Sex hormones (HRT, Contraceptives)

Question 1

What type of HRT should be prescribed for women at hight risk of VTE?

Answer 1

Transdermal

Question 2

When should women be prescribed cyclical combined HRT?

Answer 2

if their LMP was less than 1 year ago

Question 3

When should women be prescribed continuous combined HRT?

Answer 3

• If they have taken cyclical combined for at least 1 year or
• it has been at least 1 year since their LMP or
• it has been at least 2 years since their LMP, if they had premature menopause (menopause below the age of 40)

Question 4

HRT post hysterectomy?

Answer 4

oestrogen only

• elleste solo (PO), evorel (patch, transdermal), sandrena (PV gel)

Question 5

what is the 1st line PO oestrogen?

Answer 5

elleste solo

Question 6

what is the 1st line transdermal oestrogen?

Answer 6

evorel (twice weekly regime)

Question 7

how can progesterone be added to HRT regime (if not on combination therapy)

Answer 7

• IUS mirena (4 yrs)
• medroxyprogesterone acetate (Provera, PO)
• Utrogestan PO

Question 8

examples of combined cyclical HRT

Answer 8

• elleste duet (oestrgiol + norethisterone) - 1st line PO
• evorel sequi (oestradiol + norethisterone), 1st line transdermal

Question 9

formulations of continuous HRT?

Answer 9

• indicated after menopause, no bleed
• kilovance (E + norethisterone), PO , 1st line oral
• evoral conti - E + N, 1st line transdermal

Question 10

oestrogen SE

Answer 10

• breast tenderness
• nipple sensitivity
• bloating
• leg cramps
• nausea/heartburn
• headaches

Question 11

how to manage HRT SE?

Answer 11

• wait if just started Tx - most settle in 3/12
• if severe reduce dose
• consider change from PO to transdermal

Question 12

SE of progesterones

Answer 12

• PMS symptoms
• mood changes
• breast tenderness
• bloating
• headache
• acne/greasy skin

Question 13

risks of HRT

Answer 13

• cancer
  
  • E only - breast + endometrial
  • combined - breast (more than E alone)
• VTE (reduced if transdermal E)

Question 14

what should be monitored on hormonal treatments?

Answer 14

BP

weight

Question 15

non hormonal menopause treatment

Answer 15

• vasomotor
  
  • SSRI (fluoxe) → citalo/venla
• dryness → lubricants
• bone protection - bisphosphonates

Question 16

What are the HRT options availabe for women with uterus?

Answer 16

1. Cyclical combined (Estrogen with 12-14 days/ months progesterone)
   or
2. Continous combined - only suiteable if LMP >12 months

Question 17

Name an example of a commonly prescribed combined oral HRT preparation

Answer 17

Estradiol (1 mg) with norethisterone (500 micrograms)

one table once a day - if cyclical norethisterone only added on 12 days

Question 18

Name an example of a commonly combined transdermal HRT formulation

Answer 18

Estradiol 50 microgram per 24 hour, Norethisterone acetate 170 microgram per 24 hour

Usually applied 1-2 weekly (depending on wheather combined or cyclical)