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PR - ENDOCRINE > SEX HORMONE RESPONSIVE CONDITIONS: HRT > Flashcards

SEX HORMONE RESPONSIVE CONDITIONS: HRT Flashcards

1
Q

Perimenopause

A
  • Periods still present in some sort of pattern
  • Age 45
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2
Q

Post menopause

A
  • 1 year after last period
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3
Q

Health risks associated with menopause

A
  • Osteoporosis
  • CVD
  • TIIDM
  • Depression
  • Cognitive decline, early dementia
  • Other: dry hair and skin, headaches
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4
Q

Onset of symptoms

A
  • Female oestrogen levels decline and menstruation ceases
  • Symptoms can start several years before final menstrual period and continue for up to 12 yrs
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5
Q

Symptoms

A

Vasomotor symptoms - hot flushes and sweats
Musculoskeletal symptoms - joint and muscle pain
Effect on mood - low mood, anxiety
Urogenital symptoms - vaginal dryness
Sexual difficulties - low sexual desire

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6
Q

Oestrogens

A
  • Natural Ostrogens (estradiol, estrone and estriol)
  • Synthetic Ostrogens (ethinylestradiol and mestranol)
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7
Q

Progestogens

A

norethisterone
levonorgestrel
desogestrel

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8
Q

Tibolone

A

ostrogenic, progestogenic and weakly androgenic

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9
Q

HRT risks (cancer)

A

Breast cancer
Endometrial cancer
Ovarian cancer

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10
Q

Breast Cancer

A
  • Increased risk after 1 year - longer use = higher risk
    → Risk higher in combined HRT over ostrogen only
  • Excess risk persists for more than 10 years
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11
Q

Endometrial Cancer

A

Increased risk in oestrogen only
Increased risk in tibolone

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12
Q

Ovarian Cancer

A

Small increase which disappears a few years after stopping

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13
Q

HRT risks (CVD)

A

Venous Thromboembolism
Stroke
Coronary Heart Disease

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14
Q

Venous Thromboembolism

A

Increase risk of DVT with both ostrogen-only and combined HRT
Increase risk with prolonged bed rest, obesity, trauma, family history

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15
Q

Coronary Heart Disease

A

Increased risk in combined HRT when started more than 10 years after menopause

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15
Q

Stroke

A
  • Slight increase with both ostrogen-only and combined HRT
  • Tibolone increases risk by 2.2 times in first year of treatment
16
Q

HRT (with uterus)

A

Combined - oestrogen + progestogen
- cyclical (sequential)
- continuous
Tibolone avoided in perimenopausal phase or if within 12 months of last menstrual period

17
Q

Cyclical (sequential)

A

for women who are still having monthly bleed, or last period was less than a year ago = require progesterone
* Oestrogen continuously and cyclical progesterone (last 12-14 days of cycle)
- progestogen added to trigger a bleed

18
Q

Continuous

A

for women whos last menstrual period was more than 12 months ago
* Same amount of oestrogen and progestogen everyday

19
Q

HRT (without uterus)

A

e.g. hysterectomy
oestrogen only
If endometriosis occurs - consider an addition of progesterone

20
Q

Gols standard HRT

A
  • Body identical or regulated bio-identical hormones
  • Oestrogen through skin
    o Patch, gel, spray
  • +/- micronized progesterone
  • +/- testosterone – can help to improve mood, energy, stamina
  • Combo of all 3 is not something seen in GP, would be specialist care
21
Q

Woman with uterus - cyclical (sequential) HRT (ORAL)

A

Elleste duet - 1mg or 2mg estradiol + 1mg norethisterone
Prempak-C 0.625mg or 1.25mg conducted oestrogen + norgestrel 150mcg

progestognenic side effects offer:
Femoston 1/10 or 2/10 1mg or 2mg estradiol + dyhydrogesterone 10mg

22
Q

Woman with uterus - Continuous combined HRT (ORAL)

A

Elleste duet conti: 2mg estradiol + 1mg norethisterone
Premique: conjugated oestrogen 655mcg + medoxyprogesterone acetate 5mg
Kilofem: 2mg estradiol + 1mg norethisterone
Tibolone

Progestogenic side effects offer:
Femoston conti: 1mg estradiol + 5mg dydrogesterone

23
Q

Woman with no uterus - oestrogen only (ORAL)

A

Elleste solo: 1mg or 2mg estradiol
Premarin: 0.624 or 1.25mg conjugated oestrogen

24
Q

Woman with uterus - cyclical (sequential) combined (PATCHES)

A

Evorel Sequi patches: Change
TWICE per week 50mcg estradiol + 170mcg norethisterone

FemSeven Sequi patches:
Change ONCE weekly 50mcg estradiol + 10mcg levonorgestrel

25
Q

Woman with continuous - combined (PATCHES)

A

Evorel conti patches: chance twice a week 50mcg estradiol + norethisterone
if progestognenic side effects offer:
Femseven conti patches: change once weekly 50mcg estradiol + 7mcg levonorgestrel

26
Q

oestrogen only (PATCHES)

A

Evorel patches: change twice per week
Estradot patches - change twice per week
Oestrogen: 2 measures = standard regime

27
Q

Clonidine

A

vasomotor symptoms
larger side effect profile

28
Q

CI

A

History of breast cancer or other ostrogen-dependent cancers.
Active or recent arterial thromboembolic disease, e.g. angina or MI.
Current venous thromboembolism or thrombophlebitis, or history of recurrent VTE
Thrombophillic disorder.
Undiagnosed vaginal bleeding.
Untreated endometrial hyperplasia.
Liver disease (with abnormal LFTs).
Dubin-Johnson and Rotors syndromes, unless monitored closely (rare genetic disorders leading to increased bilirubin).

29
Q

Lifestyle advice

A

Eat a healthy balanced diet
Maintain a healthy BMI
Ensure sufficient dietary calcium (700mg/day)
Undertake regular weight-bearing exercise
stopping smoking, reducing alcohol intake
Treatment optimisation of other conditions

30
Q

Stopping HRT

A
  • Unscheduled vaginal bleeding is common
  • Choice of gradually or immediately stopping
31
Q

Elective surgery

A

Stop HRT 4-6 weeks before
Reinitiate when fully mobile

32
Q

Non-elective surgery

A

Prophylactic heparin
Graduated compression stockings

33
Q

Reasons to stop HRT

A

Sudden severe chest pain / breathlessness
Unexplained swelling or severe pain in calf of one leg (DVT)
Severe stomach pain (hepatotoxicity)
Serious neurological effects: Unusual severe, prolonged headache, fainting, first unexplained epileptic seizure, motor disturbances, numbness
Hepatitis / jaundice
BP > 160 mmHg systolic or 95 mmHg diastolic
Prolonged immobility

34
Q

Testosterone

A

Sexual libido in postmenopausal women
Replacement therapy in androgen deficiency
(Hypogonadism due to androgen deficiency)

35
Q

Why would testosterone be used in androgen deificnecy

A

Hypogonadism due to androgen deficiency

36
Q

testosterone side effects

A

Masculinisation
Virilisation in women
Acne
Anxiety
Male pattern baldness
-Sexual development in pre-pubescent males

37
Q

Male sex hormone antagonism

A

Cyproterone

PR - ENDOCRINE (25 decks)

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