Sex Hormones

Question 1

What oestrigens are better for HRT

Answer 1

Natural over synthetic

So estradiol estrone estriol

Question 2

How is oestrogen therapy given

Answer 2

Either cyclically or continuously

Question 3

If a women has a uterus what is coprescribed

Answer 3

Progesterone to reduce risk of cystic hyperplasia and possible transformation to cancer

Question 4

What are the indications for HRT

Answer 4

Menopausal symptoms such as vaginal atrophy or vasomotor instability

Question 5

When can oestrogen be used to treat menopausal symptoms

Answer 5

Peri and post menopause

Question 6

When can tibolone be used

Answer 6

Post menopausal period and is also licensed for post menopausal osteoporosis

Question 7

How is tibolone given

Answer 7

Continuously without cyclical progestogen

Question 8

When else can HRT be given

Answer 8

Early natural menopause or surgical menopause (before 45yo) as they are at high risk of osteoporosis

Question 9

If osteoporosis is the main concern in early menopause what should be given

Answer 9

An alternative to HRT

Question 10

How long is HRT given for patients with an early menopause

Answer 10

Until the approximate age of natural menopause (ie 50yo)

Question 11

What can be given to women who cannot take HRT

Answer 11

Clonidine

Question 12

When is HRT contraindicated

Answer 12

Angina MI history of breast cancer VTE hx oestrogen dependent cancers active or recent thromboembolism disease thrombophlebitis disorder undiagnosed vaginal bleeding untreated wndometrial hyperplasia

Question 13

What is the huge risk of HRT

Answer 13

Breast cancer risk and it’s persistence after stopping

Question 14

How long do you need to take HRT before your risk of breast cancer is increased

Answer 14

1 year

Question 15

Which is the only form of HRT that does not increase the risk of breast cancer

Answer 15

Vaginal oestrogens

Question 16

Is the risk higher for breast cancer with oestrogen alone or combined oestrogen progesterone

Answer 16

Oestrogen and progesterone has a higher risk

Question 17

What are the 6 cautions of HRt

Answer 17

Breast cancer 
Endometrial cancer
Ovarian cancer
VTE 
Strokes 
Coronary heart disease

Question 18

What happens at the end of the progesterone of HRT

Answer 18

Withdrawal bleed

Question 19

If progesterone were to be given continuously what would be the pro and con?

Answer 19

Pro - eliminated risk of endometrial cancer

Con - significantly increased risk of breast cancer

Question 20

Who on HRT has an increased risk of coronary artery disease

Answer 20

Start combined HRT more than 10 years after menopause

Question 21

What types of HRT are not suitable in the perimenopausal or within 12 months of last period

Answer 21

Continuous combined HRT or tibolone

Question 22

How long should you stop HRT before major surgery

Answer 22

4-6 weeks

Question 23

What are the two main groups of progestogen?

Answer 23

Progesterone and it’s analogues (dyseogesterone and meseoxyprogesterone acetate)

And

Testosterone analogues (norethisterone and norgestrel)

Question 24

Desogestrel, norgestimate and gestodene are all derivatives of

Answer 24

norgestrel