HRT - Hormone Replacement Therapy Flashcards
Background
NOTE MORE INFO IN THE T100
and menopause section
HRT is oestrogen + Progestogen to remove symptoms of menopause
Complications/Benefits of HRT
COMPLICATIONS:
- VTE - Increased with combined/oestrogen HRT esp in 1st yr. > risk oral vs patch. Patch 1st IF VTE risk and BMI>30.
- Stroke - Risk increases with age. HRT slight increase risk. Tibolone higher increase.
- CVD - No affect IF started on <60 yrs
- Increases risk of CHD in women who start 10 yrs after menopause
OBE cancers
- Ovarian cancer increased risk with long use but disappears within few years of stopping.
- Breast cancer - ALL HRT (inc tibolone) increases risk within 1 yr. of use. CHC> increase than others. Longer use further increases risk. Risk disappears within 5 yrs of stopping.
- Endometrial cancer - depends on dose & duration of oestrogen only HRT. Progesterone’s cyclically reduce risk (in women with uterus). Risk is eliminated if progesterone given continuously but increases breast cancer risk.
BENEFITS:
- Osteoporosis - Risk of fragility fracture decreased with HRT.
- VMS symptoms reduced
- Atrophy of urogenital organs reduced
PRSC notes
HRT
Uses minimum effective dose for shortest duration - Review at least annually and consider ALT treatments for osteoporosis
- Benefits of short term treatments outweighs long term risk esp in <60s
Oestrogen:
For HRT can get natural or synthetic.
- Natural better for HRT
Oestrogen can be given cyclically or continuously. Oestrogen can cause VTE.
- Progesterone ADDED to women with a uterus on long term therapy to reduce cancer/cystic hyperplasia.
- Progesterone’s dont cause VTE. They only work with women who has a uterus.
Tibolone - Combines oestrogenic/ Progestogenic activity with androgenic activity given WITHOUT Cyclical progesterone - not needed as already has progesterone activity
Clonidine - Used to reduce menopausal symptoms if unable to use oestrogen.
- Can cause BAD AEs
Ethinylestradiol (HRT a oestrogen)
- Short term symptoms of oestrogen deficiency
- Osteoporosis prophylaxis
- Female hypogonadism & menstrual issues
Raloxifene:
- Treatment & prevention of postmenopausal osteoporosis
unlike HRT dont reduce VMS
Starting and stopping HRT/ Surgery
Vaginal bleeding can occur for 1st 3 months WHEN USING HRT should report at 3 month appointment. Can gradually reduce or rapid stop HRT.
- Gradual reduce = decrease short term symptom. Long term no difference.
Symptoms that mean STOP HRT(EXAM Q)
- Sudden severe chest pain/Breathlessness,
- Unexplained swelling or severe pain in one leg,
- Sever stomach pain,
- serious neurological effects (visual issues, headaches, seizure, 1 side numb, fainting),
- Hepatitis, Jaundice, Liver enlargement
- Prolonged immobility after surgery or leg injury
Women with, or at high risk of, breast cancer:
- Give info on treatment available
- Inform that SSRi’s paroxetine and fluoxetine AVOID WITH TAMOXIFEN
Surgery
Major surgery is a predisposing factor of VTE
- STOP HRT 4/6 weeks b4 surgery and restart after full PT mobilisation
IF CANT STOP - prophylaxis with LMWH
