LC 3.9 Menopause HRT Flashcards
What is the composition of HRT?
Can be:
1) Oestrogen
2) Oestrogen and progesterone
3) Tibolone
What are the formulations of HRT?
Systemic HRT
• Tablets, patches, implants, nasal spray
Local HRT
• Creams, pessaries, rings
Who should receive a sequential/long-cycle HRT? What does this do?
Peri-menopausal women with an intact uterus. This induces a regular menstrual bleed
Who must have a combined form of HRT which includes a progestogen? What does this do?
Women with uteruses, to prevent hyperplasia which may lead onto malignancy. Induces endometrial atrophy.
Who should receive continuous combined HRT? What is this?
Post-menopausal women with intact uteruses
Oestrogen and progestogen combined in one tablet, identical tablets taken every day
What do sequential/long-cycle HRT options do in perimenopausal women?
Induces a regular bleed
Why is establishing post-menopausal status difficult in those on cyclical HRT? How is post-menopausal status established in these patients? What is done once post-menopausal status is established?
Natural menstrual cycle is masked by the cyclical therapy. Post-menopausal status is assumed at the age of 54 years. Patients are then switched to continuous combined HRT
What is tibolone?
A synthetic steroid with oestrogenic, progestogenic and androgenic properties: similar effect to CC preparations
What is local oestrogen used for?
Why is it used for these, and why does this not require added progestogen?
- Specific relief of urogenital symptoms.
- Pulmonary thromboembolism hx
- Oestrogen receptor positive breast cancer hx
No significant systemic absorption
What is sequential/cyclical HRT?
The sequence in which the oestrogen and progestogen is taken induces a regular bleed, in most cases monthly but can also be quarterly for patients who are not keen on frequent bleeds (long-cycle)
What are the side effects of HRT?
Oestrogen: • Bloatedness and nausea • Breast tenderness • Leg cramps Progestogen: • PMS & Depressed mood • Reduced libido
What does HRT increase the risk of?
Oestrogen • Stroke & PE • Dementia Oestrogen and progesterone: All of the above, plus: • CHD • Breast cancer
What are the recommended uses of HRT?
- Treatment of vasomotor symptoms
- Second line osteoporosis treatment
- (Topical) Urogenital symptoms
How long should you wait before investigating persistent irregular bleeding on HRT?
3 months
What are the causes of postmenopausal bleeding?
- Endometrial hyperplasia on HRT
- Endometrial polyps
- Uterine malignancy
- Atrophic endometritis
