Hormone Replacement Therapy Flashcards
What is the definition for monopause?
Monopause is the permanent cessation of menstration resulting from loss of activity of the ovarian follicles.
What is diagnosed as menopause?
After 12 months of spontaneous amenorrohea.
What occurs during perimenopause?
Gradual onset of endocrine changes as ovaries start to fail.
What occurs during premature menopause?
Menopause occurs before the age of 40 years -> increased risk of developing osteoporosis and CVD.
What happesn during post menopause?
Occurs after 12 months after spontaneous amenorrhoea.
What are the short term menopause?
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
What are the long term symptoms of menopause?
Significant loss of calcium from bones -> increased risk of osteoporosis.
Increased chance of CVD
Why should you go on Oestrogen with progesterone?
Women with a uterus.
To stop overstimulatinon of the endometrium.
Why should you go on oestrogen without progesterone?
Women who have have a hysterectomy.
Uterus has been removed no endometrium to be stimulated.
What are the aims of Oestrogen therapy?
Restor and matain near normal plasma oestrogen lvls.
Reinstates negative feedback loop on LH & FSH so lvls fall.
What naturally occuring oestrogen is given?
Estradiol
Estrone
Conjugated oestrogen (equine)
How long is progesterone needed for in a 28 day cycle?
10 days min, to protect againt overgrowth.
What are the less adrogenic progesterone?
Dydrogesterone
Medroxyprogesterone acetate
What are the more adrogenic progesterone?
Norethisterone
Levonorgestrel
What are the different routes of administration of HRT?
Oral, patch, gel, spray, cream, vaginal ring, implant.
What are the difference between Transdermal vs Oral route
Gives less day-day variation in blood lvls.
Lowers rate of VTE.
Why should an anual review of HRT be conducted?
Increased risk of Stroke, breast cancer, Endometrial cancer, VTE.
Oestrogen side effects?
Nausea & vomiting
Abdominal cramps and bloating.
Weight changes.
Breat tenderness and enlargment.
Sodium and fluid retention.
Progestogen more adrogenic drug side effects?
Cause greasy skin/hair.
Progestogen less adrogenic drugs side effects?
Abdominal bloating
Mood changes such as irritability, depression, breat tenderness.
What are the short term benefits of HRT?
Control of their symtpoms :
Hot flushes & sweats
Headaches
urianry and vaginal symtpoms
mood changes
thinning of skin
What are the long term benefits of HRT?
Decreased risk of Osteoporosis
What are the risk of HRT?
VTE, breast cancer, Endometrial cancer, Ovarain cancer, Stroke, CVD
Why is Tibolone given?
2.5mg given OD
Gonadomimetic
Licensed for short-term treatment of symptoms and osteoporosis prophylaxis (2nd line)
Why is Clonidine given?
50mcg BD
Vasomotor symptoms.
Alpha adrenergic agonist.
What other things can women use for menopausal symptoms?
St John’s Wort
Black Cohosh
Red Clover
What are the risk with St Johns Wort?
Interaction with CYP3A4.
What risk is with Black Cohosh?
Liver impairment .
What are the risks with Red Clover?
Contains coumarins which interact with warfarin.
