Hormone replacement therapy

Question 1

what is the purpose of HRT?

Answer 1

effective treatment for menopause-related symptoms

• reduces risks of osteoporosis, cardiovascular disease and stroke
• aim is to restore levels of hormones reducing as a result of menopause

Question 2

How is HRT taken?|

Answer 2

• oral HRT
• transdermal - patch or oestrogen gels
• combined methods of gel and tablets
• implanted devices - mirena coil

Question 3

what type of HRT regimens are there?

Answer 3

• combined regimens for those with uterus
• monthly oestrogen daily and progestogen end of cycle for 10-14 days
• 3m oestrogen daily and progestogen for 14 days every 13w
• continuous both daily without breaks when postmenopausal

Question 4

how does HRT work?

Answer 4

• menopause causes ovaries to stop producing eggs and therefore there is a decrease in oestrogen and progesterone
• this results in hot flushes, weakened bones and vaginal dryness
• by replacing these hormones the symptoms can be reduced in turn

Question 5

what are some indications of HRT?

Answer 5

• favourable risk benefit ratio in menopausal women
• early menopause until age of natural menopause at 51 even is asymptomatic
• women under 60 with risk of osteoporosis fracture in whom non-oestrogen treatments are unsuitable

Question 6

what are some sx for menopause?

Answer 6

night sweats, vaginal dryness, headaches, brain fog, insomnia, low mood, reduced sex drive, and the infamous hot flushes

Question 7

what are some advantages of HRT?

Answer 7

• reduction of vasomotor sx
• improved mood
• urogenital sx - vaginal dryness
• reduces osteoporosis risk
• CVS protection

Question 8

what are some disadvantages of HRT?
ie side effects

Answer 8

• oestrogen - breast tenderness, leg cramps, bloating, nausea and headaches
• progestogen - pre-menstrual sx, breast tenderness, backache, depression and pelvic pain
• bleeding - monthly preparations should produce regular, predictable bleeds towards the end or soon after progestogen phase, breakthrough bleed common in first 3-6m in continuous combined

Question 9

what are some risks with HRT?

Answer 9

• VTE: oral COCP in creases by 2-3 times
• ischaemic stroke
• breast cancer
• endometrial cancer with only oestrogen

Question 10

what are contraindications for HRT?

Answer 10

• current, past or suspected BC
• known or suspected oestrogen-sensitive cancer
• undiagnosed vaginal bleeding
• untreated endometrial hyperplasia
• previous idiopathic or current VTE unless on anticoag.
• active or recent arterial thromboembolic disease
• untreated HTN
• active liver disease with abnormal LFT
• pregnancy

Question 11

how would you reassure someone regarding HRT?

Answer 11

• HRT is taken for the correct reasons, i.e. to alleviate the symptoms of the menopause. It has a role in the prevention of osteoporosis but long term use is often required
• The dose and duration of HRT use should be made on an individual basis after discussing the risks and benefits, No arbitrary limit should be set on duration of use
• HRT users are assessed by their GP at least once a year