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Women's Health Flashcards

1
Q

What is PCOS? (4)

A

A condition in which the clinical symptoms vary in severity between individuals over time.

It is characterised by:

  • Hyperandrogenism +/- associated clinical manifestations of acne, hirsutism and alopecia in adults
  • Menstrual disturbances (olio/amenorrhoea or oligo/anovulation, and subsequent subfertility
  • Polycystic ovaries on ultrasound
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2
Q

Cause of PCOS?

A

The cause of PCOS is unknown but it is likely to be multifactorial with environmental and genetic components

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3
Q

Complications of PCOS?

A
  • Cardiovascular Risk (MIDDCS)
  • Fertiliy and pregnancy (Subfertility, poorer preg outcomes)
  • Cancer (Endometrial hyperplasia and cancer)
  • Pscyhological impact (BAPED)
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4
Q

PCOS (Normal physiology of ovaries)

A

There are 2 layers of cells in the ovary:

  • Theca cells, where cholesterol is converted to androgen under the influence of luteinizing hormone (LH).
  • Granulosa cells, where androgens are converted to oestradiol under the influence of follicle-stimulating hormone (FSH).

Production of these hormones leads to normal follicular growth and ovulation.

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5
Q

Pathophysiology of PCOS

A

Excess Androgen Production:
* High LH levels drive increased androgen production.
* Androgens promote small follicle development but block full maturation and ovulation.
* Unopposed estrogen (due to lack of ovulation) increases the risk of endometrial hyperplasia.

Hyperinsulinemia:
* Insulin resistance (present in 65–80% of women with PCOS) leads to elevated insulin levels.
* Insulin amplifies LH-induced androgen production, worsening symptoms.

Reduced SHBG:
* Insulin resistance and weight gain lower sex hormone-binding globulin (SHBG), increasing free androgens and their effects.

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6
Q

When to suspect PCOS?

A
  • Oligo-/amenorrhoea (indicating infrequent ovulation or anovulation).
  • Heavy, irregular or prolonged periods.
  • Acne.
  • Androgen-related alopecia.
  • Hirsutism.
  • Obesity.
  • Infertility.

HAI HAOO

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7
Q

Diagnosis of PCOS in adults?

A

Note: 20% of women have appearances suggestive of polycystic ovaries on ultrasound, but, unless they are symptomatic, they do NOT have PCOS.

Rotterdam criteria
Diagnosis of PCOS is based on the Rotterdam criteria in which two out of the three following criteria should be present:

  • Amenorrhoea or oligomenorrhoea (cycle >35d or <8 periods a year).
  • Polycystic ovaries on ultrasound scan.
  • Clinical or biochemical hyperandrogenism (acne, hirsutism, alopecia or raised free androgen index).

An elevated free androgen index (FAI) of >5 suggests PCOS (note: reference ranges vary between labs).

FAI is a measure of biologically-active testosterone. Some labs calculate this for you; otherwise, it is calculated from total testosterone and sex hormone-binding globulin levels using the formula below:

FAI = total testosterone × 100/SHBG

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8
Q

Overall management for PCOS

A
  1. Lifestyle and weight management
  2. Menstrual regulation
  3. Management of hyperandrogenism (Acne + hirsutism)
  4. Fertility management
  5. Pscyhological and long term health
  6. Cardiovascular and diabetes risk
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9
Q

How to manage weight in PCOS?

A

First-line for Overweight/Obese Women:
* Combine diet, exercise, and behavioral strategies to reduce weight.
* Even a 5–10% weight loss can restore ovulation and improve metabolic markers.
* Referral for specialized weight management support if needed, including medications (e.g., orlistat, liraglutide) or bariatric surgery for severe cases.

General Recommendations:
* Emphasize sustainable, patient-preferred diets as there is no single superior diet.
* Address weight stigma with sensitivity, considering life stages prone to weight gain (e.g., adolescence, pregnancy).

For Non-Obese Women:
* Focus on weight maintenance and healthy lifestyle practices.

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10
Q

Managing menstrual irregularities in PCOS?

A

First-Line Treatment:
* Combined hormonal contraception (CHC) regulates periods, reduces LH levels, and increases sex hormone-binding globulin (SHBG) to lower androgen activity.
* Use 1st/2nd-generation pills (e.g., Microgynon) as first-line options; newer pills like Yasmin may be considered if others are not tolerated.

