HRT

Question 1

What are the benefits of HRT?

Answer 1

Reducing risk of osteoporosis
Redcue incidence of hot flushes
Improves sleep
Reduces myalgia
Improves mood
Reduced UTI/atrophic vaginitis

Question 2

What are the risks associated with HRT?

Answer 2

VTE (Oral > transdermal)
CHD
Stroke
Breast cancer
Ovarian cancer
Endometrial cancer

Question 3

At what time does HRT increase risk of CHD?

Answer 3

10 years post menopause

Question 4

What is the risk of ovarian cancer?

Answer 4

1 in 1000 of women who start around the age of 50 and continue for at least 5 years

Question 5

What is the risk of breast cancer?

Answer 5

There is increased incidence inf women regardless of type or delivery of HRT
However, there is no increase in risk of those using vaginal oestrogens

Question 6

Who needs to use protestogen with HRT and for how long?

Answer 6

Any woman with a uterus and for a minimum of 10 days during a 28 day cycle, switching to continuous combined HRT after 1 year removes the risk.

Question 7

Who needs contraception with HRT?

Answer 7

Under 50 - Within 2 years of last menstrual period
Over 50 - Within 1 year of last menstrual period

Question 8

When should follow-up be booked after commencing HRT?

Answer 8

3 months from start or if changed, and annually thereafter

Question 9

What are the indications for initiation of HRT?

Answer 9

Alleviation of menopausal symptoms if they are having a significant effect on life
Those under 45 (due to increased risk of osteoporosis)

Question 10

Initial HRT history

Answer 10

Discuss symptoms
Regularity of periods?
Change in blood loss?
Check risk factors for osteoporosis, CHD, and breast cancer
Does pt have a uterus

Question 11

What is the average age of menopause?

Answer 11

51 +/- 5 years
Early menopause is <45
<40 = premature ovarian insufficiency

Question 12

What is postmenopausal bleeding?

Answer 12

PV bleeding after a 12 month period of amennorhea

Question 13

What are the contraindications to HRT?

Answer 13

History of or current breast cancer
Hsitory of VTE/stroke/MI
Uncontrolled HTN
History of ovarian/endometrial cancer
Abnormal vaginal bleeding
Active liver disease with abnormal LFTs
Pregnancy
Thrombophilic disorders

Question 14

True/False: HRT has an effect on blood glucose control.

Answer 14

False

Question 15

True/False: Women with low thyroid should not take HRT.

Answer 15

False
TSH levels need monitored for 6-12 weeks after starting HRT as dose of levo might need increased

Question 16

What blood test would indicate meonpause?

Answer 16

FSH
Checked on two samples 6 weeks apart ideally (British menopause society)

Question 17

What’s the difference between progesterone and progestogen?

Answer 17

Progesterone is the hormone (P4)
However progestogen is an umbrella terms for various progesterone treatments, including synthetic ones

Question 18

List the common types of progestogens

Answer 18

Norethisterone
Levonorgestrel
Medroxyprogesterone
Dydrogesterone
Norgestrel
Drospirenone

Question 19

What hormone is in the mirena?

Answer 19

Levonorgestrel

Question 20

How long can you use the mirena with HRT?

Answer 20

5 years and then it needs replaced

Question 21

What’s a benefit associated with dydrogesterone?

Answer 21

Lowers lipid profile

Question 22

What is a benefit associated with drospirenone?

Answer 22

Reduced fluid retention

Question 23

What are the side effects of progestogens?

Answer 23

Fluid retention
Breast tenderness
Headaches/migraine
Mood swings
Depression
Acne
(ALL usually occuring cyclically)

Question 24

What is the montly cyclical regiment for HRT?

Answer 24

Daily oestrogen + progestogen for 10-14 days at end of cycle
Ideally 0.5mg/day of norethisterone or 2.5mg/day of medroxyprogesterone

Question 25

Advice on using vaginal oestrogen?

Answer 25

One vaginal tablet daily for 2 weeks, then reduce to one tablet twice weekly One applicatorful daily for 3-4 weeks, then reduce to one applicatorful twice weekly, applied at bedtime One pessary daily for 3 weeks, then reduce to one pessary twice weekly, inserted at bedtime

Question 26

In which people is transdermal preparations appropriate?

Answer 26

Persistent troublesome symptoms with oral treatment Adverse effects with oral History of VTE CVD risks Concomitant hepatic enzyme-inducing drug treatment GI disorder which inhibits absorption Hsitory of migraine or gallbladder disease Lactose sensitivity (most contain lactose)

Question 27

What is available as a transdermal prep?

Answer 27

Gel Spray Patch

Question 28

What are the side effects of oestrogen therapy?

Answer 28

Fluid retention Bloating Breast tenderness Nausea Headaches

Question 29

Which women could use tesoterone treatment?

Answer 29

Low libido Low energy Low mood