MHT

Question 1

Symptoms (5 domains)

Answer 1

1) VASOMOTOR: flushes
2) GUT: frequency/stress incont/dyspareunia
3) MOOD: depression/anxiety , irritable,s wings
4) SOMATIC: restless, headches, bloating
5) OTHER: insomnia, lower concentration, fatigue, word finding difficulties

USE MRQ QUESTIONAIRE

Question 2

history

Answer 2

Sx
Periods
?uterus

Age
BMI
PHx / comorbidities
 - OP/cvasc RF/VTE, BMD risks (weight/malabs/steroid)
FHx
 - OP/cvasc/cancer/vte
Occupation

mammogram
fobt
cst
metabolic check up (5 yearly lipids if low risk; 3 yearly AUSDRISK if low risk)

contraceptive needs: < 50; mirena also a good option or very low dose cocp if non smoker/low cvasc

Question 3

absolute contraindication

Answer 3

undiagnosed PV bleeding
breast cancer
endometrial cancer
ovarian cancer

Question 4

relative contraindication

Answer 4

established CVD
VTE
liver disease
migraine w aura

Question 5

pro

Answer 5

symptom control/improved QOL
bone impacts - benefit to fracture risk
cvasc - can benefit

Question 6

con

Answer 6

WHI initially thought to be danger, now redone

breast cancer only really > 5 year or use or > 60 yo when starting

• even then 3: 1000 to 4: 1000
• some progesterones are safer than others : micronized prog /dyprogesterones > MDPA.

VTE 1: 10 000 –> 3: 10 000, pregnancy/COCP much higher

PO: cholecystitis

Question 7

SFX

Answer 7

weight gain
breast tenderness
spotting, particularly within 1 year and cyclical

Question 8

non pharma

Answer 8

breathable clothes
cooler environment/fans/AC
avoid etOH/spicy foods
healthy diet/regular exercise
CBT/stress management

Question 9

continuous

• > 1 year from period
• or 3 months of cyclical

Answer 9

PO: femosten continous (uses dydrogesterone)
Transdermal: estalis continuous (better for HTN/DM/hyperchol as less VTE/CVA risk)

can just do oestrogen if no uterus; or if mirena in.

Question 10

cyclical

- within 1 year of period

Answer 10

PO: femosten 1/10 (uses dydrogesterone)
Transdermal: estalis sequ (better for HTN/DM/hyperchol as less VTE/CVA risk)

PV: ovestin topically or pessary.

Question 11

non MHT based Rx. (4)

Answer 11

1. venlefaxine 75mg SR
2. tibolone - only > 1 year post menopausal, helps w low libido
3. gabapentin - helps w sleep issue, 100 mg nocte
4. clonidine 25mg BD

Question 12

CAM

Answer 12

black kohosh has most research, but benefit evidence very limited/not enough safety data. liver SFX

compounding pharmaceuticals - no evidence. and no evidence the prog is safe for uterus.

Question 13

F/U

Answer 13

3 months
MRQ prior
dose adjust/SFX adjust/change up. 
gradually reduce as time goes on
aim < 5 years.