Endometrial Protection:
* If <1 period every 3 months:
* CHC, progestogens (e.g., medroxyprogesterone acetate), or progestogen-releasing IUDs.
* Unopposed estrogen from infrequent cycles raises the risk of endometrial hyperplasia/cancer; periodic monitoring or hormonal therapy is crucial.

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11
Q

Managing hirsutism and acne in PCOS?

A

Hirsutism:
* CHC is the first-line therapy to increase SHBG and reduce androgens.
* Cosmetic options include laser hair removal, shaving, or topical eflornithine cream for temporary relief.
* Anti-androgens (e.g., spironolactone) are effective but require contraception due to teratogenic risks.

Acne:
* Manage initially like any other acne case.
* Add CHC (e.g., Dianette) if first-line therapies fail; review after six months.

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12
Q

Managing fertility in PCOS?

A

Fertility Challenges:

PCOS is a leading cause of anovulatory infertility, often linked to obesity or metabolic factors.

Recommendations:
* Weight loss significantly improves ovulation and pregnancy outcomes.
* Refer after 6 months of trying to conceive if oligo-/amenorrhoeic or >36 years old.

Treatment Options:
* Ovulation induction: Letrozole (first-line), clomiphene, metformin, or gonadotropins.
* IVF for resistant cases.

Risks:
* Increased risk of superovulation and multiple pregnancies during ovulation induction, requiring careful monitoring.

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13
Q

Explain PCOS to a patient

A

Polycystic ovary syndrome, or PCOS, is a common condition that affects how your ovaries work. It can cause a range of symptoms, but the exact cause isn’t fully understood. But what happens is:

Your body produces too many male hormones (called androgens), which can disrupt ovulation. This means your ovaries might not release eggs regularly.

Small Cysts on Ovaries: The name ‘polycystic’ refers to tiny fluid-filled sacs in your ovaries. These aren’t harmful but can interfere with how your ovaries function.

Symptoms You Might Notice:
* Irregular periods or no periods at all.
* Difficulty getting pregnant because you’re not ovulating regularly.
* Excess hair on your face or body, acne, or thinning hair on your scalp.
* Weight gain or difficulty losing weight.

Long-term Risks: If untreated, PCOS can increase your risk of diabetes, heart disease, or issues like high blood pressure.

The good news is, we can manage PCOS with lifestyle changes, medications, or a combination of both. Eating healthily, staying active, and maintaining a healthy weight can significantly improve symptoms. If you’re trying to get pregnant, there are treatments that can help with ovulation.

You’re not alone in this, and there’s a lot we can do to support you. If you’d like, we can create a plan together to manage your symptoms and address any concerns you have.”

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14
Q

Analogy explanation for PCOS?

A

“Think of your ovaries like a garden, and every month, the goal is to grow a single healthy flower (an egg). For the flower to bloom, the garden needs the right balance of sunlight, water, and nutrients—this is like your hormones working together.

In PCOS, it’s as if there’s too much of one ingredient, like fertilizer (androgens, the male hormones). Instead of one flower blooming, a lot of little buds start to grow but don’t fully develop. These buds are the tiny cysts we see on the ovaries.

This imbalance can make it harder for the garden to stick to its schedule (your monthly cycle), and it might take longer or not happen at all.

The good news is, just like a garden, with the right care—like adjusting the balance of sunlight, water, or nutrients—we can help things grow properly again. Lifestyle changes or treatments can help your body find the right balance, so your garden blooms the way it should.”

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15
Q

What are fibroids?

A

Fibroids are a mixture of smooth muscle cells and fibroblasts that form hard, round, whorled tumours in the myometrium.

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16
Q

What is the size range of fibroids?

A

Size ranges from a few millimetres to >30cm.

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17
Q

What are the risk factors for developing fibroids?

A
  • Family history
  • Age
  • Early menarche
  • Nulliparity
  • Obesity (especially central)
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18
Q

True or False: Fibroids are rare before menarche.

A

True

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19
Q

Fill in the blank: The incidence of fibroids increases with _______.

A

[age during reproductive years]

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20
Q

What happens to fibroids at menopause?

A

Fibroids regress at menopause.

