Menopause HRT Flashcards
What is the menopause?
The last menstrual period (LMP)
When do FSH levels peak?
Peak around the time of the menopause
FSH levels diagnostic of ovarian failure?
FSH > 30 IU/L on 2 separate occasions = menopause
Ovaries and responsiveness to LH/FSH in the lead up to menopause
The ovaries become less responsive to FSH/LH in the lead up to menopause
Which type of oestrogen is predominant in pre-menopausal women?
E2 (oestradiol) is predominant in pre-menopausal women
-produced in the ovaries
Where is E2 produced?
The ovaries
Which oestrogen is predominant in post-menopausal women?
E1 (Oestrone) is predominant in post-menopausal women
-produced by the peripheral conversion of androgens in the adipose tissue
Where is E1 (oestrone) produced?
Produced by the peripheral conversion of androgens in the adipose tissue
Which is less biologically active, E1 or E2?
E1 is less biologically active
What makes hot flushes worse?
Smoking
High BMI
Menopause effects on the urinary tract?
- increased frequency/nocturia
- urgency
- stress/urge incontinence
- recurrent UTI
Long term effects of the menopause
- cardiovascular effects
- cerebrovascular effects
- osteoporosis
Lifestyle measures to improve menopause symptoms
- healthy diet
- regular exercise
- stop smoking
Who do you give sequential HRT to?
Peri-menopausal women (they will still get a bleed, mimics the normal menstrual cycle)
Who do you give continuous HRT to?
Post-menopausal women (they won’t get a bleed)
When can you start sequential HRT and how long can you use it for?
- can be started when required
- but can only be used for max 5 years (because increased risk of endometrial cancer)
When can continuous combined HRT be started?
-should not be started till 1 year since LMP
Over 54 and more than 1 year since LMP, which HRT should you use?
Continuous (CCT)
Under 54, which HRT should you use?
Use sequential for 2 years and then switch to continuous (CCT)
What is tibolone and what is it licensed for?
Tibolone is an alternative to CC HRT
-licensed for vasomotor, psychological and libido problemds
Tibolone risk:benefit ration
Over 60 = increased risk of stroke
Tibolone and bone mass
Tibolone preserves bone mass and prevents fractures (not hip)
This helps general feeling of well-being and improves libido
Testosterone
Which forms is testosterone available in?
- Patch
- implant
What are local systemic oestrogen preparations used for?
- used for bladder and vaginal symptoms in women who do not want systemic treatment
- rings, creams, tablets
-low systemic absorption so don’t need to add progesterone
HRT helps reduce the risk of which type of cancer?
Colorectal
-likely due to the anti-oxidant effect of oestrogen
Major risk factors for osteoporosis
- prolonged steroid use
- early menopause
- prolonged amenorrhoea
Which type of HRT has greatest risk of breast cancer?
Combined HRT
oestrogen only - the lowest risk
Which type of risk gives greatest risk of venous thromboembolism?
Combined HRT (but oestrogen only still has risk) -risk may be lowered by transdermal route/changing progestogen
Which type of HRT increases risk of endometrial cancer?
Use of oestrogen-only HRT in women with uterus substantially increases the risk of endometrial hyperplasia/carcinoma
Dependent on dose/duration
Risk reduced with sequential HRT and eliminated with CC HRT
If you’re using HRT, which preparation could you use to ELIMINATE the increased risk of endometrial cancer?
Continuous HRT (so oestrogen and progesterone continuously)
What is premature ovarian failure?
Periods stop and complete/partial loss of ovarian activity before age 45
Consequences of premature ovarian failure?
Short term – oligomenorrhoea or 2° amenorrhoea, menopausal symptoms
Longer term – bone loss, CVS and stroke risk, cognitive decline/dementia, infertility*, ↓ life expectancy
Infections which could cause premature ovarian failure?
TB, mumps
Treatment for premature ovarian failure
- HRT or OCP up to age 52
- testosterone (patch or implant)
- additional vaginal oestrogen may be needed
