Menopause and HRT Flashcards
Menopause definition
Permanent cessation of menses
- Due to loss of ovarian function (loss of oestrogen effects)
Peri-menopause
- Definition
- Age
- Mean duration
Transition from reproductive cycle to post-menopause
Age
- Median is 47.5 (45-50)
Duration= 3.8 (4) years.
Mechanism + symptoms of peri-menopause
Very few ova remaining that can respond to hormones
- Causes irregular cycles
- Occasional heavy bleeding
- Hot flushes
- Mood changes
Primary symptoms of menopause
Menstrual cycle changes
Vasomotor
- Night sweats
- Hot flushes
- Can present early before menopause or or late after.
Vaginal dryness
Secondary symptoms of menopause [7]
Urinary stress/ urge incontinence
UTI/ cystitis risk
Mood changes
MSK pains (oesteoporosis)
Dry skin, hair thin, nail changes
Decreased concentration
Decreased libido.
Vasomotor symptoms
Includes
- Night sweats
- Hot flushes
Less severe in women of higher social class and better educational qualifications
Drugs for osteoporosis
Bisphosphonates
- Alendronate
- Risedronate
Drugs to reduce vasomotor symptoms [4]
Beta-blocks
Progesterone (not used commonly)
Selective oestrgen receptor modulators
- Raloxifene
Clonidine (alpha adrenergic stimulator)
Alternatives to HRT
No evidence suggested that they are particularly beneficial
Includes
- Phyto-oestrogens (soya beans)
- Herbalism
- Progesterone cream
- Homeopathy
- Acupunture
- Reflexology
Route of HRT [6]
Oral
Patches
Implants
Vaginal rings
Transdermal gel
Nasal
HRT regemines
Continuous
- Oestrogen only
- Indicated for those without uterus
- No bleeding or tablet break
Continuous sequential
- Oestrogen then progestogen at day 14
- Regular bleeding end of cycle
- No tablet break
Continuous combined HRT
- Oestrogen and progestogen given without tablet break
- No bleeding at the end of cycle
Unopposed oestrogen
Usually indicated in those without uterus
Low dose of oestradiol= cannot be contraception
Has to be taken continuously unless symptoms would return
HRT regime for females with uterus
Either
- Oestradiol everyday
Or
Norgestrol (oestrogen + progesterone) for 11 days
- Withdrawal bleeding
Absolute HRT contraindications [6]
Pregnancy
Active venous thromboembolism
Severe active liver disease
Endometrial carcinoma with recurrence
Breast carcinoma with recurrence
Relative contraindications HRT
Abnormal bleeding
Investigation that reveals breast lump
Previous breast cancer/ Strong family history of breast cancer
Family history of thromboembolism
Side effects of HRT [9]
Weight gain/ bloating
Lower abdo pain
Nausea/ headaches
Leg cramps
Headaches
Mood swings/ low mood
Breast pain/ tenderness
Bleeding
Indigestion
Benefits of HRT
Short term
- Relieves vasomotor symptoms
- Improves psychological symptoms
Long term
- Reduces osteoporosis risk, increases bone mass
- Reduces bowel cancer risk
- Reduces urogenital problems
- May: reduce falls, tooth loss, be protective against arthritis
Risks of HRT
Increased risk of endometrial cancer (unopposed estradiol)
Increased risk:
- Breast cancer
- Venous thromboembolism
- CVD (stroke, MI)
Endometrial cancer
- Investigation
- Diagnosis
- Treatment
Investigation
- Transvaginal USS
>5mm
Diagnosis
- Biopsy
Treatment
- Hysterectomy and oophorectomy
- Possible radiotherapy
Compare COCP and HRT
- The type of drug used
- Dose
- Clotting factors/ liver
- Gonadal axis
- Ovulation
HRT- natural estradial, COCP not natural
HRT- lower dose, less increase in clotting factors than COCP
COCP- massive first pass hepatic metabolism
HRT- dose not high enough to suppress FSH and LH compared to COCP
HRT- does not stop ovulation, COCP does
WHI study
Showed HRT had increased risk for CV in certain women
- Overweight
- Older (>60)
Did not assess other routes for HRT
HRT with breast cancer, CVD, thromobosis
No risk for CVD under 60
Risk of thrombosis with oral HRT
Breast cancer risk increases with combined HRT