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21
Q

What is the exact pathophysiology of fibroids?

A

Unknown, but thought to derive from mutations in smooth muscle cells.

The specific mechanisms leading to the development of fibroids are still under research.

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22
Q

Which hormones control the proliferation and maintenance of fibroids?

A

Oestrogen and progesterone.

Progesterone receptor stimulation is thought to mediate this process.

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23
Q

What is the variability in the growth rate of fibroids?

A

Growth rate is variable.

This means that fibroids can grow at different rates in different individuals.

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24
Q

Does hormone replacement therapy (HRT) affect fibroid growth?

A

HRT may cause some growth of fibroids, but this is of uncertain clinical significance.

The impact of HRT on fibroid growth is not well defined.

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25
Are there effective prevention strategies for fibroids?
No effective prevention strategies. ## Footnote Current medical knowledge does not provide strategies to prevent the formation of fibroids.
26
Types and location of Fibroids (Image)
27
What is the most common symptom of fibroids?
Menstrual problems or pelvic pain ## Footnote The majority of fibroids are asymptomatic, but when symptoms do occur, they often manifest as menstrual issues or pelvic discomfort.
28
List some symptoms that can occur due to fibroids.
* Heavy menstrual bleeding * Pelvic pain * Secondary dysmenorrhoea * Abdominal distension or distortion * Pressure symptoms/discomfort * Urinary tract problems (e.g., frequency, urgency, urinary incontinence, and hydronephrosis) * Non-specific bowel problems * Subfertility ## Footnote Symptoms depend on the location and size of the fibroids.
29
True or False: The size of fibroids always determines the severity of symptoms.
False ## Footnote While larger fibroids can cause pressure symptoms, the size does not necessarily determine the presence or severity of symptoms.
30
Fibroids encroaching on the endometrial cavity are more likely to cause which issues?
Menstrual problems and subfertility ## Footnote The location of fibroids significantly impacts the type of symptoms experienced.
31
Fill in the blank: The majority of fibroids are _______.
asymptomatic ## Footnote Most individuals with fibroids do not experience any symptoms.
32
What urinary tract problems can be associated with fibroids?
* Frequency * Urgency * Urinary incontinence * Hydronephrosis ## Footnote These problems can arise due to pressure exerted by fibroids.
33
What type of pain can fibroids cause besides pelvic pain?
Secondary dysmenorrhoea ## Footnote Dysmenorrhoea refers to painful menstruation, which can be exacerbated by fibroids.
34
What abdominal symptoms may be associated with larger fibroids?
Abdominal distension or distortion ## Footnote Larger fibroids may lead to noticeable changes in abdominal shape or size.
35
List two non-specific bowel problems that can be caused by fibroids.
* Bowel discomfort * Changes in bowel habits ## Footnote Non-specific bowel issues can arise due to pressure from fibroids on surrounding organs.
36
How should you investigate and refer for fibroids?
37
What is the first-line medical management for fibroids in primary care?
IUS, Tranexamic acid/NSAIDs, Hormonal treatments (CHC, oral progestogens - POP, implant, injection) ## Footnote IUS may not be suitable if fibroids distort the uterine cavity
38
What does FSRH UKMEC 3 indicate regarding IUS use with fibroids?
Risks usually outweigh the benefits for contraception ## Footnote FSRH stands for Faculty of Sexual and Reproductive Healthcare
39
List some hormonal treatments for fibroids.
* CHC * Oral progestogens * Progestogen-only injection/implant ## Footnote CHC refers to combined hormonal contraceptives
40
Fill in the blank: Tranexamic acid and _______ can be used for managing fibroids.
NSAIDs
41
True or False: IUS is always recommended for women with fibroids.
False ## Footnote IUS is not recommended if fibroids distort the uterine cavity
42
What is the general indication for surgical management of fibroids?
Symptomatic fibroids > 3cm or if medical management has failed
43
What is the primary aim of uterine artery embolisation?
To block the blood supply to the uterus, causing ischaemic degeneration of fibroids
44
What type of new blood supply develops in the myometrium after uterine artery embolisation?
