Hormone Replacement Therapy

Question 1

Main estrogens and progestogens used in menopausal hormone replacement therapy.

Answer 1

Estrogens:

Progestogens: Medroxyprogesterone acetate, norethindrone, progesterone in peanut oil

Question 2

Megestrol

Answer 2

Synthetic progestin. Induces secretory changes in endometrium, increased basal body temp, pituitary inhibition.
Main indication are AIDS-Related Cachexia, cancer-related cachexia, breast cancer and endometrial cancer.

Question 3

First line of therapy for vulvar and vaginal atrophy

Answer 3

low dose local estrogen cream

Question 4

When and why you add a progestogen to estrogen therapy.

Answer 4

Using unopposed estrogen in women with a uterus puts them at increased risk for endometrial cancer.
Estrogen alone can only be given to patients who don’t have a uterus.

Question 5

What is the concern with skin applied estrogen

Answer 5

• Breast budding, breast masses, and gynecomastia have been reported in children following unintentional secondary exposure to Evamist (estrogen).

Question 6

What are bio-identical hormones?

Answer 6

Hormones from other species or synthetically produced that are identical to those produced by the human body (like those produced by the ovaries).

Question 7

The verdict on whether or not to give HRT to women post menopause?

Answer 7

For postmenopausal women with moderate-severe vasomotor symptoms (and no history of breast cancer or cardiovascular disease) suggest use estrogen-progestin therapy (or unopposed estrogen if woman is post-hysterectomy).

For women with vaginal atrophy symptoms only, suggest vaginal estrogen.

Most experts suggest that combined (E&P) therapy be limited to 5 years due to breast cancer risk, more flexible with unopposed estrogen.