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Endocrinology > Hormone Replacement Therapy (HRT) > Flashcards

Hormone Replacement Therapy (HRT) Flashcards

1
Q

What is the definition of Menopause?

A

Menopause is the permanent cessation (stop) of menstruation resulting from loss of activity of the ovarian follicles

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2
Q

When can Menopause be determined?

A

After 12 months of spontaneous amenorrhoea (absence of menstrual period)

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3
Q

What is the mean age for menopause

A

51

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4
Q

What happens during menopause?

A
  1. Number of eggs decreases until none are left
  2. Follicular activity fails
  3. Oestrogen levels fall -> leading to symptoms
  4. Negative feedback loop on pituitary starts to fail
  5. Levels of FSH and LH rise
  6. Low oestrogen - High FSH - High LH
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5
Q

What is perimenopause?

A

Perimenopause is when you have symptoms before your periods have stopped.

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6
Q

What happens during perimenopause?

A

Gradual onset of endocrine changes as ovaries start to fail

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7
Q

How long does perimenopause last?

A

Last approximately 4 years starting on average at 47.5 years

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8
Q

What percentage of women will not experience perimenopause and will cease menstruation abruptly?

A

10%

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9
Q

What is premature menopause ?

A
  • Menopause occurs before the age of 40 years
  • Lead to increased risk of developing osteoporosis and cardiovascular disease
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10
Q

What is postmenopause?

A
  • The time after the menopause
  • Occurs after 12 months of spontaneous amenorrhoea
  • Difficulty to identify, especially in women who have started HRT
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11
Q

By what age are 80% of women postmenopausal?

A

54 years

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12
Q

What are the short term symptoms of menopause?

A
  • Menstrual cycle shortens or lengthens
  • Menstrual blood loss alters
  • Vasomotor symptoms (Hot flushes/Night sweats/Palpitations)
  • Psychological problems (Mood changes/Irritability/Sleep disturbance/ Depression/ Decreased libido)
  • Musculoskeletal symptoms (Joint & muscle pain)
  • Vaginal symptoms (Vaginal dryness/Dyspareunia (pain during sex))
  • Urinary symptoms (UTIs/Urinary incontinence/Urethral syndrome)
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13
Q

What are the long term symptoms of menopause?

A
  • Significant loss of calcium fro bones giving an increased risk of fractured due to osteoporosis
  • Change in blood lipid profile giving an increased risk of cardiovascular disease

First signs of problems:
- Fractured neck of femur (broken hip)
- Myocardial infarction
- Stroke

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14
Q

What protective functions does oestrogen have in a pre-menopausal woman?

A
  1. Positive effect of bone mass
  2. Positive effect of blood lipid profile
  3. Positive effect on coagulation (formation of blood clots) and fibrinolytic activity (prevention of blood clots)
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15
Q

What is hormone replacement therapy (HRT)?

A

Hormone Replacement Therapy (HRT) is a treatment used to relieve symptoms of the menopause.

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16
Q

What kind of HRT is given to a woman with an intact uterus and why?

A
  • Oestrogen + Progestogen
  • Because to stop over-stimulation of the endometrium (layer of tissue lining the uterus) by unopposed oestrogen
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17
Q

What kind of HRT is given to a women without an intact uterus?

A
  • Oestrogen alone
  • Because if the uterus has been removed there is no endometrium to stimulate
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18
Q

What is the aim of oestrogen therapy?

A
  • Aims to restore and maintain near normal plasma oestrogen levels
  • Reinstates the negative feedback loop on LH and FSH so levels fall
19
Q

What are the 3 nature;;y occurring oestrogens?

A
  • Estradiol
  • Estrone
  • Conjugated oestrogens (equine)
20
Q

Why are natural oestrogens used in HRT over synthetic oestrogen?

A

In HRT the risk of using synthetic oestrogen outweighs the benefits because of potentially serious side effects:
- Adverse lipid profile
- Raised BP
- Increased risk of abnormal blood clotting

21
Q

Synthetic oestrogen used in oral contraceptives are up to 200 time more potent (powerful) than natural oestrogens. True or False

A

True

22
Q

HRT is not as effective as contraceptive. True or False

A

True
- HRT is less potent therefore not as effective

23
Q

For how long are women considered potentially fertile if they are under 50 years and menopause?

