HRT for menopause

Question 1

menopause

Answer 1

the final menstrual period

Question 2

mean age of menopause

Answer 2

50-52

Question 3

peri-menopause

Answer 3

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

Question 4

post menopause

Answer 4

12 months after the final period

Question 5

early menopause

Answer 5

last period 40-45 years

Question 6

premature menopause

Answer 6

premature ovarian insufficiency POI
last period before 40 years
may be spontaneous, surgical or drug induced

Question 7

the symptoms of menopause

Answer 7

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

Question 8

diagnosing menopause

Answer 8

indications for treating are clinical - no need to check FSH, LH estradiol or testosterone
blood test results will not influence management decisions

Question 9

causes of premature ovarian insufficiency

Answer 9

idiopathic 
X chromosome disorders - Turner syndrome, fragile X 
autoimmune 
surgical 
previous chemoRx, DXRT

Question 10

menopause time is good time to do a health audit

Answer 10

fasting glucose 
lips 
bone density 
BMI 
smoking, alcohol 
mammogram

Question 11

indications for MHT

Answer 11

relief of menopausal symptoms

maintenance of bone density and prevention of osteoporotic fracture

Question 12

non-agreed indications for MHT

Answer 12

primary prevention of CVD

primary prevention of dementia

Question 13

oestrogen provides

Answer 13

relief of menopausal symptoms - flushes, tiredness, moods

preserves bone density, lowers cardiovascular risk if started early

Question 14

progestogen provides

Answer 14

protects the endometrium from the stimulatory effects of oestrogen

Question 15

for women with no uterus

Answer 15

NO progestogen

Question 16

in women less than 12 months post last manstural period

Answer 16

use cyclical MHT

the endometrium still has endometrial thickening - prevent breakthrough bleeding

Question 17

in women more than 12 months past menopause

Answer 17

may change to continuous MHT

if still getting breakthrough bleeding - go back to cyclical

Question 18

3 types of MHT preparations

Answer 18

• oestrogen only (women with no uterus)
• oestrogen combined with cyclical progestogen (regular bleed MHT)
• oestrogen combined with continuous progestogen (no bleed MHT)

Question 19

MHT and breast cancer

Answer 19

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

Question 20

replace the progestogen wth a SERM

Answer 20

selective oestrogen receptor modulator
antoganosises eostorgen effect in only some tissues
breast and uterus doesn’t respond to the oestrogen as much

Question 21

proposed mechanisms for protective effect on cardiovascular disease

Answer 21

• lipoprotein effects (raised HDL, lowered LDL
• antioxidant effects
• lowering of insulin resistance
• progestogen antagonises beneficial effect of oestrogen

Question 22

weight gain in MHT

Answer 22

reduced oetrogen associated with increased central abdominal fat deposition
MHT does not cause weight gain

Question 23

contraindications to MHT

Answer 23

• VTE - use transdermal
• endometriosis - use oestrogen + progestogen even is prior hysterectomy
• migraine - use transdermal
• BRCA mutations