HRT

Question 1

Define Menopause

Answer 1

Permanent cessation of menstruation due to loss of follicular activity

Question 2

Average age of onset of menopause in UK

Answer 2

51

Question 3

List symptoms of Menopause

Answer 3

Vasomotor Symptoms (hot flushes, night sweats, palpitations)

Urogenital tissue atrophy (causes vaginal dryness + painful intercourse)

Osteoporosis (loss of calcium from bones)

Psychological problems (mood changes, irritability, sleep disturbance, depression)

Coronary Heart disease

Question 4

When to use HRT?

Answer 4

Used for symptomatic relief of menopausal symptoms

When symptoms are affecting quality of life

Try use LOWEST effective dose for SHORT period of time

Treatment reviewed ANNUALLY

Question 5

Contraindications of HRT

Answer 5

Oestrogen dependent cancer

History of breast cancer

Active thrombophlebitis (inflammation of vein after blood clot)

Liver disease

Active/recent arterial thromboembolic disease (MI)

VTE/Venous thromboembolism

Undiagnosed vaginal bleeding

Question 6

Mainstay of HRT

Answer 6

Oestrogen

Question 7

Prescribed formulations for HRT

Answer 7

Tablets containing equine (horse) oestrogen (common)

Natural oestrogens e.g. oestrodiol, estrone + estrol (found in human female only)

• available as tablets, patches, gels, vaginal creams, + rings
• reduces risk of oestrogenic effects (e.g. raised BP + altered coagulation factors)

Local oestrogen replacement used to reverse vagina ATROPHY symptoms (e.g. thining, drying + inflamation)

Only used alone in women who have had an HYSTERECTOMY

Question 8

Why is progestogens added to oestrogen in HRT?

Answer 8

For a few days a month, it is used to protect the ENDOMETRIUM from HYPERPLASIA for a women with an INTACT UTERUS

• to reduce risk, progestogen must be taken for a minimum of 10 days per 28 day cycle

Commonly used derivatives of progestogens in HRT incl. dydeogesterone, medroxyprogesterone, 19-nortestosterone

Administered ORALLY/TRANSDERMALLY

Question 9

Oestrogen + progestogen regimens

Answer 9

Sequential combined HRT

• MONTHLY bleeds
• Continuous oestogen
• MONTHLY progestogen

Tricyclic combined HRT

• 3-MONTHLY bleeds
• Continuous oestrogen
• 3-MONTHLY progestogen
• Breakthrough bleeding possible

Continuous combined HRT

• CONTINUOUS oestrogen + PROGESTOGEN
• licensed for POSTMENOPAUSAL women

Question 10

Tibolone

Question 11

Raloxifene

Question 12

Benefits of HRT

Question 13

Use of vaginal oestrogen