Sex hormones responsive conditions Flashcards
what are the two types of oestrogens?
Natural
Synthetic
examples of natural oestrogens
estradiol, estrone, estriol
examples of synthetic oestrogens
ethinylestradiol + menstranol
examples of progestrones used in tx of HRT
norethisterone, levonorgestrel, desogestrel
examples of tibolone used in tx of HRT
oestrogenic
progestogenic
weakly adrongenic
why is oestrogen given as tx in HRT?
-It helps to alleviate menopausal symptoms
-can also reduce postmenopausal osteoporosis
when is progestrone given with oestrogen
if pt has uterus
topical + systemic
what are the menopausal symptoms?
-vaginal atropy (topical)
-vasomotor instability (systemic)
pro and con of clonidine
-pro= can be used for vasomotor symptoms
-con = large s/e profile
when should HRT be used
only when benefit outweighs risk especially in under 60
what are the risks of HRT
-Breast cancer
-endometrial cancer
-ovarian cancer
-venous thromboembolism
-stroke
-coronary heart disease
how long is breast cancer a risk in HRT
-increased risk after 1 yr
-longer use = higher risk
-risk higher in combined HRT than oestrogen alone
-excess risk persists for 10+yr
when is is endometrial cancer a risk in HRT
-women with uterus lower risk with combined than oestogren alone
-tibolone also increases risk
how long is ovarian cancer a risk in HRT
small increase which disappers a few years after stopping
what increases risk of VTE in HRT
-increase risk of DVT with both oestrogen-only and combined HRT
-increased risk with prolonged bed rest, obesity, trauma, family history
oestogen-only or combined HRT
which drugs increases risk of stroke in HRT
-slight increase with both oestogen-only and combined HRT
-tibolone increases risk by 2.2x in 1st yr of tx
what increases risk of coronary heart disease in HRT
-increased risk in combined HRT when started 10yr+ after menopause
choosing HRT women with uterus
-oestrogen + cyclical progestogen for last 12-14 DY of cycle
-continous admin of oestrogen + progestogen
-avoid continous admin of combined + tibolone in perimenopausal phase or within 12MT of last menstrual period
choosing HRT women without uterus
-continous oestrogen use
-if endometriosis occurs consider + progestrone
HRT and elective surgery
stop HRT 4-6wk before surgery + restart when fully mobile
what is given in non-elective surgery when taking HRT
-prophylactic heparin
-graduated compression stockings
reasons to stop HRT
-stopped pending investigation + tx
-sudden severe chest painand breathlessness
-unexplained swelling/severe pain =calf one leg = DVT
-severe stomach pain
-serious neurological effects (unusual severe, prolonged headache, fainting 1st unexplained epileptic seizure, motor disturbances, numbness
-hepatitis and jaundice
-BP >60 sys 95 diast
-prolonged immobility
