T3 L7 Menopause and HRT Flashcards
What is menopause?
Permanent cessation of menses following loss of ovarian activity
How much of a female’s lifespan is spent in menopause?
1/3 to 1/2
What is peri-menopause?
Transition from reproductive cycles to post menopause
How long before menopause do changes in the reproductive cycle start occurring?
10 years
What is the typical age for the start of menopause?
45 - 50 years
Median age is 47.5 years
What is the mean duration of peri-menopause?
3.8 years
What happens during peri-menopause?
Few ova remain and are less responsive to hormones Irregular menstrual cycles Occasional heavy bleeding Hot flushes Nervousness, irritability
What are the primary symptoms of menopause?
Menstrual cycle changes - oligomenorrhoea, amenorrhoea
Vasomotor symptoms - hot flushes, night sweats
Vaginal dryness
What are the secondary symptoms of menopause?
Urinary stress / urge incontinence
Cystitis like symptoms
Musculoskeletal pains - joint aches, osteoporosis
Dry skin, hair thinning, nail changes
Psychophysiological changes - decreased concentration, depression, irritability, insomnia, fatigue
Decreased libido
What are the 4 groups of menopausal symptoms identified in the 2012 British prospective cohort study?
Psychological
Somatic
Vasomotor
Sexual discomfort
In HRT, what is oestrogen required for?
Treatment of symptoms
In HRT, what are progestogens required for?
Preventing endometrial cancer
What are the 3 alternatives to HRT?
Drugs for osteoporosis
Drugs to reduce vasomotor symptoms
Complementary and alternative therapies
What drugs are used for osteoporosis?
Bisphosphonates
What drugs are used to reduce vasomotor symptoms?
Progesterone
SERMs - raloxifene
Beta blockers
Clonidine
What are some complementary and alternative therapies?
Phyto-oestrogens Herbalism - Black cohost, St John's Wort, Gingseng, oil of evening primrose Progesterone cream Homeopathy Acupuncture Reflexology
What are the options for route in HRT?
Oral Patches Implants Vaginal rings Transdermal gel Nasal
What HRT is given when there is no uterus?
Just given oestrogen
1mg Oestradiol taken continuously
Too low a dose to act as a contraception
What HRT is given when there is a uterus?
Combined HRT
Oestradiol every day
Norgestrol (oestrogen and progestogen) for 11 days
Take packet one after the other or have 7 days break
What are the absolute contraindications to HRT?
Pregnancy Active venous thromboembolism Severe active liver disease Endometrial carcinoma with recurrence Breast carcinoma with recurrence
What are the relative contraindications to HRT?
Abnormal bleeding Breast lump Previous endometrial cancer Previous breast cancer Strong family history of breast cancer Family history of thromboembolism
What are the side effects of HRT?
Tender or painful breasts Fluid retention leading to bloating and weight gain Nausea Headaches Leg cramps Mood swings Acne Backache Lower abdominal ache Bleeding Stomach upset (indigestion)
What are the short term benefits of HRT?
Reduces vasomotor symptoms
Improves psychological symptoms
What are the long term benefits of HRT?
Maintains bone mass and reduces risk of fractures Reduces urogenital problems Improves skin Reduces risk of bowel cancer May improve balance and reduce falls May reduce tooth loss May protect against arthritis
What are the risks of HRT?
Endometrial cancer if unopposed oestrogen is used
Breast cancer
Cardiovascular disease
Venous thromboembolic disease
How does endometrial cancer first present?
Post-menopausal bleeding
What are the risk factors for endometrial cancer?
Obesity Unopposed HRT Nulliparity Late menopause Diabetes Family history of breast, colon and ovarian cancer
What investigations are done in endometrial cancer?
Trans vaginal ultrasound scan to measure endometrial thickness
How is endometrial cancer diagnosed?
Endometrial biopsy
What is the treatment for endometrial cancer?
Hysterectomy and oophorectomy
Radiotherapy
How is HRT different to COCP?
Oestradiol is natural
Lower dose
HRT doesn’t suppress FSH and LH to same degree as COCP
Doesn’t stop ovulation
What is the advice regarding HRT?
Little or no risk of CVD with HRT below age of 60
There is a risk of thrombosis with oral HRT - avoid by using gels / implants
Combined HRT has a risk of breast cancer
