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Endocrine > Hormone Replacement Therapy (HRT) > Flashcards

Hormone Replacement Therapy (HRT) Flashcards

1
Q

What is HRT and what is it used for?

A

It is the use of oestrogens and progesterones to alleviate symptoms of menopause.

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2
Q

What are the symptoms of menopause?

A
  1. Hot flushes
  2. Vaginal atrophy
  3. Vaginal dryness
  4. Sexual dysfunction
  5. Bone loss
  6. Decreased muscle mass
  7. Accelerated skin aging
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3
Q

What age is early menopause? What age is natural menopause?

A

Early is when period stops before the age of 45. Before 40 is premature menopause.

Natural is between 45-55

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4
Q

What are examples of natural oestrogens? And examples of synthetic?

A

Natural:
1. Estradiol
2. Estrone
3. Estriol

Synthetic:
1. Ethinylestradiol
2. Mestranol

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5
Q

What are the side effect of Oestrogens?

A

Thromboembolism

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6
Q

What is the nature of Tibolone?

A

It has oestrogenic, progestogenic & weak androgenic activity

And it is given continuously without cyclical progestogen

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7
Q

Which patients should receive Progestogen?

A

Women with a uterus on long term therapy to reduce risk of cancer and cystic hyperplasia.

It is added to oestrogen regimens

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8
Q

What can be given as an alternative to oestrogen for menopausal symptoms?

A

Clonidine but can cause difficult side effects

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9
Q

What are the risks of HRT?

A
  1. Endometrial cancer (risk reduced by progestogen
  2. Venous thromboembolism
  3. Stroke
  4. Breast cancer
  5. Ovarian cancer
  6. Coronary heart disease
  7. CHD in women who started combined HRT more than 10 years after menopause
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10
Q

Which HRT medications increase the risk of breast cancer?

A

All types of HRT, including tibolone.
Increase in cancer within 1-2 years of initiating treatment

Increase risk is related to duration of HRT.

The risk disappears within 5 years of stopping

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11
Q

What does the risk of Endometrial cancer depend on?

A

It depends on the dose and duration of oestrogen-only HRT

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12
Q

What can reduce the risk of Endometrial cancer?

A

The addition of a progestogen cyclically (10 days per 28 day cycle).

Risk is eliminated if progestogen is given continuously but higher risk of breast cancer

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13
Q

Which HRT regime increases the risk of ovarian cancer and Venous Thromboembolism? When does the risk disappear?

A

Long term use of combined HRT or oestrogen-only HRT.

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14
Q

Which HRT drugs and regimens increase the risk of stroke?

A

Combined HRT or Oestrogen only HRT increases stroke slightly. But more with older women, as risk increases with age.

Tibolone increases risk 2.2 times from the 1st year of treatment

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15
Q

When is Oestrogen given alone?

A

For continuous use in women without a uterus (except endometriosis, then add progesterone)

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16
Q

When is Oestrogen & Progesterone used together?

A

Only for women with uterus

Cyclical progesterone is given for the last 12-14 days of cycle or can be given continuously

17
Q

What should happen to HRT for surgeries?

A

Stop HRT 4-6 weeks before surgery and restart after full patient mobilisation.

If HRT cannot be stopped (like due to non-elective surgery), give prophylaxis with unfractionated or LMWH heparin & graduated compression hosiery

18
Q

When most HRT be stropped?

A
  • Sudden severe chest pain (even if not radiating to left arm)
  • Sudden breathlessness (or cough with blood stained sputum)
  • Unexplained swelling or severe pain in calf of one leg
  • Severe stomach pain
  • Prolonged immobility after surgery or leg injury
  • Hepatitis, jaundice, liver enlargement
  • Severe neurological effects like severe headaches, hearing disturbances, loss of vision, epileptic seizures, fainting etc
19
Q

Examples of sex hormones?

A
  • Ethinylestradiol
  • Raloxifene
20
Q

Learning points for Ethinylestradiol?

A
  • Licensed for short term symptoms of oestrogen deficiency
  • Osteoporosis prophylaxis
  • Female hypogonadism & menstrual disorders
21
Q

Learning points for Raloxifene?

A
  • Treatment & prevention of postmenopausal osteoporosis
  • Unlike HRT, it does not reduce menopausal vasomotor symptoms like hot flushes
22
Q

What are the two main groups of progestogens

A
  1. Progesterone & its analogues (e.g. dydrogesterone & medroxyprogesterone acetate
  2. Testosterone analogues (e.g. noretgisterone & norgestrel)
23
Q

What are examples of derivatives of norgestrel?

A
  • Desogesterel
  • Norgestimate
  • Gestodene

Levonorgestrel is an active isomer of norgestrel and has twice its potency

24
Q

Why must progestogen be added to oestrogen for women with a uterus?

A

To prevent cystic hyperplasia of the endometrium and possibly transform into cancer

Can be added on cyclically or continuous basis

25
Q

Examples of Oral contraceptions?

A
  • Desogestrel
  • Gestodene
  • Levonorgestrel
  • Norethisterone
  • Norgestimate

In either combined or progestogen-only

26
Q

What is the name of a commonly used Progesterone receptor modulators?

A

Ulipristial acetate

(Note that it also has a partial progesterone antagonist effect)

27
Q

What is Ulipristial acetate for?

A

Fibroids & hormonal emergency contraception

Can also be considered if haemoglobin levels are more than 102g/l

28
Q

What is Androgens and what are the learning points for it?

A

A male sex hormone that causes masculinisation.
It inhibits pituitary gonadotropin secretion and depress spermatogenesis.
It has an anabolic action in normal men.

  • It is used as replacement therapy in castrated adults and those who are hypogonadal

Example include: Testosterone (Testogel, testim, tostran

29
Q

Examples of Anti-androgens?

A
  • Cyproterone acetate
  • Dutasteride & Finasteride
30
Q

What is Cyproterone acetate for?

A

Treatment of severe hyper sexuality & sexual deviation in men

31
Q

What are the uses of Dutasteride & Finasteride?

A

They are alternatives to alpha blockers in men with enlarged prostate

  • Low strength Finasteride is used to treat male baldness
  • The use of Finasteride with doxazosin in management of benign prostatic hyperplasia
32
Q

What are the cautions of Dutasteride & Finasteride?

A
  1. Both decrease serum concentration of prostate cancer markers
  2. Both excreted in semen - use condom if planning pregnancy or pregnant
  3. Women should avoid handling crushed/broken tabs n caps
33
Q

What are the side effects of Dutasteride & Finasteride?

A
  1. Impotence
  2. Decreased libido
  3. Ejaculation disorders
  4. Breast tenderness
  5. Breast enlargement
34
Q

What is the drug action for Finasteride?

A

A specific inhibitor of the enzyme 5 alpha reductase, which metabolises testosterone into the more potent androgen, dihydrotestosterone

35
Q

What are the indications for Finasteride?

A
  1. Benign prostatic hyperplasia - 5mg daily
  2. Alopecia in men - 1mg daily
36
Q

What are the MHRA advices for Finasteride?

A
  • Reports of suicidal thoughts and depression in men taking for male pattern baldness
  • Cases of male breast cancer also reported

Endocrine (7 decks)

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