HRT Flashcards
HRT
Helps alleviate symptoms of menopause e.g. hot flushes, vaginal dryness, vaginal atrophy, sexual dysfunction, bone loss
Early and natural menopause
Below 45 years (at risk of OP) and 50 years
Natural oestrogens - can cause VTE
Estradiol, estrone and estriol
Synthetic oestrogens
Ethinylestradiol
Tibolone
Oestrogenic, progestogenic, and weak androgenic activity
How can oestrogen be given?
Cyclically or continuously
When can progestogen be given?
With a women with an intact uterus (reduce endometrial cancer) -contin/cyclically increase the risk of breast cancer
When can clonidine be given?
For women who cannot take oestrogen
Risks of HRT?
- Breast cancer (all types of HRT)
- Endometrial cancer (reduce by progestogen)
- Ovarian cancer
- Risk of stroke
- VTE
- CHD risk (greater than 10 years after meno)
Risk of breast cancer
Increased - within 1-2 years of starting
Risk is related to the duration of HRT and disappears within 5 years of stopping
Risk of endometrial cancer
Dose and duration dependent of oestrogen only HRT
Cyclically 10/28 days - progestogen reduces risk, can be given contin - but increased risk of breast cancer
Risk of VTE
In the first year of use - increased risk
Pre-disposing factors e.g. trauma, obese - prolonged immobility - risk
Risk of stroke
Increases with age
Tibolone - increased risk of stroke, 2.2 times from the 1st year of treatment
Risk of CHD
Increased risk of CHD who start combined HRT after 10 years starting menopause
When can oestrogen be given on its own?
Without a uterus - except endometrosis (can given progresterone)
