T3 L7:Menopause & HRT Flashcards
what is menopause
- permanent cessation of menses (no periods) following loss of ovarian activity
- loss of estrogen significantly impacts on women in this time of life
- proportion of average female lifespan spent in menopause years: 1/3 to 1/2
what is peri-menopause
is period of transition to post menopause
Changes in menstrual cycle begin occurring up to 10 years before menopause
what are the characteristics of peri-menopause
typical age at start 45-50 y, median 47.5 y
mean duration: 3.8 y
few ova remain – less responsive to hormones
irregular menstrual cycles
occasional heavy bleeding
hot flushes
nervousness, irritability
primary symptoms of menopause
menstrual cycle changes
-oligomenorrhea, amenorrhea
vasomotor symptoms
-Hot flushes, night sweats
vaginal dryness
secondary symptoms of menopause
urinary stress/urge incontinence
cystitis-like symptoms
depression/irritability changes
musculoskeletal pains (joint aches & osteoporosis)
dry skin, hair thinning, nail changes
decreased concentration
decreased libido
what does HRT consist of
Oestrogen required for symptoms
Progestagens required to prevent endometrial cancer
what are the alternatives to HRT
Drugs for osteoporosis – Biphosphonates
Alendronate
Risedronate
Reducing vasomotor symptoms :
- Progesterone
- SERMs – Raloxifene
- Beta-blocker
- Clonidine
what are the alternative medicine therapies to HRT
-Phyto-oestrogens (soya bean)
- Herbalism
- -Black Cohost
- -St John’s Wort
- -Gingseng
- -Oil of Evening Primrose
- Progesterone Cream
- Homeopathy
- Acupunture
- Reflexology
what are the optional routes for HRT
Choice of route
- Oral
- Patches
- Implants
- Vaginal rings
- Transdermal gel
- Nasal
Choices of dose and type of drug
Choice of regimen
what happens if someone has no uterus
Only oestrogen
Oestradiol 1 mg
Too low a dose of oestrogen to act as a contraception
Taken continuously as symptoms would return if not taking the oestrogen
what happens of they do have a uterus
Oestradiol every day (white tablets)
Oestrogen plus progestagen (norgestrol) for 11 days (brown tablets)
Packet taken one after the other or 7 days break
Withdrawal bleeding during the brown tablets
contraindications to HRT
- Pregnancy
- Active venous thromboembolism
- Severe active liver disease
- Endometrial carcinoma with recurrence
- Breast carcinoma with recurrence
what are the side effects
Tender or painful breasts
Fluid retention causing bloating and weight gain
Nausea
Headaches
Leg cramps
ST benefits of HRT
Reduces vasomotor symptoms (eg hot flushes)
Improves psychological symptoms (eg mood
LT Benefits of HRT
Maintains bone mass and reduces the risk of fracture
Reduces urogenital problems (eg dry vagina)
Improves skin (cosmetic)
Reduces the risk of bowel cancer
May improve balance and reduce falls – less fractures
May reduce tooth loss
May protect against arthritis
