Latest evidence on using hormone replacement therapy in the menopause 2014 TOG Flashcards
Median age of menopause
51.4
How common are vasomotor symptoms, median duration
70%
20% severe
Median duration 5.2 years
Effect of oestrogen’s on cardiovascular health
Reduces atherosclerosis
Increases HDL-cholesterol
Lowers LDL-cholesterol
Promotes coronary artery vasodilatation
Prevents platelet aggregation
Decreases lipoprotein-a and inhibits LDL-cholesterol oxidation
What is the ‘window of opportunity’
10 year after menopause, reduction in heart disease and CV mortaility
Risk of breast cancer on HRT
Unopposed estrogen - little/no increase risk in breast cancer
Combined
Duration dependant risk
Continonus > Sequential
Very small increase
Combined + 10 cases per 1000 age 50-59
Alcohol and BMI also +10 per 1000
HRT after breast cancer
- Vasomotor Sx
1st Lifestyle & HRT alternatives
- Avoid paroxetine & fluoexitin if taking tamoxifen (reduced efficacy)
- Severe, refectory - cancer systemic HRT after discussion with breast cancer team & documented consent
- Systemic HRT should not be used with aromatise inhibitor
Post breast cancer HRT
Vulvo-vaginal atrophy
Vulvo-vaginal atrophy
- Vaginal moisteriser
- Consider low dose topical oestrogen
- Topical should be avoided in the presence of aromatase inhibitor
British menopause society flow diagram for HRT prescribing
Minimum number of days for progesterone in sequential regime
12-14 days
Dose of progesterone should be proportional to oestrogen
Mirena 52mg licence for endometrial protection?
4 years
Studies show to be effective for 5 year
Which progesterones are micronised progesteron
Utrogestan 100mg OD (continous), 200mg 12days/cycle for cyclical
Risk of VTE on HRT
Seen mostly within the 1st 12 months
Oral has higher risk the transdermal
Higher risk combined the. oestrogen alone
Background risk 50-59 5/1000
Estrogen alone 7/1000
Combined 12/1000
