Sex Hormones

Question 1

What are the THREE main types of HRT?:

Answer 1

NATURAL oestrogens;
Estradiol
Estrone
Estriol

Synthetic oestrogens:
Ethinylestradiol and mestranol

Progestogens:
Norethisterone
Levonorgestrel
Desogestrel

Tibolone:
Oestrogenic
Progestogenic and weakly androgenic

Question 2

What are main indications of oestrogens (combined with oestrogens if pt has uterus)?

Answer 2

Vaginal atrophy
Vasomotor instability
Reduce post menopausal osteoporosis

Question 3

What can clonidine be used for?

Answer 3

Vasomotor symptoms but has a large side effect profile.

Question 4

What are the risks of HRT ?

Answer 4

The benefits should always outweigh the risk.

Breast cancer
Endometrial cancer
Ovarian cancer; small increased risk however disappears few years upon discontinuation
VTE
Stroke
Coronary heart disease

Question 5

What increases the risk of. Breast cancer in HRT use?

Answer 5

Risk is increased if:
> 1 year and longer use
Greater in combined HRT
Excess risk persist for more than 10 years after stopping

Question 6

What increases the risk of endometrial cancer in HRT use?

Answer 6

Women with uterus-the risk is lower with combined oestrogen.
Tibolone also increases risk

Question 7

What increases the risk of VTE in HRT use?

Answer 7

Increased risk with Oestrogen only and combined HRT
Prolonged bed rest, obesity, trauma, family history

Question 8

What increases the risk of stroke in HRT use?

Answer 8

Tibolone increases risk by 2.2 times in first year of treatment

Slight increase in both combined HRT and oestrogen

Question 9

What increases the risk of CHD?

Answer 9

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

Question 10

What oestrogen regime is given in women with uterus?

Answer 10

Oestrogen with cyclical progestogen for the last 12-14 days of the cycle.

OR

Continuous administration of oestrogen and a progestogen

Question 11

When should you avoid starting continuous combined and tibolone in women with a uterus?

Answer 11

Avoided in perimenopausal phase

Or

If within 12 months of last menstrual period

Question 12

What HRT regime should be given to women WITHOUT a uterus?

Answer 12

Continuous oestrogen use
If endometriosis occurs consider addition of progesterone

Question 13

When would you stop HRT before elective surgery?

Answer 13

Stop HRT 4-6 weeks before surgery

Reinitiate when fully mobile

Question 14

What would you do if patient is on HRT and is taken in for non-elective surgery?

Answer 14

Give prophylactic heparin
Mechanical prophylactic:graduated compression stockings

Question 15

What are reasons for stopping HRT?

Answer 15

Sudden severe chest pain/breathlessness
Unexplained swelling or severe pain on one leg
Severe stomach ache
Serious neurological effects:
Unusual severe prolonged headache , fainting, seizure, motor disturbances, numbness
Hepatitis/jaundice
BP>160 OR 95
Prolonged immobility