Managing the menopause

Question 1

What are some contraindications to HRT?

Answer 1

Known, suspected, or history of breast cancer and other oestrogen based cancers like uterine cancer

Women who have had a hysterectomy and have no remaining evidence of disease are still candidates for HRT

Question 2

What is a FSH blood test used to diagnose?

Answer 2

Premature menopause

It confirms that somebody has already gone through menopause

Question 3

Is the mirina coil a form of HRT?

Answer 3

Yes
It doesn’t affect mood but helps with heavy periods and contraception

Question 4

When is HRT prescribed?

Answer 4

It’s used to treat symptoms of menopause and quality of life but is not essential

Question 5

Why may SSRI’s and CBT be prescribed to treat symptoms of menopause?

Answer 5

They help with mood and reframe menopause to not make menopause sound so bad

Also helps with sleep and teaches techniques for dealing with hot flushes

Question 6

What is some lifestyle advice to help with symptoms of menopause?

Answer 6

Exercise
Diet
Good sleep hygiene
Weight loss
Reducing stress
Avoid smoking, alcohol and spicy food

Question 7

Why does an FSH blood test need to be repeated in 4-6 weeks?

Answer 7

Because hormones fluctuate so repeating helps to confirm diagnosis

Question 8

Why is HRT/COCP prescribed in premature ovarian failure?

Answer 8

It protects against osteoporosis and heart disease

A study tried to show that oestrogen decreases the risk of heart disease in women aged 65+ but it caused lots of strokes because oestrogen is thrombogenic

Now ethical issues prevent further study around oestrogen being cardio protective

Question 9

Why is a migraine with aura a risk factor for stroke?

Answer 9

People who experience aura might have increased tendency to form blood clots due to temporarily narrowed blood vessels

Question 10

What is sequential HRT?

Answer 10

You take oestrogen only for the first 14 days. Then you take oestrogen and progesterone together for the next 12 to 14 days. This usually results in monthly withdrawal bleeds

It increases the risk of endometrial cancer?

Question 11

Which hormones protects against endometrial cancer?

Answer 11

Progesterone

Oestrogen increases endometrial cancer

Oestrogen and progesterone combined increase risk of breast cancer