Collateral ovarian/vaginal circulations
45
How is uterine artery embolisation generally considered in terms of effectiveness and safety?
An effective and safe treatment
46
What are some minor complications associated with uterine artery embolisation?
Nausea, pain, and vaginal discharge
47
How does the rate of reintervention for uterine artery embolisation compare to surgery?
More common than with surgery
48
What is myomectomy?
Surgical removal of fibroid tissue
49
Does myomectomy preserve fertility?
Yes, but no evidence it increases fertility
50
What are the methods of performing a myomectomy?
Laparoscopically/hysteroscopically or by open surgery
51
What is a common complication of myomectomy?
Bleeding (30% require transfusion)
52
What is the rare complication that may occur during myomectomy?
Hysterectomy
53
What is the primary outcome of a hysterectomy?
Does not preserve fertility
54
What are the methods of performing a hysterectomy?
Laparoscopically/hysteroscopically or by open surgery
55
What is the relationship between fibroids and infertility?
Not well understood ## Footnote The exact relationship remains unclear, with varying impacts based on the type of fibroid.
56
Which type of fibroids may cause subfertility?
Submucous fibroids ## Footnote Submucous fibroids are located within the uterine cavity and can interfere with implantation.
57
What is the impact of intramural fibroids on fertility?
Uncertain ## Footnote The effect of intramural fibroids, which grow within the muscular wall of the uterus, is not clearly defined.
58
What is the effect of subserosal fibroids on fertility?
No known effect ## Footnote Subserosal fibroids are located on the outer wall of the uterus and do not appear to affect fertility.
59
What treatment is supported for submucous fibroids?
Myomectomy ## Footnote Myomectomy is a surgical procedure to remove fibroids and is recommended for submucous types.
60
What treatment is recommended for intramural fibroids?
Conservative treatment ## Footnote Conservative treatment may include monitoring and non-surgical options, as the impact on fertility is unclear.
61
What percentage of women have uterine fibroids present on ultrasound in early pregnancy?
Around 8-18% ## Footnote Fibroids are often asymptomatic during early pregnancy.
62
Are most women with uterine fibroids symptomatic or asymptomatic during early pregnancy?
Asymptomatic ## Footnote Most women with fibroids do not experience symptoms.
63
What may be more common in women with fibroids during pregnancy?
Spontaneous miscarriage ## Footnote Age is a confounding factor that increases the risk of both fibroids and miscarriage.
64
True or False: The presence of fibroids guarantees complications during pregnancy.
False ## Footnote Most women with fibroids are asymptomatic, and not all will experience complications.
65
Fill in the blank: Around ______ of women have uterine fibroids present on ultrasound in early pregnancy.
8-18% ## Footnote This statistic highlights the prevalence of fibroids among pregnant women.
66
Fibroids - complications in pregnancy?
May be due to: 'Red' degeneration: where increase in fibroid size outstrips blood supply, resulting in ischaemia. Bleeding secondary to fibroids. Both are rare but we should refer promptly for specialist advice. Treatment of fibroids in pregnancy is only indicated if acute complications occur.
67
Do fibroids ever turn nasty?
Yes - but not very often. ## Footnote Fibroids are generally benign but can sometimes be mistaken for malignancies.
68
What are leiomyosarcomas?
Rare malignancies which are difficult to distinguish clinically from fibroids. ## Footnote Leiomyosarcomas can be mistaken for fibroids during examinations.
69
What is the relationship between age and the risk of sarcoma?
Risk of sarcoma increases with age. ## Footnote Older individuals may have a higher likelihood of developing malignant transformations.
70
What is the estimated prevalence of unexpected leiomyosarcoma at the time of surgery for presumed fibroid?
Ranges from < 1-13/10,000. ## Footnote This indicates a low but significant risk of undetected malignancy during fibroid surgery.
71
What should be done with fibroids that grow rapidly?
Refer urgently any fibroids that grow rapidly, especially after menopause. ## Footnote Rapid growth can be a sign of malignancy and requires immediate evaluation.
72
At what average age does menopause occur?
51 years ## Footnote This marks a significant transition in a woman's life.
73
What percentage of their lives will women spend postmenopausally?
