Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCOG Part 2 > Menopause - NICE 23 and TOG - Latest evidence on using HRT in Menopause > Flashcards

Menopause - NICE 23 and TOG - Latest evidence on using HRT in Menopause Flashcards

1
Q

What is the prevalence of menopausal symptoms?

A

2/3 have hot flushes, 10-20% severe symptoms
1/3 will have symptoms for up to 5 years
20% symptoms for up to 15 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for hot flushes?

A

High BMI
Smoker
African American/Caucasian
Surgically-induced menopause (90% within 1st year)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

In what % does HRT improve vasomotor symtpoms?

A

80-90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which botanicals have phytoestrogens?

A 
Soy
Red clover (Trifolium pretense)
Black cohosh (Cimicifuga racemosa)

Avoid in breast Ca/tamoxifen use - hinder ability to inhibit breast ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the advice re: HRT and gynae cancer survivors?

A
  • ?reasonable in young women with early stage endometrial
  • limited data ovarian - no adverse effect on survival/recurrence
  • lack definitive evidence in cervical - tend to have ovarian conservation
  • Varied evidence breast - systemic HRT likely increases risk recurrence. sparse re: vaginal but no increase in risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the transdermal preparation of oestrogen in HRT?

A

17-beta- estradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the cardiovascular benefits of HRT?

A
  • Reduces atherosclerosis
  • Increases HDL-cholesterol
  • Lowers LDL-cholesterol
  • Promotes coronary artery vasodilatation
  • Prevents platelet aggregation
  • Decreases lipoprotein-a and inhibits LDL-cholesterol oxidation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which herbal remedies may help menopausal symptoms short term but there is uncertain safety/interactions with other medications?

A

Isoflavones/black cohosh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What complementary therapies can be suggested if there is a hx of breast cancer or otherwise high risk?

A

St John’s wort may help vasomotor symptoms
Uncertainty re: doses/persistence of effect
Potential interactions with e.g. tamoxifen, anticoagulants, anticonvulsants…

Not for fluoxetine/paroxetine if hx of breast Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How often should women on HRT be reviewed?

A

3/12 short term symptoms - unscheduled bleeding common for this time
Then annually unless required earlier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the effect of HRT with regards to VTE?

A

Increases VTE relative to baseline population risk
Transdermal preparations back to baseline - consider if high risk for VTE esp BMI >30

If very high risk consider haematological assessment first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the effect of HRT on cardiovascular disease?

A

No increase in risk if commence <60yo
Risk factors not a contraindication if optimally managed
Slight increase in risk of stroke with PO>transdermal prep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the effect of HRT on T2DM?

A

No increased risk or adverse effect on glucose control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the effect of HRT on breast cancer?

A

Oestrogen alone - little/no increase in risk

Combined - increase in risk related to duration of treatment, reduces upon cessation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the effect of HRT on osteoporosis?

A

Risk of fragility fractures decreases while on HRT

Benefit stops when treatment ceased but if on HRT a long time may continue for longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is premature ovarian insuffiency diagnosed?

A

<40 yo

2 x raised FSH 4-6 weeks apart NOT AMH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which trial looked at whether HRT reduced the recurrence of coronary heart disease in women with established CHD? And what were the findings?

A

Heart and Estrogen/progestin Replacement Study (HERS)

Did decrease recurrence of CVD events but VTE increased - older women, route and preparation may have had an effect

The Women’s Hormone Intervention Secondary Prevention Study - micronised progesterone; more favourable outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What were the findings of The Women’s Health Initiative Study?

A
  • To evaluate effect of HRT on cardiovascular outcomes
  • Closed early as:
  • Increase in breast Ca, CVA, heart disease, VTE, gallbladder disease
  • Not seen in oestrogen alone
  • Reanalysed - see fewer CV effects (6/10,000 woman years) if HRT given within 10 years of menopause

Decrease in fracture rate, DM and bowel cancer

i.e. ‘window’ for short term symptom relief; does more harm if given many years after the menopause

19
Q

What were the findings of the million women study?

A

Increase in breast Ca on combined HRT vs oestrogen alone
Women attending for screening using questionnaire
Flaws in methodology - existing breast Ca not excluded, Pts concerned on HRT more likely to attend, much data missing from follow up questionnaires

20
Q

What were the findings of the 2012 Cochrane systematic review?

