sex hormone responsive conditions Flashcards
women without uterus, what HRT should be given ?
oestrogen only, given continuously
women with uterus, what HRT should be given ?
combined HRT: oestrogen and progestogen cyclically or continuously which avoids withdrawal bleeding
if a women is peri-menopause or had their last period in the last 12 months are they suitable for combined continuous HRT ?
no not suitable
if irregular bleeding continues after stopping combined continues HRT, what could be the possible cause ?
endometrial cancer
how long before surgery should HRT be stopped ?
stop 4-6 weeks before elective surgery, restart HRT
if its not possible to stop HRT before emergency surgery what can be done to prevent VTE?
low molecular heparin and compression stockings
women who is under 50 years of age and is on HRT asks your advice if she is protected from pregnancy or not?
fertile 2 years after last period; thus can use low oestrogen combined contraceptive if free from venous/arterial disease risk factors
women who is over 50 and is on HRT asking is it possible for her to still get pregnant ?
fertile one year after last period; advise to use condoms
what are the side effects of HRT?
ovarian cancer breast cancer cervical cancer endometrial cancer coronary heart disease: if combined HRT started 10 years after menopause
how can endometrial cancer risk from HRT be reduced ?
add progesterone at least for 10 days out of 28 days cycle or given continuously
what would be the reason to stop HRT?
sudden severe chest pain, sudden breathlessness or cough with blood-stained sputum ( pulmonary embolism)
unexplained swelling or severe pain in calf of one leg ( DVT)
stroke?: unusual severe prolonged headache, sudden or partial loss of vision, first unexplained seizure, weakness etc
liver impairment: jaundice, sever abdominal pain,
blood pressure: above 160 systolic and above 95 diastolic
what can estrogens do to the liver?
cause liver impairment
what risk factors would contraindicate HRT?
prolonged immobility after surgery or leg injury (VTE) thrombophelebitis angina, MI VTE recurrent VTE ( unless anticoagualted) thrombophillic disorder liver disease untreated endometrial hyperplasia undiagnosed vaginal bleeding oestrogen-dependent cancer history of breast cancer
what is clomifene and what is it used for ?
ovulation stimulant
used for infertility due to lack of ovulation or secondary ammenoreaha due to POCS
how should clomifene be used ?
use for 6 cycles only, increased risk of ovarian cancer
