Hormone Replacement Therapy

Question 1

definition and diagnosis of the menopause

Answer 1

12 months after LMP
perimenopause
post menopause from 1 yea after LMP

Question 2

symptoms of the menopause

Answer 2

menstrual bleeding
hot flushes/night sweats
sleep disturbances
anxiety/mood disturbances
sexual changes
memory/cognition
urinary symptoms
joint and msucular pains
tiredness and lethargy

Question 3

How to choose which formulation and to select type of HRT (oestrogen only, oestrogen and progesterone and different delivery mechanisms and patient choice

Answer 3

recommended to stop the combined at 50 (increasing risk of AV disease)

if on POP/IUS will likely be amenorrhoeic then measure FSH and if >30IU then can stop contraception after 12M

FSH can diagnose premature ovarian insufficiency

Question 4

contraindications for COCP
(UK Medical Eligibility Criteria for Contraception)

UK Mec guidelines

Answer 4

BP
BMI

• breast cancer, ovarian cancer
• migraines
• DVT

Question 5

combined hormonal contraceptions

Answer 5

nuva ring

patch

Question 6

combined hormonal contraceptions

Answer 6

nuva ring
patch

*smoking and >35 is a contraindciation for CHC and a BMI >28

Question 7

tailored regimes for pill-taking

Answer 7

licensed way is to have 7 day free but now it’s not the best way. shortened to 4 days

1. shortened hormone free interval
2. extended use (tricycling)
3. flexible extended use
4. continuous use

Question 8

if contraindicated for COCP

Answer 8

1. progesterone-only pills

long-acting reversible contraceptive

2. IUS= Mirena
3. IUDS
4. Injectible contraceptives depo medroxyprogesterone acetate (DMPA)

Question 9

POP

Answer 9

light/infrequent/irregular bleeeding

micronor
cenzaette
feanolla/desogestrol

Question 10

nexplanon

Answer 10

contaceptive implant on arm

Question 11

IUS

Answer 11

mirena
up to 3 years
6ug levongestreolol

Kyleena (smaller)
Mirena (heavy menstrual bleeding, endometrial cancer protection in HRT)

Question 12

Depo-porevra

Answer 12

/

Question 13

drug interactions

Answer 13

depo, IUS, IUCD- not effected by enzyme inducers (st johns)

CHC can affect lamotrigdine (epilepsy)

oestrogen can increase thyroid-binding globulin hormone= hypothyroidism

Question 14

emergency contraception

Answer 14

IUD copper coil

morning after pill:
ellaone uliprisal acetate
levonelle levonorgesterol

Question 15

emergency contraception

Answer 15

IUD copper coil (day 19)

morning after pill:
ellaone uliprisal acetate
(delays ovulatoin)

levonelle levonorgestrel (works by stopping the LH surge so only stops pregnancy if they have not already ovulated)

Question 16

assess HRT

Answer 16

VTE
CVS disease
breast cancer
osteoporosis
metabolic factors
liver disease
meds

Question 17

contraindications to HRT

Answer 17

breast cancer
oestrogen- dependent cancer
active/recent CVD
current VTE / thrombophilic disorder
undiagnosed vaginal bleeding
acute liver disease, abnormal liver function

Question 18

cautions with HRT

Answer 18

HTN, migraines, epilepsy, endometriosis, fibroids, FHx of breast cancer

Question 19

HRT increases risk of?

Answer 19

VTE
ischaemic stroke
breast cancer

Question 20

benefits of HRT

Answer 20

reduces fragility fracture
improves low mood
improves libido

Question 21

types of HRT

Answer 21

oestrogen only *women who have had hysterectomy

cyclical combined therapy
triggers regular bleed

continues combined CCT >12 monhs after 5 LMP or after 5 years of cyclical HRT as CCT

delivery-
oestrogen
progesterone

Question 22

types of HRT

Answer 22

oestrogen only *women who have had hysterectomy

cyclical combined therapy
triggers regular bleed

continues combined CCT >12 monhs after 5 LMP or after 5 years of cyclical HRT as CCT

delivery- 
oral
transdermal
uterine
vaginal

oestrogen
progesterone