Type of HRT in low risk women

Question 1

What HRT in Perimenopausal Women

Answer 1

Continuos estrogen/cyclical progesteron

Question 2

What HRT in hysterectomised women

Answer 2

Estrogen only

Question 3

What HRT in women with subtotal hysterectomy

Answer 3

• Estrogen only if no endometrium in lower margin of excision on histology
• CCT if endometrium present

Question 4

What HRT in endometrial ablation

Answer 4

Either cycliclal or CCT

Question 5

What HRT in progesterone sensitive women

Answer 5

• Mirena plus systemic estrogen

- micronised progesterone

Question 6

What HRT in early menopause

Answer 6

May require higher levels of estrogen

Question 7

What HRT in older women

Answer 7

Start with lowest dose possible

Question 8

What HRT in Post menopause, low libido

Answer 8

Tibolone first choice

Question 9

What HRT in young surgical induced menopause

Answer 9

Subcutaneous implants of estrogen

Question 10

What HRT in perimenopause

Answer 10

• Sequential
• first period heavy, then normal
• side effects usually resolve within 3 months
• any change should be followed up after one month
• if no change annual review and swap to CCT around age 54 in view of likely postmenopause
• it is not contraception

Question 11

What HRT in postmenopause

Answer 11

• CCT or tibolone
• Low dose and increase after 3 months if necessary
• persistent bleeding over 6 months duration needs to be investigated

Question 12

Non hormonal Tx of post menopause in patients with breast cancer

Answer 12

• clonidine ( if not on tamoxifen): selective serotonine reuptake
• selective noradrenaline reuptake inhibitors
• gabapentin
• self help tips