HRT, menopause and contraception Flashcards by aderonke adesanoye

HRT increases the risk of _____ and _____when combined with progesterone but does not apply for _______

breast cancer

VTE

Transdermal formulations

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Risk risk of breast cancer reduces when HRT ________

Is stopped.

Reaches the same level as never taking HRT in 5 years.

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Unopposed oestrogen increases the risk of _______

Endometrial cancer

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Non-cancerous risks of HRT

Stroke

Ischaemic heart disease
- If taken >10 years post-menopause

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Menopause is defined as…

Cessation of menses for at least 1 year
- In age 45+

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Perimenopause describes…

Menopausal symptoms/ irregular periods

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Complications of menopause

Cardiovascular disease

Osteoporosis

Mood
- Depression/ anxiety
- Irritability

Atrophic vaginitis/ Dyspareunia

Poor hair/ skin

Reduced libido

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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

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Premature menopause describes…

Menopause <45 years but >40 years.

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Oestrogen only HRT is indicated for _______

Women with no uterus
- No risk of endometrial cancer

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Contraindications of oestrogen-containing HRT

VTE

Breast cancer

Immobility

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What HRT is indicated in people with a uterus with no risk factors

Combined HRT

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________ is indicated first line for vasomotor symptoms

Clonidine

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_________ is indicated for mood symptoms if HRT doesn’t work

Duloxetine

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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.

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Perimenopause is diagnosed with lab tests if a woman presents with…

Vasomotor symptoms and irregular periods.

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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

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Lifestyle management for mood and cognitive symptoms in menopause

Low mood/ anxiety
- Good sleep
- Exercise
- Relaxation

Cognition
- Exercise
- Good sleep hygiene

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A woman is potentially fertile for _______ after last menstrual period in menopause

2 years if <50

1 year if >50

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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

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