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Repodction > Menopause HRT > Flashcards

Menopause HRT Flashcards

1
Q

What is the menopause?

A

The last menstrual period (LMP)

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2
Q

When do FSH levels peak?

A

Peak around the time of the menopause

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3
Q

FSH levels diagnostic of ovarian failure?

A

FSH > 30 IU/L on 2 separate occasions = menopause

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4
Q

Ovaries and responsiveness to LH/FSH in the lead up to menopause

A

The ovaries become less responsive to FSH/LH in the lead up to menopause

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5
Q

Which type of oestrogen is predominant in pre-menopausal women?

A

E2 (oestradiol) is predominant in pre-menopausal women

-produced in the ovaries

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6
Q

Where is E2 produced?

A

The ovaries

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7
Q

Which oestrogen is predominant in post-menopausal women?

A

E1 (Oestrone) is predominant in post-menopausal women

-produced by the peripheral conversion of androgens in the adipose tissue

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8
Q

Where is E1 (oestrone) produced?

A

Produced by the peripheral conversion of androgens in the adipose tissue

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9
Q

Which is less biologically active, E1 or E2?

A

E1 is less biologically active

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10
Q

What makes hot flushes worse?

A

Smoking

High BMI

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11
Q

Menopause effects on the urinary tract?

A
  • increased frequency/nocturia
  • urgency
  • stress/urge incontinence
  • recurrent UTI
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12
Q

Long term effects of the menopause

A
  • cardiovascular effects
  • cerebrovascular effects
  • osteoporosis
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13
Q

Lifestyle measures to improve menopause symptoms

A
  • healthy diet
  • regular exercise
  • stop smoking
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14
Q

Who do you give sequential HRT to?

A

Peri-menopausal women (they will still get a bleed, mimics the normal menstrual cycle)

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15
Q

Who do you give continuous HRT to?

A

Post-menopausal women (they won’t get a bleed)

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16
Q

When can you start sequential HRT and how long can you use it for?

A
  • can be started when required

- but can only be used for max 5 years (because increased risk of endometrial cancer)

17
Q

When can continuous combined HRT be started?

A

-should not be started till 1 year since LMP

18
Q

Over 54 and more than 1 year since LMP, which HRT should you use?

A

Continuous (CCT)

19
Q

Under 54, which HRT should you use?

A

Use sequential for 2 years and then switch to continuous (CCT)

20
Q

What is tibolone and what is it licensed for?

A

Tibolone is an alternative to CC HRT

-licensed for vasomotor, psychological and libido problemds

21
Q

Tibolone risk:benefit ration

A

Over 60 = increased risk of stroke

22
Q

Tibolone and bone mass

A

Tibolone preserves bone mass and prevents fractures (not hip)

23
Q

This helps general feeling of well-being and improves libido

A

Testosterone

24
Q

Which forms is testosterone available in?

A
  • Patch

- implant

25
Q

What are local systemic oestrogen preparations used for?

A
  • 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

26
Q

HRT helps reduce the risk of which type of cancer?

A

Colorectal

-likely due to the anti-oxidant effect of oestrogen

27
Q

Major risk factors for osteoporosis

A
  • prolonged steroid use
  • early menopause
  • prolonged amenorrhoea
28
Q

Which type of HRT has greatest risk of breast cancer?

A

Combined HRT

oestrogen only - the lowest risk

29
Q

Which type of risk gives greatest risk of venous thromboembolism?

A 
Combined HRT (but oestrogen only still has risk)
-risk may be lowered by transdermal route/changing progestogen
30
Q

Which type of HRT increases risk of endometrial cancer?

A

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

31
Q

If you’re using HRT, which preparation could you use to ELIMINATE the increased risk of endometrial cancer?

A

Continuous HRT (so oestrogen and progesterone continuously)

32
Q

What is premature ovarian failure?

A

Periods stop and complete/partial loss of ovarian activity before age 45

33
Q

Consequences of premature ovarian failure?

A

Short term – oligomenorrhoea or 2° amenorrhoea, menopausal symptoms

Longer term – bone loss, CVS and stroke risk, cognitive decline/dementia, infertility*, ↓ life expectancy

34
Q

Infections which could cause premature ovarian failure?

A

TB, mumps

35
Q

Treatment for premature ovarian failure

A
  • HRT or OCP up to age 52
  • testosterone (patch or implant)
  • additional vaginal oestrogen may be needed

Repodction (52 decks)

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