Menopause

Question 1

Which cancers contraindication for MHT, which are okay ?

Answer 1

DONT GIVE
Breast
Uterine sarcoma
Endometrial stage III and IV

CAN GIVE
High grade serous epithelial ovarian
Cervical 
Vulvovaginal
Colorectal 
Haematological

Question 2

Definition early menopause

Answer 2

Difference of at least 7 days in consecutive cycles

Question 3

Late menopause

Answer 3

Periods of amenorrhea 60 days or more
Frequent anovulation
Onset of perimenopausal symptoms

Question 4

Which symptoms does MHT relieve and what is principal indication?

Answer 4

VMS affecting QoL
Urogenital atrophy
Sexual dysfunction
Sleep disturbance
Mood swings
Joint or muscle pains

increases bone density, reduces fracture risk, NOT primary indiction

Question 5

HOw much does combined MHT increase VTE by?

Answer 5

Two fold.

Increases with age, other risk factors: hormone dose, obesity, smoking, immobility, thrombophilia, prev VTE

Prior VTE - 10% of ruecurrent within first year of treatment

Patches are better

Question 6

Cardiovascular disease and HRT

Answer 6

Complicated by age and time since menopause

WHI RCT CHD: 50-59yo RR 0.65 for estrogen only
overall no protective effect, but within 10 years of menopause lower mortality RR 070 and lower CHD with no increase of stroke

Question 7

Window of opportunity for MHT

Answer 7

Within 10 years of menopause, reduction in all cause mortality and coronary artery disease with no increased risk of stroke.

RR 0.65 E only 50-59 yo
RR 0.7 for mortality

Maximum benefit and minimal risk