Sex hormones + conditions

Question 1

What is the treatment for menopause?

Answer 1

Vaginal atrophy (dry vaginal walls)

• Topical oestrogens (cream, tabs, rings)

Vasomotor instability (hot flashes + night sweats)

• Systemic oestrogens or tibolone (tablets, transdermal patch)
• Counsel: apply below waistline (not near breast + waist band bc can cause breast cancer)

Question 2

HRT: MOA

Answer 2

replaces declining oestrogen levels to alleviate menopausal symptoms

Question 3

HRT: drugs

Answer 3

Natural oestrogens
- Estrone
- Estradiol
- Estriol

Synthetic oestrogens
- Ethinylestradiol

Tibolone
- Oestrogenic, progestogenic + weakly androgenic

Question 4

HRT: drugs when uterus is intact

Answer 4

ADD progesterone
- Cyclic: last 12-14 days of cycle
- Continuous: avoids w/drawal bleeding
- Unsuitable: peri-menopause, <12M last period
- Rule out endometrial cancer if bleed

Question 5

HRT: side effect

Answer 5

Cancer: breast, cervical, ovarian
- Endometrial: add progesterone
- CI: untreated endometrial hyperplasia, undiagnosed vag bleed, oestrogen-dependent cancer, Hx breast cancer

VTE
- CI: prolonged immobility after surgery/leg injury, VTE, thrombophillic disorder

CVD (coronary heart disease, stroke)
- CI: angina, MI

Question 6

Reasons to stop HRT

Answer 6

VTE

Stroke

Blood pressure
- Systolic above 160mmHg
- Diastolic above 95mmHg

Liver dysfunction
- CI: liver disease
- Jaundice, hepatitis, liver enlargement

Question 7

HRT: surgery

Answer 7

• Major procedure: stop 4-6 weeks before
• Significant VTE risk factor: restart when fully mobile

Question 8

HRT: contraception

Answer 8

woman fertile 2 years after last period if under 50 + 1 year over 50

• Under 50: low oestrogen combined oral contraceptive
• 50+: condom

Question 9

What are the side effects of testosterone?

Answer 9

Masculinisation

• Acne, anxiety, male pattern baldness
• Do not apply gels to genital area - apply to abdomen, shoulders or arms
• MHRA: topical testosterone: risk of harm to children after accidental exposure

Question 10

Give an example of an anti-oestrogen

Answer 10

Clomifene

Question 11

Clomifene: MOA, indication + side effect

Answer 11

• MOA: Ovulation stimulant
• Indication: Infertility (oligomenorrhoea, PCOS)
• Side effect: Ovarian cancer (used MAX 6 cycles)+ Multiple pregnancy