Wk 13: HRT in practice Flashcards
What happens to the hormones during menopause?
- Oestrogen dec (negative feedback) causing FSH + LH inc
- FSH fluctuate daily
- Dec oestrogen disrupt menstrual cycle + causes symptoms
- Estradiol = insufficient in stimulating endometrium + amenorrhoea occurs
Where does estradiol production occur?
Granulosa + theca cells surrounding oocyte
How do you diagnose someone under 45 years?
Test FSH - high = menopausal
What are long term physical effects of menopause?
- Thinning of skin + hair
- Bone mass lost + more liable to breaking
- Dryness of eyes, mouth + throat
- Atrophy of breasts, endometrium, vagina, vulva, pelvic muscle
What is the 1st line treatment for menopause?
Lifestyle advise
- Weight management + Exercise
- Avoid triggers to hot flushes - caffeine, spicy
- Sleep hygiene
What increases the likelihood of flushing?
Smoking + BMI >30kg/m2
What are the other management options without HRT other than lifestyle changes?
- Antidepressants
- Vaginal moisturiser
- Clonidine 50-75mcg BD
Why is progestogen required when giving HRT?
Oestrogen = lining proliferate inc risk uterine cancer
When do you not require progestogen?
Hysterectomy
What is the optimal HRT regimen for women at risk of cardiovascular events?
Transdermal oestrogen w/ micronised progesterone
What oestrogen is used in HRT?
17 betaestradiol
What are the benefits of transdermal oestrogen?
- No clot risk
- Given w/ Hx clot, stroke, migraine, HT + CVD
What are the tips for when giving progestogen?
- Cyclic HRT first 6-12 months if on period
- Continuous = endometrial protection
- Any age can take continuous but causes erratic bleeding if too early
How would you prescribe progesterone cyclically?
200mg each evening for 2/4 weeks
How would you prescribe progesterone continuously?
100mg each evening
Outline the monthly cyclical regimen
- Oestrogen: daily
- Progestogen: end of cycle 10-14 days (monthly bleed)
Outline the three-monthly cyclic regimen
- Oestrogen: daily
- Progestogen: 14 days every 13 weeks (bleed 3 months)
- For: infrequent period/progestogen intolerant
Outline the continuous combined regimen
Oestrogen + pro taken daily
What do you give to post menopausal women?
- Continuous combined bc no w/drawal bleeding
- Irregular/spotting first 4-6 months
What is an alternative to delivering progestogen?
- IUD mirena - low bleed risk
- Levonorgestrel
- 5 years
What is vaginal oestrogen?
- Applied to vagina for vaginal atrophy
- Systemic abs = low tf doesn’t relive hot flushes
- Used along HRT/post who have vaginal symptoms
What other hormone other than progestogen can you add to HRT?
Testosterone
- Improve sexual function + mood
For how long is a woman under/over 50 fertile for?
- Under: 2 years after last menstrual period
- Over: 1 year after
