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403- O&G > HRT, menopause and contraception > Flashcards

HRT, menopause and contraception Flashcards

1
Q

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

A

breast cancer

VTE

Transdermal formulations

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2
Q

Risk risk of breast cancer reduces when HRT ________

A

Is stopped.

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

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3
Q

Unopposed oestrogen increases the risk of _______

A

Endometrial cancer

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4
Q

Non-cancerous risks of HRT

A

Stroke

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

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5
Q

Menopause is defined as…

A

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

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6
Q

Perimenopause describes…

A

Menopausal symptoms/ irregular periods

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7
Q

Complications of menopause

A

Cardiovascular disease

Osteoporosis

Mood
- Depression/ anxiety
- Irritability

Atrophic vaginitis/ Dyspareunia

Poor hair/ skin

Reduced libido

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8
Q

Symptoms of menopause

A

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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9
Q

Premature menopause describes…

A

Menopause <45 years but >40 years.

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10
Q

Oestrogen only HRT is indicated for _______

A

Women with no uterus
- No risk of endometrial cancer

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11
Q

Contraindications of oestrogen-containing HRT

A

VTE

Breast cancer

Immobility

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12
Q

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

A

Combined HRT

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13
Q

________ is indicated first line for vasomotor symptoms

A

Clonidine

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14
Q

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

A

Duloxetine

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15
Q

Short-term adverse effects of HRT

A

Breast tenderness

Irregular PV bleeding/ spotting (<1 year)

Weight gain

Progesterone: PMS

Oestrogen: breast tenderness, leg cramps, bloating/ GI symptoms.

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16
Q

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

A

Vasomotor symptoms and irregular periods.

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17
Q

Lifestyle management for vasomotor symptoms in menopause

A

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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18
Q

Lifestyle management for mood and cognitive symptoms in menopause

A

Low mood/ anxiety
- Good sleep
- Exercise
- Relaxation

Cognition
- Exercise
- Good sleep hygiene

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19
Q

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

A

2 years if <50

1 year if >50

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20
Q

Regimens for combined HRT

A

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

21
Q

What combined HRT regimen can be used in perimenopausal women

A

Cyclical HRT (monthly/ three monthly)

22
Q

Mechanism of oestrogen containing contraception

A

Prevents ovulation

23
Q

Mechanism of progestin containing contraception

A

Thins uterine lining

Thickens cervical mucus

24
Q

Assessment requirements of COCP

A

Thorough family and medical history

BP

BMI

25
Q

How long can COCP be used for several months without a break?

A

Menarche to menopause

26
Q

Assessment requirements of IUD/IUS

A
  • Thorough medical and sexual history
  • Gynaecological examination
  • STI screen/ Prophylatic antibiotics.
27
Q

Adverse effects of IUD

A
  • Heavier and painful periods
  • Perforation, infection
28
Q

COCP decreases the rate of…

A

Ovarian cancer

Endometrial cancer

Benign ovarian cysts

29
Q

Examples of first-line COCP

A

Microgynon 30
- Ethinylestradiol + levonorgestrel

30
Q

Dianette is a COCP containing ______ which can be used to treat hirsuitsm and acne in PCOS

A

Cyproterone acetate

31
Q

Adverse effects of COCP

A

Intermenstrual bleeding (first couple months)

Breast pain/ tenderness

Mood changes

Headaches

32
Q

Absolute contraindications for COCP

A
  • <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

33
Q

Absolute contraindication for using POP

A
  • Current breast cancer
34
Q

COCP is effective immediately if…

A

Started within first 5 days of cycle

35
Q

The implant, IUD and IUS have are _____ effective

A

> 99%

36
Q

The COCP and POP are _____ effective when used perfectly.

A

99.5%

37
Q

The sub-dermal implant contains ____ and lasts for ______.
It works by _____

A

Etonogestrel, lasts for 3 years.
- Inhibits ovulation

38
Q

The IUD lasts for ______ and works by ______

A

Lasts for 5-10 years, works by being toxic to sperm.

39
Q

Risks of IUD

A

Infection

Expulsion

Ectopic

Perforation (1-2 every 1000)

40
Q

IUS works by ____

A

Thickens cervical mucus and thins the endometrium

41
Q

Side effects of IUS

A
  • Acne
  • Bloating
  • headaches
  • Mood swings
42
Q

The depo-provera IM injection is repeated every _____ and works by _______

A

12 weeks (3 months)
- Suppressed ovulation

43
Q

Side effects of depo-provera

A

Amenorrhea

Mood swings

Wait gain

Up to 1 year for fertility to return

Possible reduction in bone density

44
Q

Lactional amenorrhea contraception is ______ % effective

A

98% effective

45
Q

Ulipristal acetate works by….

A

(Progestagen antagonist)
- Delays ovulation

46
Q

Ulipristal acetate is contraindicated in….

A

Severe asthma

breastfeeding
- Should wait 1 week after and discard

47
Q

Rules of starting COCP and POP after using ulipristal acetate

A

Wait 5 days

48
Q

Hormonal contraception for transgender men

A

Cannot take COCP

Can take the POP

Testosterone therapy is not a form of contraception

49
Q

Emergency contraception for transgender men

A

IUD, EllaOne, Levonelle

403- O&G (21 decks)

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