At least 30% ## Footnote Average life expectancy now is 82, and with the average age of menopause at 51, that is roughly 30% of their life in postmenopause. This indicates the importance of addressing health during this phase.
74
What medical implications are associated with menopause?
Hypo-oestrogenic state associated with: * Symptoms that may need managing * Increased risk of osteoporosis * Increased risk of cardiovascular disease * Increased risk of stroke ## Footnote These conditions highlight the need for effective menopause management.
75
What is the normal physiology of menstrual cycle in premenopause?
The menstrual cycle begins when the hypothalamus produces gonadotrophin-releasing hormone (GnRH). This stimulates the production of follicle-stimulating hormone (FSH) from the pituitary gland. FSH stimulates follicular development in the ovary, and promotes ovarian oestrogen production. Raised oestrogen levels suppress FSH production and trigger the mid-cycle LH surge, which leads to ovulation. At the end of the luteal phase, if conception has not occurred, falling levels of oestrogen (and progesterone) lead to menstruation, and this stimulates the hypothalamus to start the process again.
76
Physiology of menstrual cycle in menopausal woman?
The ageing ovary has declining numbers of oocytes and becomes less responsive to gonadotrophins. Due to this, oestrogen production declines. Persistently low oestrogen levels stimulate the hypothalamic–pituitary axis to produce more FSH in an attempt to make residual oocytes ovulate. Ovarian dysfunction is a gradual process, marked by erratic hormonal changes and sporadic ovulation, during which FSH levels can fluctuate on a daily basis. By menopause, which is complete ovarian failure, a woman will have consistently raised FSH levels.
77
What is perimenopause?
This is the start of deteriorating ovarian function, and usually begins around the age of 45y. Perimenopausal women may experience: Menopausal symptoms due to lowering oestrogen levels. - Erratic bleeding patterns and menstrual cycles due to fluctuating hormonal levels. - Vasomotor symptoms are believed to represent a complex interplay between central and peripheral physiological mechanisms. It is thought that perimenopausal women may experience a narrowing of the thermoregulatory-neutral zone (the body’s thermostat). As a result, small changes in body temperature trigger the perception of intense heat and activate heat dissipation processes, e.g. peripheral vasodilation and sweating (
78
What is menopause?
This is the loss of ovarian follicular function. It marks the end of reproductive life and cessation of menstruation. Menopause is a retrospective diagnosis, defined as: 1y of amenorrhoea >50y OR 2y of amenorrhoea >40y (amenorrhoea/perimenopausal symptoms <40y need investigating to rule out premature ovarian insufficiency). | Early menopause is menopause occuring between 40-45 years of age. Prem
79
Symptoms of menopause?
May be attributable to oestrogen deficiency in combination with age and other factors. Symptoms typically begin in the perimenopause and last around 2–7y, although can continue for up to 15y
80
Diagnosis of menopause?
If >=45yrs: A clinical history of typical menopausal symptoms in a woman aged 45y or over is diagnostic, and no other investigation is required. If less than 45 do **FSH**: Two measurements taken 4–8w apart >30IU/L are diagnostic.
81
When to do an FSH level in the context of menopause?
FSH measurement can be helpful to: Diagnose premature ovarian failure or early menopause: * Two measurements taken 4–8w apart >30IU/L are diagnostic. Decide whether an amenorrhoeic woman >50y on hormonal contraception may stop contraception or not: * Levels >30IU/L are suggestive of menopause, but the FSRH recommends continuing contraception for a further year.
82
Can FSH be accurately measured in women on hormonal contraception?
We can measure FSH in women on progestogen-only contraception because it doesn’t affect FSH * ALTHOUGH Depot Provera may give a falsely low reading so arrange blood test just before giving next injection. Oestrogen-containing preparations (e.g. HRT, CHC) do suppress FSH so stop for at least 6w prior to taking blood.
83
What are common symptoms of menopause due to falling oestrogen levels?
* Hot flushes * Night sweats * Menstrual irregularities * Sleep disturbance * Vaginal dryness * Urinary problems * Joint and muscle pains * Sexual difficulties (e.g. low libido) * Mood changes * Cognitive disturbance ## Footnote Symptoms may vary in severity and duration among individuals.
