Menopausal Hormone Therapy

Question 1

Absolute CI

Answer 1

Current/suspected BC
Current endometrial cancer
Unexplained vaginal bleeding
Acute IHD
Acute liver dx
Cerebrovascular dx
Current DVT/PE
Active SLE 
Pregnancy

Question 2

Relative CI

Answer 2

Past history of BC, endometrial or ovarian cancer
Increased risk of VTE
Previous IHD
Focal migraine
Hypertriglyceridemia

Question 3

Cyclical oestradiol + norethisterone description, indication and benefits

Answer 3

• Oestrogen alone for 14 days then the progesterone until day 28 to mimic cycle
• for women who are still cycling/within 12 months of their last natural period
• protective against endometrial hyperplasia and malignancy

Question 4

Continuous estradiol and norethisterone daily

Answer 4

For women 12 months amenorrhea post menopause, or after 12 months on cyclical MHT

Question 5

Transdermal oestrogen indications

Answer 5

• if failed symptom control with oral HT
• those with gut absorption issues, high triglyceride, risk of VTE, smoker, overweight
• still need progestogen if uterus intact

Question 6

Transvaginal oestrogen types and indications

Answer 6

• Ovestin cream, vagifem pessaries
• for women with ONLY local vaginal, vulval, urethral, or bladder symptoms
• does not require progestogen therapy unless high dose

Question 7

Tibolone indications, benefits

Answer 7

• menopausal symptoms, osteopenia, reduced libido
• oestrogen reduces hot flushes, better bone density, reduces vaginal dryness
• progesterone opposition
• androgen enhances mood and libido
• higher vascular risk!!

Question 8

When to initiate MHT

Answer 8

• within 10 years post-menopause

Question 9

Mirena indications as MHT

Answer 9

• in those women intolerant to oral/transdermal progesterone and need the endometrial protection
• heavy or troublesome withdrawal bleeding
• as contraception

Question 10

Benefits of estrogen

Answer 10

• when initiated <10 years after menopause and in women <60 years old
• reduce CVD
• reduces all-cause mortality
• no increased risk of stroke
• protective against endometrial, ovarian and colorectal cancer
• increases risk of VTE

Question 11

When to stop hormone therapy?

Answer 11

• review annually

- at 10 years risk outweighs benefits

Question 12

Contraception for women who menopause before 50

Answer 12

• fertile for 2 years after last period
• if perimenopausal, COCP for 2 years then swap to continuous HRT
• if postmenopausal (within 1 year after last period), COCP for 1 more year then swap to cyclical
• if postmenopausal > 2 years, continuous HRT

Question 13

Contraception for women who menopause after 50

Answer 13

• fertile for one year after last period
• if perimenopausal, cyclical HRT plus barrier for 12 months then swap to continuous
• if postmenopausal, continuous terus