Lec 48- Hormone replacement therapy Flashcards
The Menopause
-Progressive decline in ovarian function \+2-3 years -Symptomology due to loss of oestrogen \+Natural decline \+Oophorectomy- removal of one or both ovaries -Marked by end of menstruation \+12 months after last period -FSH high, oestrogen low
Symptomology
-Vasomotor disturbances
+Flushing, peripheral vasodilation
+Nocturnal sweating and sleep problems
+Headaches
-Urogenital atrophy
+Wall of vagina thins and glands atrophy- reduced mucous
+Similar changes in urethra and bladder- frequency and dysuria
Symptomology continued
-Psychological effects
+Memory
+Mood
+Long term neurodegeneration- Alzheimers
-Osteoporosis
+Bone density, decrease deterioration of structure
+Risk factos: White, smoker, low physical exercise and inadequate Ca in diet
+Fractures
HRT
-Replacement of hormones
+Oestrogen
+Loss gives rise to symptoms
+Risk of endometrial hyperplasia and carcinoma: Synthesised natural oestrogens, natural oestrogens from equine sources
-Progesterone: Used in comboination
+Used in women with intact urterus
+Withdrawl from progesterone causes bleeding
Benefits of HRT
-VAsomotor and psychological
+Reduction in flushing, sleep problems, sweats, headachesa and palpatations
+Very distressing`; psychological benefit when reducing
-Urogenital ageing
+Reduction in vaginal dryness as welll as vaginal and urethral infections
+Reduction in Dysuria and urinary frequency
-Replacingg oestrogen helps regardless of route of admin
Benfits of HRT continued
Oesteoporosis -HRT delays bone loss and increases bone density in hip and spine \+But needs to be taken for 7-10 years -Effects wane rapidly on cessation -Oral and transdermal equally effective \+Oral oestradiol= 2mg \+Oral conjugated oestrogens=625 mcg \+Transdermal estradiol -Long term therapy licensed for prevention of oesteoporosis
Benefit of HRT (3)
Colorectal cancer
-Reduction in incidence dependant on age of cohort and duration of treatment
+Per 1000
+Age 50-9 NoHRT=3, HRT=2
+Age 60-9 NoHRT=8, HRT= 3
Coronary heart disease
-Normal incidence rises post menopause (=men by 65)
-Many studies: but difficult to control all other factors
-Protective effects lie with oestrogen
-Progesagen may reduce benefits (theoretically)
-Most benefit for women without a uterus
Benefit of HRT (4)
Short term -Symptom relief Long term -Osteoporosis -CHD -Colorectal cancer
Risks of HRT- endometrial cancer
Endometrial cancer
-In women with intact uterus
-During and after
-Unless taken with adequate levels of progesterone
+For 10-13 days per cycle
+Or continuous combo (not for perimenopause): irregular bleeding
-NB- combo therapy is not necessary following a hysterectomy
Risk of HRT- Breat cancer
- BNF 42: CSM warning
- Increased risk related to duration of therapy
- Returns to normal 5 years post HRT
- 45 cases/1000 50 year olf non-HRT
- +2 cases in women taking HRT for 5 years
- +6 cases in women taking HRT for 10 years
- +12 cases for women taking HRT for 15 years
Putting in context
-All types of HRT included
-Risk may well be largely or wholly causal
+Sub analysis of many possible contributing factors
-For women who use HRT for 5 years from age of about 50
+1 extra ovarian cancer per 1000 users
+1 extra ovarian cancer death per 1700 users
Risk of HRT- VTE
-HRT use causes a 2-3 fold increase in risk of VTE
+Causes double of risk of pulmonary embolism
-Risks greatest during first year
+Return to normal after 1 year of continuing HRT use
-Oral route MAY have higher risks
NB- Surgery, other risk factors
Risk of HRT- Weight gain
- Weight gain and breast tenderness found in the short term
- No significant effects long term
- Fear of weight gain deters HRT Use
Last years news- Long term use
-Reduction in CHD NOT evident
-July 2005- US WHI stopped
+16,608 women, 5.2 follow up
-Found slight increase in CHD
-November 2005: Wisdom trial stopped
+Started 1999
+Womens international study of long term oestrogen after menopause
-Study in rats suggests long term HRT in Alzheimers may worsen memory
-This and clinical studies suggest
+Beneficial effects of short term HRT
+Particular benefit in very aged
-BUT beneficial effect reduced or reverse on long term HRT
Million women study
-Published in Lancet, August 2003 \+1,084,110 women 50-64 \+Recruited between 1996-2001 -Increased risk of breast cancer -Current users of combined HRT -Oestrogen only HRT -Tibolone