HRT

Question 1

HRT post hysterectomy?

Answer 1

oestrogen only

• elleste solo (PO), evorel (patch, transdermal), sandrena (PV gel)

Question 2

what is the 1st line PO oestrogen?

Answer 2

elleste solo

Question 3

what is the 1st line transdermal oestrogen?

Answer 3

evorel (twice weekly regime)

Question 4

how can progesterone be added to HRT regime (if not on combination therapy)

Answer 4

• IUS mirena (4 yrs)
• medroxyprogesterone acetate (Provera, PO)
• Utrogestan PO

Question 5

examples of combined cyclical HRT

Answer 5

• elleste duet (oestrgiol + norethisterone) - 1st line PO
• evorel sequi (oestradiol + norethisterone), 1st line transdermal

Question 6

formulations of continuous HRT?

Answer 6

• indicated after menopause, no bleed
• kilovance (E + norethisterone), PO , 1st line oral
• evoral conti - E + N, 1st line transdermal

Question 7

oestrogen SE

Answer 7

• breast tenderness
• nipple sensitivity
• bloating
• leg cramps
• nausea/heartburn
• headaches

Question 8

how to manage HRT SE?

Answer 8

• wait if just started Tx - most settle in 3/12
• if severe reduce dose
• consider change from PO to transdermal

Question 9

SE of progesterones

Answer 9

• PMS symptoms
• mood changes
• breast tenderness
• bloating
• headache
• acne/greasy skin

Question 10

risks of HRT

Answer 10

• cancer
  
  • E only - breast + endometrial
  • combined - breast (more than E alone)
• VTE (reduced if transdermal E)

Question 11

what should be monitored on hormonal treatments?

Answer 11

BP

weight

Question 12

non hormonal menopause treatment

Answer 12

• vasomotor
  
  • SSRI (fluoxe) → citalo/venla
• dryness → lubricants
• bone protection - bisphosphonates