HRT

Question 1

what is the menopause

Answer 1

permanent cessation of menstruation resulting from loss of activity from ovarian follicles

Question 2

women are potentially fertile for:

Answer 2

if <50 y/o - 2 years after last period
if <50 y/o - 1 year after last period

Question 3

steps in menopause

Answer 3

1. number of eggs decrease until there are none left
2. follicular activity falls
3. oestrogen levels fall causing symptoms
4. negative feedback loop on pituitary starts to fail
5. FSH and LH levels rise to establish menopausal pattern

Question 4

perimenopause

Answer 4

gradual onset of endocrine changes as ovaries start to fail, approx 4 years

Question 5

premature menopause

Answer 5

when the menopause occurs before 40 y/o

Question 6

post menopausal

Answer 6

after 12 months of spontaneous amenorrhoea

Question 7

short term symptoms of menopause

Answer 7

menstrual changes, mood changes, irritability, sleep disturbance, depression, joint pain, vaginal dryness, urinary symptoms

Question 8

long term symptoms of menopause

Answer 8

osteoporosis, increased CVD risk

Question 9

what is hormone replacement therapy

Answer 9

aims to maintain near normal plasma oestrogen levels to reinstate negative feedback loop

Question 10

HRT for women with uterus

Answer 10

oestrogen and progesterone to stop endothelium overproduction

Question 11

HRT for women with no uterus

Answer 11

oestrogen alone

Question 12

oestrogen therapy

Answer 12

uses naturally occurring oestrogens, causes increased lipid profile, blood pressure and blood clotting

Question 13

side effects of oestrogen therapy

Answer 13

nausea, vomiting, bloating, cramps, weight gain, breast tenderness, sodium and fluid retention

Question 14

progesterone therapy

Answer 14

needed for a minimum of 10 days per cycle, all artificial. less adrenergic - medroxyprogesterone, more adrenergic - levonorgestrel

Question 15

side effects of progesterone

Answer 15

less adrenergic - bloating, mood changes, breast tenderness
more adrenergic - greasy, off-sets some positive effects of oestrogen

Question 16

sequential combined HRT

Answer 16

used in perimenopausal stage to mimic natural hormone levels

Question 17

tricyclic combined

Answer 17

borderline post menopausal, one bleed every three months

Question 18

transdermal

Answer 18

less day to day variation and produces a more natural ratio, by passes FPM lower VTE risk

Question 19

vaginal

Answer 19

monotherapy when vaginal/bladder symptoms predominate

Question 20

systemic

Answer 20

tablets, gels, spray etc - for vasomotor and other symptoms

Question 21

risks of HRT

Answer 21

VTE, breast cancer - risk reduced after 1 year, endometrial cancer- reduced if progesterone is taken, ovarian cancer, stroke and CVD (non-conclusive)

Question 22

short term HRT benefits

Answer 22

symptomatic control; headaches, hot flushes, sweats, mood changes, libido, hair loss, irregular menstration

Question 23

long term HRT benefits

Answer 23

reduced osteoporosis risk as oestrogen rebalances bone resorption

Question 24

MRHA advice

Answer 24

used in the minimum effective dose for the shortest duration if there is symptoms

Question 25

other treatments for the menopause

Answer 25

tibolone - 2.5mg OD, gonad mimetic, mixed oestrogenic, progestogenic and androgenic activity
clonidine - 50mcg BD to 75mcg BD, for vasomotor symptoms

Question 26

unlicensed medications for the menopause

Answer 26

SSRIs
Gabapentin
Pregabalin