 months of spontaneous amenorrohea.

Question 3

What occurs during perimenopause?

Answer 3

Gradual onset of endocrine changes as ovaries start to fail.

Question 4

What occurs during premature menopause?

Answer 4

Menopause occurs before the age of 40 years -> increased risk of developing osteoporosis and CVD.

Question 5

What happesn during post menopause?

Answer 5

Occurs after 12 months after spontaneous amenorrhoea.

Question 6

What are the short term menopause?

Answer 6

Menstural cycle lengthens or shortens
Vasomotor symptoms - Hot flushes, night sweats, palpitations.
Psychological symptoms - mood changes, irritability, depression
Joint & muscle pain
Vaginal dryness.
Recurrent lower UTI
Urinary incontience

Question 7

What are the long term symptoms of menopause?

Answer 7

Significant loss of calcium from bones -> increased risk of osteoporosis.
Increased chance of CVD

Question 8

Why should you go on Oestrogen with progesterone?

Answer 8

Women with a uterus.
To stop overstimulatinon of the endometrium.

Question 9

Why should you go on oestrogen without progesterone?

Answer 9

Women who have have a hysterectomy.
Uterus has been removed no endometrium to be stimulated.

Question 10

What are the aims of Oestrogen therapy?

Answer 10

Restor and matain near normal plasma oestrogen lvls.
Reinstates negative feedback loop on LH & FSH so lvls fall.

Question 11

What naturally occuring oestrogen is given?

Answer 11

Estradiol
Estrone
Conjugated oestrogen (equine)

Question 12

How long is progesterone needed for in a 28 day cycle?

Answer 12

10 days min, to protect againt overgrowth.

Question 13

What are the less adrogenic progesterone?

Answer 13

Dydrogesterone
Medroxyprogesterone acetate

Question 14

What are the more adrogenic progesterone?

Answer 14

Norethisterone
Levonorgestrel

Question 15

What are the different routes of administration of HRT?

Answer 15

Oral, patch, gel, spray, cream, vaginal ring, implant.

Question 16

What are the difference between Transdermal vs Oral route

Answer 16

Gives less day-day variation in blood lvls.
Lowers rate of VTE.

Question 17

Why should an anual review of HRT be conducted?

Answer 17

Increased risk of Stroke, breast cancer, Endometrial cancer, VTE.

Question 18

Oestrogen side effects?

Answer 18

Nausea & vomiting
Abdominal cramps and bloating.
Weight changes.
Breat tenderness and enlargment.
Sodium and fluid retention.

Question 19

Progestogen more adrogenic drug side effects?

Answer 19

Cause greasy skin/hair.

Question 20

Progestogen less adrogenic drugs side effects?

Answer 20

Abdominal bloating
Mood changes such as irritability, depression, breat tenderness.

Question 21

What are the short term benefits of HRT?

Answer 21

Control of their symtpoms :
Hot flushes & sweats
Headaches
urianry and vaginal symtpoms
mood changes
thinning of skin

Question 22

What are the long term benefits of HRT?

Answer 22

Decreased risk of Osteoporosis

Question 23

What are the risk of HRT?

Answer 23

VTE, breast cancer, Endometrial cancer, Ovarain cancer, Stroke, CVD

Question 24

Why is Tibolone given?

Answer 24

2.5mg given OD
Gonadomimetic
Licensed for short-term treatment of symptoms and osteoporosis prophylaxis (2nd line)

Question 25

Why is Clonidine given?

Answer 25

50mcg BD
Vasomotor symptoms.
Alpha adrenergic agonist.

Question 26

What other things can women use for menopausal symptoms?

Answer 26

St John’s Wort
Black Cohosh
Red Clover

Question 27

What are the risk with St Johns Wort?

Answer 27

Interaction with CYP3A4.

Question 28

What risk is with Black Cohosh?

Answer 28

Liver impairment .

Question 29

What are the risks with Red Clover?

Answer 29

Contains coumarins which interact with warfarin.