Wk 13: HRT in practice

Question 1

What happens to the hormones during menopause?

Answer 1

• 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

Question 2

Where does estradiol production occur?

Answer 2

Granulosa + theca cells surrounding oocyte

Question 3

How do you diagnose someone under 45 years?

Answer 3

Test FSH - high = menopausal

Question 4

What are long term physical effects of menopause?

Answer 4

• Thinning of skin + hair
• Bone mass lost + more liable to breaking
• Dryness of eyes, mouth + throat
• Atrophy of breasts, endometrium, vagina, vulva, pelvic muscle

Question 5

What is the 1st line treatment for menopause?

Answer 5

Lifestyle advise

• Weight management + Exercise
• Avoid triggers to hot flushes - caffeine, spicy
• Sleep hygiene

Question 6

What increases the likelihood of flushing?

Answer 6

Smoking + BMI >30kg/m2

Question 7

What are the other management options without HRT other than lifestyle changes?

Answer 7

• Antidepressants
• Vaginal moisturiser
• Clonidine 50-75mcg BD

Question 8

Why is progestogen required when giving HRT?

Answer 8

Oestrogen = lining proliferate inc risk uterine cancer

Question 9

When do you not require progestogen?

Answer 9

Hysterectomy

Question 10

What is the optimal HRT regimen for women at risk of cardiovascular events?

Answer 10

Transdermal oestrogen w/ micronised progesterone

Question 11

What oestrogen is used in HRT?

Answer 11

17 betaestradiol

Question 12

What are the benefits of transdermal oestrogen?

Answer 12

• No clot risk

- Given w/ Hx clot, stroke, migraine, HT + CVD

Question 13

What are the tips for when giving progestogen?

Answer 13

• Cyclic HRT first 6-12 months if on period
• Continuous = endometrial protection
• Any age can take continuous but causes erratic bleeding if too early

Question 14

How would you prescribe progesterone cyclically?

Answer 14

200mg each evening for 2/4 weeks

Question 15

How would you prescribe progesterone continuously?

Answer 15

100mg each evening

Question 16

Outline the monthly cyclical regimen

Answer 16

• Oestrogen: daily

- Progestogen: end of cycle 10-14 days (monthly bleed)

Question 17

Outline the three-monthly cyclic regimen

Answer 17

• Oestrogen: daily
• Progestogen: 14 days every 13 weeks (bleed 3 months)
• For: infrequent period/progestogen intolerant

Question 18

Outline the continuous combined regimen

Answer 18

Oestrogen + pro taken daily

Question 19

What do you give to post menopausal women?

Answer 19

• Continuous combined bc no w/drawal bleeding

- Irregular/spotting first 4-6 months

Question 20

What is an alternative to delivering progestogen?

Answer 20

• IUD mirena - low bleed risk
• Levonorgestrel
• 5 years

Question 21

What is vaginal oestrogen?

Answer 21

• Applied to vagina for vaginal atrophy
• Systemic abs = low tf doesn’t relive hot flushes
• Used along HRT/post who have vaginal symptoms

Question 22

What other hormone other than progestogen can you add to HRT?

Answer 22

Testosterone

• Improve sexual function + mood

Question 23

For how long is a woman under/over 50 fertile for?

Answer 23

• Under: 2 years after last menstrual period

- Over: 1 year after