Hormone Replacement Therapy Flashcards

1
Q

On average, how long do these symptoms last for?

A

4 years

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2
Q

What are the indications for Hormone Replacement Therapy?

A
  • Vasomotor symptoms such as flushing, insomnia and headaches
  • Low sexual desire
  • Low Mood
  • Premature menopause
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3
Q

For hysterectomy before menopause or early menopause, how long should HRT be continued?

A

To when women would naturally go through the menopause.

~50 years old.

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4
Q

For symptomatic relief, how long should HRT be continued?

A

~5 years

(Remember that most menopausal symptoms lasted for only 4 years)

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5
Q

For osteoporosis, how long should HRT be continued?

A

5 years

The minimum period for which benefits have been shown.

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6
Q

Vasomotor symptoms affect how many women going to menopause?

A

80%

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7
Q

What are the 3 types of oral HRT and who are they used in?

A
  1. Oestrogen only - w/o womb. (Hysterectomy)
  2. Cyclical HRT - Perimenopausal - helps to limit erratic bleeding.
  3. Continuous combined HRT - use when 1 year later than menopause otherwise erratic bleeding.
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8
Q

How else can HRT be delivered apart from orally?

A
  • Transdemeral patch or topical
  • Oral Oestrogen - with Progestogen by Mirena coil
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9
Q

When stopping HRT can it be tapered or stopped abruptly?

A

Tapering is better over the short term.

Long terms outcomes are the same.

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10
Q

Generally speaking, between what age should HRT be stopped and why?

A

60-65 years.

Risks start to outweight the benefits.

(If used >60 years - use low doses)

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11
Q

When should patients be reviewed?

A

3 months THEN

Annually

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12
Q

What should you do as part of your review?

A
  1. Discuss S/E.
  2. Ask about vaginal bleeding.
  3. BMI
  4. BP
  5. Review FH
  6. Review Medical history
  7. Calculate 10 year CVD risk.
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13
Q

Oral HRT increases the risk of devleoping what conditions?

A
  • Ovarian cancer
  • Breast cancer
  • Ischaemic stroke
  • VTE
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14
Q

Transdermal HRT DOES NOT increase the risk of what conditions? (that oral HRT does)

A
  • VTE
  • Ischaemic stroke
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15
Q

What conditions is HRT contraindicated in?

A
  • Pregnancy.
  • Undiagnosed abnormal vaginal bleeding.
  • Active or recent blood clot or myocardial infarction (heart attack)
  • Suspected or active breast or endometrial (womb) cancer.
  • Active liver disease with abnormal liver function tests.
  • Porphyria cutanea tarda.
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16
Q

What is a good resource to discuss the risks of HRT with patients?

A

The Table at the back of the BNF.