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Women’s Health > HRT > Flashcards

HRT Flashcards

1
Q

What are the benefits of HRT?

A

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

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2
Q

What are the risks associated with HRT?

A

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

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3
Q

At what time does HRT increase risk of CHD?

A

10 years post menopause

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4
Q

What is the risk of ovarian cancer?

A

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

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5
Q

What is the risk of breast cancer?

A

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

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6
Q

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

A

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.

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7
Q

Who needs contraception with HRT?

A

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

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8
Q

When should follow-up be booked after commencing HRT?

A

3 months from start or if changed, and annually thereafter

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9
Q

What are the indications for initiation of HRT?

A

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

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10
Q

Initial HRT history

A

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

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11
Q

What is the average age of menopause?

A

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

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12
Q

What is postmenopausal bleeding?

A

PV bleeding after a 12 month period of amennorhea

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13
Q

What are the contraindications to HRT?

A

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

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14
Q

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

A

False

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15
Q

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

A

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

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16
Q

What blood test would indicate meonpause?

A

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

17
Q

What’s the difference between progesterone and progestogen?

A

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

18
Q

List the common types of progestogens

A

Norethisterone
Levonorgestrel
Medroxyprogesterone
Dydrogesterone
Norgestrel
Drospirenone

19
Q

What hormone is in the mirena?

A

Levonorgestrel

20
Q

How long can you use the mirena with HRT?

A

5 years and then it needs replaced

21
Q

What’s a benefit associated with dydrogesterone?

A

Lowers lipid profile

22
Q

What is a benefit associated with drospirenone?

A

Reduced fluid retention

23
Q

What are the side effects of progestogens?

A

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

24
Q

What is the montly cyclical regiment for HRT?

A

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

25
Q

Advice on using vaginal oestrogen?

A

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

26
Q

In which people is transdermal preparations appropriate?

A

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)

27
Q

What is available as a transdermal prep?

A

Gel
Spray
Patch

28
Q

What are the side effects of oestrogen therapy?

A

Fluid retention
Bloating
Breast tenderness
Nausea
Headaches

29
Q

Which women could use tesoterone treatment?

A

Low libido
Low energy
Low mood

Women’s Health (2 decks)

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