HRT in Menopause Flashcards
What is the difference between menopause, peri-menopause and post-menopause?
Menopause = final menstrual period
Peri-menopause = trasition to end of woman’s reproductive life:
- Menstrual cycle changes in length
- Symptoms: Heightened symptoms
- Takes about 10 years
Post-menopause = 12 months after final menstrual period.
Symptoms of menopause:
- Joint aches, muscle pains
- Hot flushes and night sweats
- Loss of libido and mood swings
- Urogenital: Dry vagina, urinary frequency/incontinence, painful sex
- Skin: Dry, thin
What are some causes of premature ovarian insufficiency?
- Fragile X
- Turner syndrome
- Autoimmune
What are two agreed and two non-agreed indications for menopausal hormone therapy (MHT)
Agreed:
- relief of menopause
- Maintenance of bone density / prevention of osteoporotic fracture
Non-agreed
- Prevention of CVD
- Prevention of dementia
What different benefits do oestrogen and progestogen provide in MHT?
Oestrogen
- Relief of menopausal symptoms
- Preservation of bone density
Progestogen
- Protect endometrium from stimulatory effects of oestrogen
- NO BENEFIT IN WOMEN WITH HYSTERECTOMY
What are the two types of regimens used in MHT, and for who do we use them?
Cyclical
- Continuous oestrogen, cyclical progestogen
- Will still get periods
- Use for women <12 months post last menstrual period
Continuous
- Continuous oestrogen and progestogen
- Use for women >12 months post last menstrual period
Risk of breast cancer with HRT?
Strategies to alleviate?
Progestogen has been linked to an increased risk of breast cancer.
STrategies:
- Reduce dose
- Substitute with SERM
True or false: Addition of progestogen to oestrogen therapy decreases cardiovascula benefit and increases breast cancer risk?
True.
Oestrogen is the most effective therapy for menopause.
Addition of progestogen has an adverse effect on CVD and breast cancer risk.
Modification of progestogen and replacement by SERM is being explored.
