HRT, menopause and contraception Flashcards
HRT increases the risk of _____ and _____when combined with progesterone but does not apply for _______
breast cancer
VTE
Transdermal formulations
Risk risk of breast cancer reduces when HRT ________
Is stopped.
Reaches the same level as never taking HRT in 5 years.
Unopposed oestrogen increases the risk of _______
Endometrial cancer
Non-cancerous risks of HRT
Stroke
Ischaemic heart disease
- If taken >10 years post-menopause
Menopause is defined as…
Cessation of menses for at least 1 year
- In age 45+
Perimenopause describes…
Menopausal symptoms/ irregular periods
Complications of menopause
Cardiovascular disease
Osteoporosis
Mood
- Depression/ anxiety
- Irritability
Atrophic vaginitis/ Dyspareunia
Poor hair/ skin
Reduced libido
Symptoms of menopause
Vasomotor symptoms
- Hot flushes/ night sweats
- Palpitations
Mood/ cognition
- Cognitive impairment/ memory problems
- Swings
- Irritability
- Low/ tearful
Urogenitorary
- Vaginal dryness/ itchiness/ bleeding
- Urinary frequency/ incontinence
Sexual function
- Reduced libido
- Dyspareunia
MSK
- Joint and muscle pain
- Fatigue
Premature menopause describes…
Menopause <45 years but >40 years.
Oestrogen only HRT is indicated for _______
Women with no uterus
- No risk of endometrial cancer
Contraindications of oestrogen-containing HRT
VTE
Breast cancer
Immobility
What HRT is indicated in people with a uterus with no risk factors
Combined HRT
________ is indicated first line for vasomotor symptoms
Clonidine
_________ is indicated for mood symptoms if HRT doesn’t work
Duloxetine
Short-term adverse effects of HRT
Breast tenderness
Irregular PV bleeding/ spotting (<1 year)
Weight gain
Progesterone: PMS
Oestrogen: breast tenderness, leg cramps, bloating/ GI symptoms.
Perimenopause is diagnosed with lab tests if a woman presents with…
Vasomotor symptoms and irregular periods.
Lifestyle management for vasomotor symptoms in menopause
Exercise
Weight loss in BMI >30
Keeping cool
- Lighter clothes
- Using fans
- Sleeping in cool room
Avoid triggers
- Alcohol, smoking, stress, caffeine
Lifestyle management for mood and cognitive symptoms in menopause
Low mood/ anxiety
- Good sleep
- Exercise
- Relaxation
Cognition
- Exercise
- Good sleep hygiene
A woman is potentially fertile for _______ after last menstrual period in menopause
2 years if <50
1 year if >50
Regimens for combined HRT
Cyclical, monthly
- Oestrogen daily, progesterone at the end of cycle for 14 days.
Three-monthly cyclical
- Daily oestrogen + progesterone for 14 days every 13 weeks.
Continuous
What combined HRT regimen can be used in perimenopausal women
Cyclical HRT (monthly/ three monthly)
Mechanism of oestrogen containing contraception
Prevents ovulation
Mechanism of progestin containing contraception
Thins uterine lining
Thickens cervical mucus
Assessment requirements of COCP
Thorough family and medical history
BP
BMI
How long can COCP be used for several months without a break?
Menarche to menopause
Assessment requirements of IUD/IUS
- Thorough medical and sexual history
- Gynaecological examination
- STI screen/ Prophylatic antibiotics.
Adverse effects of IUD
- Heavier and painful periods
- Perforation, infection
COCP decreases the rate of…
Ovarian cancer
Endometrial cancer
Benign ovarian cysts
Examples of first-line COCP
Microgynon 30
- Ethinylestradiol + levonorgestrel
Dianette is a COCP containing ______ which can be used to treat hirsuitsm and acne in PCOS
Cyproterone acetate
Adverse effects of COCP
Intermenstrual bleeding (first couple months)
Breast pain/ tenderness
Mood changes
Headaches
Absolute contraindications for COCP
- <6 weeks post-partum and breastfeeding
-Age >35, smoking >15 a day - Migraine with aura (level 3 if >5 years)
- Current breast cancer
- Severe liver cirrhosis
Cardiovascular
- SBP >160, DBP >100
- Vascular disease
- Stroke, IHD, VTE
- Prolonged immobilisation
- AF
Clotting
- Thrombophilia
- Antiphospholipid antibodies
Absolute contraindication for using POP
- Current breast cancer
COCP is effective immediately if…
Started within first 5 days of cycle
The implant, IUD and IUS have are _____ effective
> 99%
The COCP and POP are _____ effective when used perfectly.
99.5%
The sub-dermal implant contains ____ and lasts for ______.
It works by _____
Etonogestrel, lasts for 3 years.
- Inhibits ovulation
The IUD lasts for ______ and works by ______
Lasts for 5-10 years, works by being toxic to sperm.
Risks of IUD
Infection
Expulsion
Ectopic
Perforation (1-2 every 1000)
IUS works by ____
Thickens cervical mucus and thins the endometrium
Side effects of IUS
- Acne
- Bloating
- headaches
- Mood swings
The depo-provera IM injection is repeated every _____ and works by _______
12 weeks (3 months)
- Suppressed ovulation
Side effects of depo-provera
Amenorrhea
Mood swings
Wait gain
Up to 1 year for fertility to return
Possible reduction in bone density
Lactional amenorrhea contraception is ______ % effective
98% effective
Ulipristal acetate works by….
(Progestagen antagonist)
- Delays ovulation
Ulipristal acetate is contraindicated in….
Severe asthma
breastfeeding
- Should wait 1 week after and discard
Rules of starting COCP and POP after using ulipristal acetate
Wait 5 days
Hormonal contraception for transgender men
Cannot take COCP
Can take the POP
Testosterone therapy is not a form of contraception
Emergency contraception for transgender men
IUD, EllaOne, Levonelle
