Hormones and HRT etc

Question 1

What is danazol licensed for?

Answer 1

• Treatment of endometriosis
• relief of severe pain and tenderness in benign fibrocystic breast disease.

-hereditary Angioedema (unlicensed)

Question 2

How does cetrorelix and Ganirelix work? What is it used for?

Answer 2

LH releasing Hormone antagonist, inhibits the release of gonadrotrophins.

Can be used in the treatment of infertility

Question 3

What are gonadorelin analogues used for?

Answer 3

Used for the treatment of :

• endometriosis
• precocious puberty
• infertility
• male hypersexuality

Question 4

What are the other drug treatments for endometriosis?

Answer 4

1. 3 month trial of non-Opioids analgesics.
2. If pain management is inadequate, hormone treatment (with COC or PO) should be offered to women with suspected, confirmed or recurrent endometriosis.

Question 5

Which oestrogens are better for HRT?

Answer 5

Natural oestrogens: estradiol, estrone, estriol

More appropriate profile compared to synthetic oestrogens.

Question 6

What are the two ways that oestrogen therapy can be given?

Answer 6

• Continuously

- cyclically

Question 7

What activity does tibolone have?

Answer 7

Oestrogenic, progestrgenic and weak androgenic activity

Question 8

What HRT therapy is offered to women (and women with a uterus) to alleviating menopausal symptoms ? (Vaginal atrophy, vasomtor instability etc)

Answer 8

HRT with small doses of an oestrogen (+ progrestrogen in women with a uterus)

Question 9

What hormone therapy can be offered for dismissing post menopausal osteoporosis?

Answer 9

• oestrogen given systemically in the peri and post menopausal stage.
• or tibolone given in the post menopausal period.

Question 10

What hormone can be given to allievate oestrogen deficiency symptoms such as vasomotor symptoms?

What is the non hormone alternative?

Answer 10

• tibolone
• give continuously, without cyclical progestogen

Alternative: Clonidine, but may cause unacceptable SEs.

Question 11

Can HRT be given to women with early menopause (below age 45)? If so, For how long?

Answer 11

• Yes it can for natural or surgical menopause.
• They are at high risk of osteoporosis.

-HRT can be given until the approx age of natural menopause (approx age 50)

Question 12

What risk factors does HRT increase?

Answer 12

VTE
Stroke
Endometrial cancer (reduced by progestogens)
Ovarian cancer
Breast cancer 

There is an increased risk of CHD in women who start combined HRT more than 10 years after menopause

Question 13

Explain the risk of breast cancer with HRT

Answer 13

• Increases risk within 1-2 years of starting treatment.
• the increased risk is related to the duration of HRT use.

-the excess risk disappears within 5 years of stopping.

-

Question 14

Explain the risk if endometrial cancer with HRT

Answer 14

Increased risk depends on the dose and duration of oestrogen only HRT.

Women with a uterus add cyclical progestrogen (for at least 10 days of the 28 day cycle)= this reduces the risk.

Risk is eliminated if progestrogen is given continuously, however risk vs benefit ratio should be discussed.

Question 15

Explain the risk of stroke with HRT?

Answer 15

Risk of t=stroke increases with age, therefore older women have a greater absolute risk of stroke.

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

Question 16

Explain the risk of VTE with HRT

Answer 16

-Women using oestrogen only or combined HRT are at an increased risk of VTE especially in the 1st year of treatment.

Question 17

When should HRT be stopped before a major surgery?

Answer 17

4-6 weeks before surgery

Question 18

What are the advantages of COC?

Answer 18

• reliable and reversible
• reduced dysmenorrhea and menorrhagia
• reduced incidence of premenstural tension
• less symptomatic fibroids and function ovarian cysts
• less benign breast disease
• reduced risk of ovarian and endometrial cancer
• reduced risk of PVD