Sex Hormones Flashcards
What is the reason for HRT
Small doses of an oestrogen to alleviate menopausal symptoms
(Vaginal atrophy, vasomotor instability)
Add progesterone in women with uterus
What are the vasomotor symptoms of menopause
Night sweats
Hot flashes
Vaginal dryness
What is the age range for HRT
Used in women with early menopause (under 45) since they are at high risk of osteoporosis
Until the age of natural menopause (age 50)
What is an alternative to oestrogen to treat vasomotor symptoms
Clonidine
But may cause unacceptable side effects
What are the HRT limitations
⬆️risk of venous thromboembolism, Stroke, Endometrial cancer, Breast cancer, Ovarian cancer
How often should HRT be reviewed
Annually
Also alternatives for osteoporosis treatment considered
What is tibolone’s activity
Combines oestrogen + progesteron activity with weak androgenic activity
HRT and cancer risk
Breast cancer risk increases within 1-2 years of treatment (linked to duration) and disappears within 5 years of stopping
Small ovarian risk
Endometrial cancer (depends on dose/duration) progesterone addition ⬇️risk but ⬆️breast cancer risk
What is the risk of VTE with HRT
Deep vein thrombosis
Pulmonary embolism
(Esp first year of use)
If family history review risk:benefit
HRT and surgery protocols
Stop HRT 4-6 weeks before surgery and restarted after full mobilisation
If not possible add unfractioned or low molecular weight heparin to reduce VTE risk
Reasons to stop HRT
Severe chest pain Sudden breathlessness Severe stomach pain Severe prolonged headache Loss of vision/hearing Jauntice/hepatitis Prolonged immobility after surgery
What is the use of progesterone in women with uterus in HRT regime
Preventing cystic hyperplasia of the endometrium and possibly transformation to cancer
(Cyclical or continuous basis)
Which is the indication of raloxifene
Treatment and prevention of postmenopausal osteoporosis
60mg once daily
Symptoms of cyclical HRT
Regular withdrawal bleeding towards the end of the progestogen