A

No indication to use HRT for primary or secondary prevention of CVD or dementia or for protection of cognitive function

Reduction of risk of bone fracture after 5 years of use

21
Q

What are the effects of HRT on recently menopausal women?

A

After 10 years women on HRT had sig. decrease on mortality and CVD-disease with no increase in VTE, stroke or cancer

Benefits seen for up to 6 years after cessation

Conclusion - lowest dose for shortest time possible

22
Q

What is the HRT advice for women with POI?

A

Strongly advise to take HRT until at least 50yo

23
Q

What is the absolute increased risk of breast cancer risk with HRT?

A

6 extra cases per 1000 women for 5 years of oestrogens and progestogens
Reverts back to population risk 5 years after cessation

24
Q

What type of HRT should be used in perimenoapausal women?

A

Continuous oestrogen/cyclical progesterone (ie sequential)

25
Q

What type of HRT should be used in hysterectomised women?

A

Oestrogen alone

- If subtotal but endometrium seen at margin use continuous combined

26
Q

What type of HRT should be used in women who have undergone endometrial ablation?

A

Cyclical or combined continuous

27
Q

What type of HRT should be used in women who are very sensitive to progesterone?

A

Mirena or micronised progesterone plus systemic oestrogen

28
Q

What type of HRT should be used in women who have undergone premature menopause?

A

May require higher oestrogen dose

29
Q

What type of HRT should be used in older women?

A

Start with lowest dose and adjust

30
Q

What type of HRT should be used in women with potential malabsorption?

A

Non-oral route

31
Q

What type of HRT should be used in women who are post-menopausal with low libido?

A

Try Tibolone as first choice

32
Q

What type of HRT should be used in women who do not respond to standard treatment, or young women who have surgical-induced menopause?

A

Consider subcutaneous implants of oestrogen

33
Q

What are the common adverse effects of HRT?

A

Headaches, breast tenderness, bloating, muscle cramps
NOT weight gain
Usually resolve by 3/12

34
Q

When should women taking sequential HRT wishing to stay on it be advised to change to continuous combined?

A

After 5 years of use - increase risk endometrial hyperplasia on sequential

35
Q

What % of women will be menopausal aged 54?

A

80%

36
Q

What are the relative contraindications to HRT that require referral for specialist advice?

A
  • Existing cardiac disease
  • Active liver disease
  • SLE
  • Previous breast cancer
  • Previous ovarian/endometrial cancer
  • Undiagnosed vaginal bleeding
  • Previous personal/FHx of VTE
37
Q

When is risk of VTE associated with HRT the highest?

A

After initiation and falls over the next 12 months

38
Q

What is the rate of VTE with 5 years of oestrogen/oestrogen+progesterone compared with background risk for women aged 50-59?

A

Background - 5/1000
Oestrogen - 7/1000
Oestrogen and progesterone - 12/1000

39
Q

What are the additional benefits of HRT?

A
  • Low mood improvement
  • Protection against loss of connective tissue
  • ?Neuroprotective reducing Alzheimers/Parkinsons
  • Prevention loss of bone mineral density
40
Q

What are the ‘self help’ tips and coping strategies for women with debilitating symptoms of menopause?

A
  • Avoid sudden temperature change (hot drinks)
  • Reduce caffeine/alcohol intake
  • Avoid spicy foods
  • Increase exercise
  • Wear layers of clothes to be able to take off and put on when necessary
  • Practise relaxation techniques
  • Use cooling devices e.g. facial spray, cold pillows/pads in bed
  • Wear absorptive night attire
41
Q

Which breast cancer treatment is ineffective with HRT?

A

Aromatase inhibitors

42
Q

What is the effect of tibolone as HRT in women with previous breast Ca?

A

Increased recurrence in only those with ER+

43
Q

What is the advice re: HRT in women with a family Hx of breast Ca or BRCA carriers?

A
  • No increase if FHx
  • Indicated in BRCA as young following risk reducing BSO will depend on the progesterone used/womb still in situ, but no additional risk

MRCOG Part 2 (97 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions