Menopause 2 Flashcards
What is oestrogen only HRT?
After hysterectomy
may be concerns about remnant of endometrium in the cervical stump in women who have had a subtotal hysterectomy -if this is suspected, the presence or absence of bleeding induced by monthly sequential HRT is useful diagnostic tool
What is combined HRT?
combination reduces the increased risk of endometrial hyperplasia and carcinoma, which occurs with unopposed oestrogen
progestogen can be given
‘sequentially’ for 10-14 days every 4 weeks or for 14 days every 13 weeks or can be continuous
What from HRT can be given to perimenopausal women?
if still bleeding or bled in last 12 months, they can given sequential or cyclic therapy
or IUS with oral/patch oestrogen is useful in heavy menstrual bleeding or requiring contraception
What HRT can be given to postmenopausal women
continuous regimen should be used because of the lack of induced bleeding and at reduced risk of endometrial CA compared to sequential regimen
induces endometrial atrophy, use of SERM & oestrogen is approved
What is used to treat urogenital symptoms?
oral ospemifene (SERM) used for moderate-to-severe symptomatic vulvovaginal atrophy in postmenopausal women
What are the benefits of HRT?
oestrogen treats hot flushes within 4 weeks
vaginal dryness, soreness, superficial dyspareunia, urinary frequency and urgency respond well to topical and systemic oestrogen
may also improve sexuality, but may require testosterone
Beneficial in preventing osteoporosis- HRT reduces the risk of spine and hip fractures
women before 60yrs or within 10yrs after menopause
Reduces risk of colorectal cancer by a 1/3
What are the risks of HRT?
Breast cancer- risk falls on stopping combined therapy. Not seen in women who start early for premature menopause
unopposed (non-vaginal) oestrogen HRT increases risk of endometrial CA
oral HRT increase risk of VTE twofold in women >50yrs
Increases risk of gallbladder disease
How long is HRT continued for?
treatment is usually continued for up to 5yrs- stopped to evaluate whether sympyoms recur with sufficient severity to warrant continuation
• Osteoporosis- treatment may need to be lifelong, women may change to other drugs after cessation of treatment
• Premature menopause- usually advised to continue with HRT until the median age of the natural menopause (eg. 51yrs)
What non-oestrogen therapies can be used for hot flushes and night sweats?
o Progestogens- 5mg/day norethisterone or 40mg/day megestrol acetate
o Clonidine- centrally acting alpha-adrenoreceptor agonist
o SSRIs or SNRIs- effective in treating hot flushes in short-term studies
o Gabapentin- limited evidence shows that it may be effective
What is used for the management of osteoporosis?
Bisphopshonates (can affect foetal skeleton)
Strontium ranelate- decreases risk of fractures (increased heart disease
Raloxifene and bazedoxifene (SERMs)- reduces vertebral fractures
Parathyroid hormone peptides - reduce risk of vertebral fractures. Limited to 2 years (osteosarcoma)
Denosumab- monoclonal antibody to RANKL, so reduces osteoclast activity- given subcutaneous every 6 months
Calcium and vitamin D supplements
