Menopause and HRT Flashcards
1
Q
Diagnosis
A
- > 45yo- based on symptoms
- 1 year of amenorrhoea wo cont and vasomotor symp
<45yo
- Stop COCP/POP for 2 weeks
- Check FSH
- If FSH >30 x2 (6 wks apart) confirm menopause
- ONLY STOP pill after 1 year
2
Q
Symptoms
A
- Amenorrhoea
- Hot flushes
- MSK pain
- Vaginal dryness
- Low sexual desire
3
Q
Mx of vasomotor sympt
A
- HRT
4
Q
Mx of mood changes
A
- HRT
- CBT
- Do not offer SSRI/SNRI/clonidine as 1st line
- If vasomotor +depression- SSRI
- on tamoxifen- SNRI- venlaflaxine
5
Q
Mx of hot flushes
A
- Clonidine
6
Q
Mx of urogential atrophy
A
- Vag estrogen
- Advise pt to contact GP if any bleeding on treatment
7
Q
Benefits of HRT
A
- Bone protection
- Red brain fog
- Lower cardiac risk and T2DM
8
Q
SE of HRT
A
- VTE and stroke risk inc on oral HRT
- Patches- same VTE risk as gen population
- Use patches if BMI>30 or VTE risk
- No inc cardiovascular risk
- Inc breast CA risk for combined HRT
9
Q
Alternative treatments
A
- Black cohosh- safety is uncertain
- Inc estrogen, inc risk of uterine CA if given wo progesterone
- St John’s wart- can help vasomotor symp
- Can cause serious risks w some meds
10
Q
Referral to specialist
A
- If unable to take HRT
- Other health concernings making the best rx difficult
11
Q
Breast CA and HRT
A
Add image
12
Q
Bleeding on HRT
A
- Normal for 1st 3 months on sequi
- 12 months for conti
- If continues- to see GP uregently, need 2ww
13
Q
Premature ovarian insuff
A
- Menopausal sympt <40yo
- FSH>30 x2 (6w apart)
- Dont diagonose w AMH
14
Q
Mx of pre-mature ovarian insuff
A
- HRT + testosterone
- Explain importance of HRT
- HRT is not contraceptive
- If used in young pt- does not inc cardio/breast CA risk
15
Q
HRT based on age
A
<40- high dose HRT w cyclical prog
- Allows for monthly bleed
> 45yo- Sequi HRT
- Patches or tablet, average dose
50-60yo- Low dose combined
