Men and Womens Health Presentations

Question 1

Management options for menorrhagia

Answer 1

1. Levonorgestrel intrauterine system (hormonal mirena coil)
2. Tranexamic acid (+/- NSAID eg Mefanamic acid)
3. COCP/cyclic progesterone

Question 2

How to take COCP for heavy bleeding?

Answer 2

• Take for 21 days back to back
• Take 7 day break every 3-6 months
• Effects will reduce within 1-2 months if pt wants to get pregnant

Question 3

What to avoid in heavy periods management contraception wise?

Answer 3

• Implant
• Injection

^^ These both take 12 months for fertility to come back

• Copper coil
• POP

POP causes no periods in 1/3, normal in 1/3 and erratic in 1/3

Question 4

Management BPH

Answer 4

• Conservative - keep fluid intake good in day, reduce at night, avoid caffeine, alcohol etc
• Alpha blocker eg Tamsulosin - can get dizzy and ED, works within few days
• 5 alpha reductase inhibitor - Finasteride - if prostate enlarged and likely to progress, but takes 6 months to work
• Use Doxazosin if pt has high BP and BPH

Question 5

Advice on fluid intake BPH

Answer 5

• DO NOT REDUCE FLUIDS
• Leads to kidney problems
• Fluid intake needs to be good during day but reduce at night to avoid nocturia

Question 6

Menopause management

Answer 6

• HRT
• Can have oestorgen only if hysterectomy or IUS in place
• Have sequential if perimenopause (period within last 12 months)
• Continue combined HRT if post menopausal (>12M since LMP)

Question 7

What is sequential HRT?

Answer 7

• Daily oestrogen
• Progesterone for 12-14 days of month to trigger bleed - drop triggers bleed
• Offered to perimenopausal women

Question 8

When do you not need contraception alongside HRT?

Answer 8

Do not need if:
* Over 50 and been 1yr or more since LMP
* 50 or under and has been 2yrs or more since LMP

Question 9

Options for HRT

Answer 9

• Pill - oestrogen only, sequential combi, continious combined
• Patch - oestorgen only, sequential combi, continious combined
• Gel - oestrogen only

Question 10

Contraindications to HRT

Answer 10

• History of breast cancer or oestrogen receptive tumour
• Endometrial hyperplasia - untreated
• Vaginal bleeding - undiagnosed
• Uncontrolled HTN
• Arterial thromboembolic disease
• Current or recurrent VTE
• Thrombophilia
• Liver disease

Question 11

What to do if starting HRT and on antidepressants?

Answer 11

• Keep on both
• Can try to wean down antidepressants
• Ideally should have HRT trial before antidepressants if starting them when 45+

Question 12

Risks of HRT

Answer 12

• Breast cancer - risk less with oestrogen only
• Ovarian cancer
• VTE - oral higher risk than patches
• Stroke - oral HRT risk is higher, patches safer, but generally low in this age group anyway
• CVD - but not in women under 65