Sex Hormones

Question 1

May not need to go to doctor for HRT

Answer 1

service

Question 2

Oestrogens Natrural and synthetic

Answer 2

• Natural oestrogens (estradiol,estrone,estriol)
  
  • Synthetic oestrogens (ethinylestradiol and mestranol)

Question 3

Progesterones

Answer 3

(noresthisterone,levongestrel,desogestrel)

Question 4

Tibolone is oestrogeni, prog…. And weakly

Answer 4

oestrogenic,progestogenic and weakly androgenic

Question 5

Oestrogens- combined is combined with progesterone if the patient has a (+ colonidine)

Answer 5

(combined with progesterone if patient has a uterus- alleviates menopausal symptoms such as:
- Vaginal atrophy - topical
- Vasomotor instability - systemic
- Can reduce post menopausal osteoporosis

- Clonidine can also be used for vasomotor symptoms but has large se profile

Question 6

HRT, benefits will always……. Including CANCER (3)

Answer 6

Benefits outweigh risks especially under 40

Breast Cancer:
- Increased risk after 1 year - longer use = higher risk!
- Risk higher in combined HRT over oestrogen only
- Excess risk persists for more than 10 years

Endometrial Cancer
- Women with uterus - risk lower with combined than oestrogen only

Question 7

Choosing HRT:
Women with Uterus: What do we give and for how long?
What is avoided in perimenopausal phase or if wit=thin 12 months of the last period??

Answer 7

• Oestrogens with cyclical progestogens for the last 12 to 14 days of the cycle
  
  • Continuous administration of an oestrogen and a progestrogen
  • Continuous combined and tibolone avoided in perimenopausal phase or if within 12 months of the last menstrual period

Question 8

Women without uterus we give??? If ENDO occurs consider adding?

Answer 8

• Continuous oestrogen use
  
  • If endometriosis occurs consider and addition of progesterone

Question 9

HRT AND SURGERY- Elective:

Answer 9

• Stop HRT 4-6 WEEKS BEFORE
  
  • REINITIATE WHEN THE PTX is fully mobile

Question 10

Non elective surgery:
For prophylaxis we giveeeee

Answer 10

• Prophylactic heparin
  Graduated compression stockings

Question 11

Reasons to stop HRT:

Answer 11

• Sudden severe chest pain/breathless - could be a pulmonary embolism
  
  • Unexplained swelling or severe pain in the calf of one leg - DVT
  • Severe stomach pain- Hepatoxicity
  • Serious neurological effects:unusual sever, prolonged headache,fainting,first unexplained epileptic seizure, motor disturbance, numbness
  • Hepatitis/jaundice
  • BP greater than 160mmhg systolic or 95mmhg diastolic
  • Prolonged immobility
    HRT increase the likelihood of VTE

Question 12

Tibolone increase cancer and VTE, STROKE AND CHD - 222222 tib 222 tib

Answer 12

• Tibolone also increases risk
  Ovarian cancer:
  
  • Small increase which decreases after a few years of stopping
    Venous thromboembolism:
  • Increased risk of DVT with both oestrogen -only and combined HRT
  • Increase in risk with prolonged bed rest, obesity,trauma,family history
    Stroke:
  • Slight increase with both oestrogen only and combined HRT
  • Tibolone increases risk by 2.2 times in first year of treatment
    Coronary heart disease:
  • Increased risk in combined HRT when started more than 10 years after menopause