Hormone Replacement Therapy Flashcards
definition and diagnosis of the menopause
12 months after LMP
perimenopause
post menopause from 1 yea after LMP
symptoms of the menopause
menstrual bleeding hot flushes/night sweats sleep disturbances anxiety/mood disturbances sexual changes memory/cognition urinary symptoms joint and msucular pains tiredness and lethargy
How to choose which formulation and to select type of HRT (oestrogen only, oestrogen and progesterone and different delivery mechanisms and patient choice
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
contraindications for COCP
(UK Medical Eligibility Criteria for Contraception)
UK Mec guidelines
BP
BMI
- breast cancer, ovarian cancer
- migraines
- DVT
combined hormonal contraceptions
nuva ring
patch
combined hormonal contraceptions
nuva ring
patch
*smoking and >35 is a contraindciation for CHC and a BMI >28
tailored regimes for pill-taking
licensed way is to have 7 day free but now it’s not the best way. shortened to 4 days
- shortened hormone free interval
- extended use (tricycling)
- flexible extended use
- continuous use
if contraindicated for COCP
- progesterone-only pills
long-acting reversible contraceptive
- IUS= Mirena
- IUDS
- Injectible contraceptives depo medroxyprogesterone acetate (DMPA)
POP
light/infrequent/irregular bleeeding
micronor
cenzaette
feanolla/desogestrol
nexplanon
contaceptive implant on arm
IUS
mirena
up to 3 years
6ug levongestreolol
Kyleena (smaller)
Mirena (heavy menstrual bleeding, endometrial cancer protection in HRT)
Depo-porevra
/
drug interactions
depo, IUS, IUCD- not effected by enzyme inducers (st johns)
CHC can affect lamotrigdine (epilepsy)
oestrogen can increase thyroid-binding globulin hormone= hypothyroidism
emergency contraception
IUD copper coil
morning after pill:
ellaone uliprisal acetate
levonelle levonorgesterol
emergency contraception
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)
assess HRT
VTE CVS disease breast cancer osteoporosis metabolic factors liver disease meds
contraindications to HRT
breast cancer oestrogen- dependent cancer active/recent CVD current VTE / thrombophilic disorder undiagnosed vaginal bleeding acute liver disease, abnormal liver function
cautions with HRT
HTN, migraines, epilepsy, endometriosis, fibroids, FHx of breast cancer
HRT increases risk of?
VTE
ischaemic stroke
breast cancer
benefits of HRT
reduces fragility fracture
improves low mood
improves libido
types of HRT
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
types of HRT
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
