Menopause and HRT Flashcards

Question

State the alternative or herbal therapies for mild VMS

Answer 1

Alternative/herbal therapies Acupuncture Dietary soya isoflavones, red clover, black cohosh (CI with aspirin sensitivity, as contains salicylates) Benefit hot flushes, mood changes, sleep disturbances, fatigue and vaginal dryness

Answer 2

1. Intact uterus Must have BOTH Oestrogen and P Prevents hypertrophy of endothelial lining Minimises endometriosis Protects the endometrium Induces a monthly bleed to reduce the risk of developing abnormal cancerous cells Can be sequential or continuous combined 2. No uterus (following hysterectomy) Only needs Oestrogen

Answer 3

Cyclic (sequential O and P) O for 21 days, P days 7-21 and 7 days none Withdrawal bleed days 22-30 O at lowest dose to minimise risks (see slide 29) Note that P can also be every 3 mths Eg Elleste duet

Answer 4

Protect endometrial hyperplasia and cancer. Risks and benefits, history, symptoms and concerns. Start O at lowest dose 0.3mg/day oral or 0.05mg patch BC, S and thromboembolic and CV events P may ↑ risk BC than O alone O and P daily, easiest to follow, no menstruation and preferred by most (avoid in perimenopause if irreg bleeding) If breakthrough bleed after first 9 mths switch to cyclic eg Premique

Answer 5

Transdermal or topical O P not needed, O alone if tolerated Transdermal may be preferred to oral if taking other meds, borderline triglyceride levels, gallstone risk or adherence issues Could have less risk than oral O but no RCT so probably same for (BC, S,T and CV events) VMS relief in 4-12 weeks Topical vaginal O Dryness

Answer 6

``` Oral Oestrogen Safe if no CIs for up to 7 years No increase of CVD, S or BC if alone Start low and increase slowly If not tolerated – non-hormonal considered Taper dose every 6 months ```

Answer 7

Risks of HRT diminish over time after stopping Peri – screening tests e.g. mammography, smear, colonoscopy (50yrs), osteoporosis (65yrs), serum lipids (few months post start of O) Well balanced diet and exercise

Answer 8

More than 1 year = higher risk of breast cancer than women who never use HRT (except vaginal oestrogen) If ages 40s and 50s and HRT for 5 years risk: 1 extra case for every 200 women taking oestrogen-only HR 1 extra case for every 70 women taking cyclical HRT 1 extra case for every 50 women taking continuous HRT Extra cases double if take HRT for 10 years. Increased risk of BC falls if stop HRT, but can remain for more than 10 years compared to women who have never used HRT. If for less than 1 year, no increased risk of BC. Important to attend breast cancer screening appointments if taking HRT.

Answer 9

Sudden chest pain. Sudden breathlessness, or if you cough up blood. Swelling or pain in a leg. An unusually severe headache. Yellowing of your skin or the whites of your eyes (jaundice).

Answer 10

1. Antidepressants SSRIs and SNRIs Escitalopram most effective Hot flushes with varying degrees 2. Clonidine VMS Caution with high does - ↓ BP 3. Gabapentine VMS but SE of drowsiness, dizziness and unsteadiness Taper dose as VMS subside

Answer 11

1. Vaginal oestrogen Cream, pessaries or ring for local symptoms not VMS. Less systemic effect But long term use – endometrial proliferation Ring expensive but less messy Safe in BC sufferers 2. Vaginal moisturiser Polycarbophil gel – for vaginal atrophy, dryness and dyspareunia

Answer 12

Pelvic floor rehabilitation | May be useful for urinary stress incontinence

Answer 13

Most women take it for: vasomotor symptoms Women stop because they dislike side effects, bleeding or have concerns about risks >50% will stop within a year

Answer 14

HRT is not a contraceptive. If still having periods, or have only recently stopped, still use contraception for one year after last period if older than 50, or for two years after last period if less than 50. Regular check-ups to discuss risks and benefits of taking HRT.

Answer 15

SEE SLIDE 40 for more info

Answer 16

``` breast tenderness headaches feeling sick indigestion abdominal (tummy) pain vaginal bleeding ```

Answer 17

1. Bioidentical or "natural" hormones Bioidentical hormones are hormone preparations made from plant sources that are promoted as being similar or identical to human hormones. Practitioners claim these hormones are a "natural" and safer alternative to standard HRT medicines. However, bioidentical preparations are not recommended because: they are not regulated and it's not clear how safe they are – there's no good evidence to suggest they're safer than standard HRT it's not known how effective they are in reducing menopausal symptoms the balance of hormones used in bioidentical preparations is usually based on the hormone levels in your saliva, but there's no evidence that these levels are related to your symptoms Bioidentical hormones are not the same as body identical hormones. A body identical hormone, or micronised progesterone, can be prescribed to treat menopausal symptoms. Many standard HRT hormones are made from natural sources, but unlike bioidentical hormones, they're closely regulated and have been well researched to ensure they're as effective and safe as possible. 2. Complementary therapies Several products are sold in health shops for treating menopausal symptoms, including herbal remedies such as evening primrose oil, black cohosh, angelica, ginseng and St John's wort. There's evidence to suggest that some of these remedies, including black cohosh and St John's wort, may help reduce hot flushes, but many complementary therapies are not supported by scientific evidence. Even when there is some supporting evidence, there's uncertainty about the right doses to use and whether the health benefits last. Some of these remedies (especially St John's wort) may also cause serious side effects if they're taken with other medicines. These products are often marketed as "natural", but this does not necessarily mean they're safe. The quality, purity and ingredients cannot always be guaranteed, and they may cause unpleasant side effects.