HRT

Question 1

Name 3 HRT formulations for hysterectomized patients

Answer 1

• Oestrogen therapy only (ET)
• conjugated oestrogens
• Estradiol

Question 2

Name 2 HRT formulations for patients with intact uterus and 1 contraindication.

Answer 2

•Oestrogen and progesterone / progestogen therapy (ept)

• <12 months amenorrhea: sequential EPT thus monthly withdrawal bleeds
• > 12: continuous combined thus no bleeding.

• P only for endometrial protection

oestrogen only therapy will cause endometrial hyperplasia and may cause atypia/endometrial cancer may develop so absolutely contraindicated!

Question 3

Name 10 absolute contraindications HRT post-menopausal women.

Answer 3

• Previous DvT /pe
• inherited thrombophilia (factor 5 Leiden etc)
• breast cancer and family history
• liver disease
• abnormal uterine bleeding: organic disease must be investigated and treated (endometrial hyperplasia, polyp)
• endometrial cancer
• ovarian cancer
• uncontrolled ht, dm, hypercholesterolaemia
• IHD
• smoking

Question 4

Name 4 side effects HRT postmenopausal women

Answer 4

• Cardio and cerebrovascular disease: Do not prescribe if primary or secondary disease. Of no use in Alzheimer’s. > 60 increased risk mi and cva.
• dvt or pe: increased risk especially first 6-12 months of treatment.
• endometrial carcinoma if take et only
• breast cancer: > 5 years therapy increased risk.

Question 5

Describe moa oestrogen and progesterone / progestogens in HRT? (4)

Answer 5

• Steroid hormones
• involve intracellular R which lead to altered gene expression.
• oestrogen stim synthesis progesterone R
• progesterone inhibit synthesis oestrogen R

Question 6

Name 2 main groups progestogens with examples each.

Answer 6

• Natural occurring hormone and its derivatives: hydroxyprogesterone, medroxyprogesterone, dydrogesterone, micronized progesterone
• testosterone derivatives: norethisterone, norgestrel, gestodene, desogestrel