A

For 2 years after last period

24
Q

For how long are women considered potentially fertile if they are over 50 years and menopause?

A

For 1 year after last period

25
Q

What can women under 50 use as contraception?

A

Combined oral contraceptive pill (COC) for contraception and relief of menopausal symptoms

26
Q

What can women over 50 use as contraception?

A

Non-hormonal contraception and HRT for menopausal symptoms if required

27
Q

What is progestogen therapy used for?

A
  • Progestogen is added to HRT for women with an intact uterus to protect from overgrowth and possible cancer
  • Progestogen needed for a minimum of 10 days per 28 day cycle to protect against overgrowth.
28
Q

Name 2 less androgenic progestogen

A
  • Dydrogesterone
  • Medroxyprogesterone acetate
29
Q

Name 2 more androgenic progestogen

A
  • Norethisterone
  • Levonorgestrel
30
Q

What are the 2 types of HRT?

A
  • Combined HRT
  • Oestrogen only HRT
31
Q

What are the routes of administration available for HRT?

A
  • Oral
  • Transdermal (patch/gel/spray)
  • Vaginal (cream/vaginal ring)
  • Implant
32
Q

What are the advantages of using transdermal route of HRT?

A
  • Gives less day to day variation in blood level
  • Produces a more natural physiological oeastradiol:oestrone ration
  • Bypasses first-pass metabolism and has less effect on the clotting factors produced by the liver
  • Smaller dose

Results in: Lower rate of venous thromboembolism

33
Q

What forms of vaginal oestrogen are available?

A
  • Vaginal tablets
  • Vaginal ring
  • Vaginal creams of gel
  • Pessaries
34
Q

When is vaginal oestrogen used as monotherapy for HRT?

A

When vaginal and/or bladder symptoms predominate

35
Q

What vaginal oestrogen is available over the counter and what is it used for?

A
  • Gina: Estradiol 10mg vaginal tablets - 1 tablet daily for 2 weeks then twice weekly
  • For vaginal atrophy due to oestrogen deficiency in postmenopausal women over 50 years who have not had a period for at least 1 year
36
Q

What forms of systemic HRT are available?

A
  • Tablets
  • Patches
  • Gel
  • Spray
  • Implants
  • For vasomotor symptoms and other symptoms control
  • Prevention and treatment of osteoporosis
37
Q

How long is HRT used for vasomotor symptoms?

A

2-3 years (initial review at 3 months to assess efficacy & tolerability)

38
Q

Why is an annual review recommended when using HRT?

A

Due to increased risk of side effects such as
- Stroke
- Breast cancer
- Endometrial cancer
- Venous thromboembolism

39
Q

HRT prescribed before the age of 60 has a favourable benefit/risk profile in healthy women. True or False

A

True

40
Q

How should HRT be prescribed for women over 60 years of age?

A
  • Should be started on lower doses
  • Preferably a transdermal route of estradiol administration
41
Q

What should women be assessed for when getting HRT?

A

Risks vs Benefits

42
Q

What side effects does Oestrogen HRT give?

A
  • Nausea and vomiting
  • Abdominal cramps and bloating
  • Weight changes (gain)
  • Breast tenderness and enlargement
  • Premenstrual-like syndrome
  • Sodium and fluid retention
43
Q

What side effects does Progestogen HRT give?

A

More androgenic drug (norethisterone, levonorgestrel)
- Cause greasy skin + hair
- Tend to off-set some of the protective effect of oestrogen’s on lipid profile

Less androgenic drugs (dydrogesterone, medroxyprogesterone) cause progesterone-like side effects:
- Abdominal bloating
- Mood changes such as irritability , depression
- Breast tenderness

44
Q

Why do women stop taking HRT?

A
  • Side effects of the progestogen
  • Regular monthly bleed induced by combination therapy when periods had been in the process of stopping
  • Weight gain

Endocrinology (14 decks)

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