HRT for menopause Flashcards
menopause
the final menstrual period
mean age of menopause
50-52
peri-menopause
menstrual cycle begin to change in length and symptoms may begin to occur (takes about a decade, hormonal swings and heightened symptoms)
ovarian supply of oocytes declines steeply
post menopause
12 months after the final period
early menopause
last period 40-45 years
premature menopause
premature ovarian insufficiency POI
last period before 40 years
may be spontaneous, surgical or drug induced
the symptoms of menopause
hot flushes, night sweats, insomnia mood and memory changes
joint aches and muscle aches
palpitations and lightheadedness
urogenital - dry vagina/dyspareunia, urnary frequency, UTI, incontinence
dry skin
increased facial hair
loss of libido
diagnosing menopause
indications for treating are clinical - no need to check FSH, LH estradiol or testosterone
blood test results will not influence management decisions
causes of premature ovarian insufficiency
idiopathic X chromosome disorders - Turner syndrome, fragile X autoimmune surgical previous chemoRx, DXRT
menopause time is good time to do a health audit
fasting glucose lips bone density BMI smoking, alcohol mammogram
indications for MHT
relief of menopausal symptoms
maintenance of bone density and prevention of osteoporotic fracture
non-agreed indications for MHT
primary prevention of CVD
primary prevention of dementia
oestrogen provides
relief of menopausal symptoms - flushes, tiredness, moods
preserves bone density, lowers cardiovascular risk if started early
progestogen provides
protects the endometrium from the stimulatory effects of oestrogen
for women with no uterus
NO progestogen
in women less than 12 months post last manstural period
use cyclical MHT
the endometrium still has endometrial thickening - prevent breakthrough bleeding
in women more than 12 months past menopause
may change to continuous MHT
if still getting breakthrough bleeding - go back to cyclical
3 types of MHT preparations
- oestrogen only (women with no uterus)
- oestrogen combined with cyclical progestogen (regular bleed MHT)
- oestrogen combined with continuous progestogen (no bleed MHT)
MHT and breast cancer
unopposed oestrogen therapy decreased risk of breast cancer diagnosis and mortality in hysterectomised women
increased risk of breast cancer associated with MHT estimated at less than 0.1% per annum per 100 women per year of use
neither treatment associate with increased risk in mortality
replace the progestogen wth a SERM
selective oestrogen receptor modulator
antoganosises eostorgen effect in only some tissues
breast and uterus doesn’t respond to the oestrogen as much
proposed mechanisms for protective effect on cardiovascular disease
- lipoprotein effects (raised HDL, lowered LDL
- antioxidant effects
- lowering of insulin resistance
- progestogen antagonises beneficial effect of oestrogen
weight gain in MHT
reduced oetrogen associated with increased central abdominal fat deposition
MHT does not cause weight gain
contraindications to MHT
- VTE - use transdermal
- endometriosis - use oestrogen + progestogen even is prior hysterectomy
- migraine - use transdermal
- BRCA mutations
