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PHA332 > HRT > Flashcards

HRT Flashcards

1
Q

What is peri menopause?

A

Time before last menstrual period when ovarian activity slows and oestrogen levels start to fall (can last several years)

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2
Q

What is menopause?

A

The time when menstruation ceases permanently due to the loss of ovarian follicular activity. Occurs with final menstrual period diagnosed clinically after 12 months of amenorrhoea

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3
Q

What is post menopause?

A

Time after last menstrual period

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4
Q

What happens to the levels of oestrogen, FSH and LH?

A

Oestrogen levels decrease, FSH and LH rise

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5
Q

When does early menopause occur?

A

Before 45

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6
Q

What is premature ovarian insufficiency?

A

Menopause before the age of 40 years

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7
Q

What are the causes of early menopause?

A

Family history, premature ovarian failure, radiotherapy, chemotherapy, hysterectomy, infection (mumps, TB, malaria - very rare)

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8
Q

How to diagnose menopause?

A
  • Over 45 with irregular periods: no tests required
  • Under 45 may test FSH, if raised very likely
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9
Q

What are symptoms of menopause?

A
  • Vaginal symptoms (dryness, discomfort, itching and dyspareunia)
  • Hot flushes
  • Night sweats
  • Anxiety & depression
  • Brain fog
  • Insomnia
  • Urinary problems
  • Headaches, joint and muscle pains
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10
Q

What are long term physical effects of menopause?

A
  • Thinning of skin & hair
  • Bone mass lost, more prone to breaking
  • Dryness of eyes, mouth & throat
  • Atrophy of breasts, endometrium, vagina, vulva, pelvic muscles
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11
Q

What are associated problems of menopause?

A
  • Increased risk of osteoporosis, CVD, dementia
  • Breast cancer risk increases with HRT therapy
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12
Q

What are the treatment options for menopause?

A
  • Lifestyle advice
  • Weight management and exercise
  • Wear lighter/cooler clothes
  • Avoid triggers to hot flushes - caffeine, spicy foods
  • Sleep hygiene
  • Sleep in a cooler room
  • Reduce stress
  • Relaxation techniques
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13
Q

How to manage menopause without HRT?

A
  • Antidepressants
  • Vaginal moisturiser e.g. Replens
  • Clonidine 50-75mcg BD
  • Psychotherapy, counselling, homeopathy, supplements
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14
Q

What are the benefits of HRT?

A
  • Treating vasomotor symptoms (night sweats and hot flushes)
  • Treating urogenital symptoms (vaginal dryness)
  • Managing sleep/mood disturbances
  • Preventing osteoporosis
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15
Q

What do HRT medicines do?

A

Deliver a set dose of oestrogen into the bloodstream

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16
Q

What does oral oestrogen do?

A

Increases sex hormone binding globulin (SHBG) so reducing free androgen index (lowers libido even more)

17
Q

If a patient has a hysterectomy what do they not require?

A

Progesteron

18
Q

What is oestrogen best as?

A

17 betaestradiol

19
Q

What choice of progesterone is given?

A

Utrogestan prescribed cyclically
> 200mg each evening for 2/4 weeks (10 days taking POP)
or 100mg each evening

20
Q

What are the 4B’s (adverse effects) of progesterone?

A

Bloating, breast tenderness, bleeding, blues

21
Q

What is the IUD Mirena?

A

Alternative route of delivery of progestogen to protect endometrium
Low bleed risk, safe for up to 5 years

22
Q

Is vaginal oestrogen HRT and how is it used?

A

No, applied to the vagina for vaginal atrophy e.g. ortho gynest, vagifem pessaries

23
Q

What does testosterone do when added to HRT?

A

Improves sexual function, general wellbeing and improves libido

24
Q

What to do when stopping HRT in an emergency?

A
  • Stop 4-6 weeks before surgery
  • DVT risk
  • Severe stomach pain, calf pain in one leg, neuro effects
  • BP > 160/100
25
Q

When to stop HRT?

A

Trial withdrawal after 1-2 years if symptom free (gradual reduction of dose)

26
Q

Does HRT provide contraception and what age are they fertile till?

A

No
- Under 50: fertile for 2 years after last period
- Over 50: fertile for 1 year after last period
- Over 55: considered infertile

PHA332 (14 decks)

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