84
At what age is a clinical diagnosis of menopause typically made?
≥45 years ## Footnote Diagnosis is based on clinical history of typical symptoms.
85
What investigations should be conducted if a woman under 45 presents with menopausal symptoms?
* Investigate abnormal bleeding first * Consider differentials (e.g. alcohol, drugs, thyroid, anxiety, tumours) * Arrange FSH if <45y ## Footnote FSH levels >30 IU/L 4–8 weeks apart suggest early menopause.
86
What is the first-line treatment for vasomotor symptoms in menopause?
Hormone replacement therapy (HRT) ## Footnote HRT is also beneficial for depressive symptoms related to menopause.
87
Which lifestyle modifications are recommended for managing menopausal symptoms?
* Regular exercise * Healthy diet and BMI * Stop smoking * Reduce alcohol * Avoid symptom triggers (e.g. spicy food) * Reduce stress * Relaxation exercises * Sleep hygiene ## Footnote These changes can help alleviate symptoms and improve overall health.
88
What are the contraindications for prescribing HRT?
* History of breast cancer or oestrogen-dependent tumour * Untreated endometrial hyperplasia * Undiagnosed vaginal bleeding * Uncontrolled hypertension * Current or past VTE (unless anticoagulated) * Thrombophilic disorder or strong family history of VTE * Liver disease (with abnormal LFTs) ## Footnote Referral to a menopause specialist is advised in these cases.
89
True or False: HRT increases the risk of breast cancer in women under 50 years.
False ## Footnote HRT is unlikely to increase the risk of breast cancer in this age group.
90
What is the relationship between oral HRT and stroke risk?
Oral HRT increases the risk of stroke ## Footnote Transdermal preparations appear to have a safer profile regarding stroke risk.
91
What are the types of HRT available for menopausal women?
Oestrogen-only HRT * Oestrogen is the symptom- relieving component of HRT BUT Unopposed oestrogen causes endometrial proliferation: women with a uterus MUST have progestogen to stop this. Sequential combined HRT * Daily oestrogen with sequential progestogen (usually in last 12–14d of pack/month) to trigger a bleed. * Endogenous hormone production will lead to irregular bleeding on a continuous regimen) Continuous combined HRT * Contains daily oestrogen and progestogen. ## Footnote Each type is indicated based on the woman's menopausal status and whether she has a uterus.
92
Fill in the blank: Women with a uterus must have _______ to prevent endometrial proliferation when using oestrogen.
progestogerone ## Footnote This is essential to prevent endometrial hyperplasia.
93
What should be considered when switching from sequential to continuous combined HRT?
Swap within 5 years of starting HRT or by age 54 ## Footnote This is recommended if more than 12 months have passed since the last menstrual period.
94
What are the common side effects of HRT that may require a switch to an alternative preparation?
* Unscheduled bleeding * Progestogenic side effects ## Footnote Persistent symptoms may necessitate an increase in dosage or a change in formulation.
95
Which progestogen is considered the safest option for HRT?
Micronised progesterone ## Footnote More data is needed to confirm its safety profile.
96
What is the primary benefit of HRT for menopausal women?
Relief of menopausal symptoms ## Footnote HRT also supports sexual function and bone mineral density.
97
What is the dosage of Lenzetto?
1.53mg/dose, 1–3 sprays per 24h ## Footnote Lenzetto is a transdermal spray formulation of estrogen.
98
What is the volume of Lenzetto in ml?
8.1ml (56 actuations) ## Footnote Each actuation delivers a specific dose of estrogen.
99
List the dosage equivalents for oral and transdermal oestrogen-only formulations.
* Ultra-low: 0.5mg oral, 12.5mcg patch, ½ pump gel, 0.25mg spray, 1 spray * Low: 1mg oral, 25mcg patch, 1 pump gel, 0.5mg spray, 2 sprays * Standard: 2mg oral, 50mcg patch, 2 pumps gel, 1mg spray, 3 sprays * Moderate: 3mg oral, 75mcg patch, 3 pumps gel, 1.5–2.0mg spray, 4–5 sprays * High: 4mg oral, 100mcg patch, 4 pumps gel, 3mg spray, 6 sprays ## Footnote Doses in italics are off-licence.
100
What is the progestogen used in sequential therapy?
Medroxy-progesterone acetate ## Footnote This is used with oestrogen-only HRT if the patient has a uterus.
101
What is the dose of Medroxy-progesterone acetate for high-dose oestrogen?
20mg (off-licence) ## Footnote This dosage is for sequential therapy taken for 12–14 days of a cycle.
102
What is the cost range for Provera?
£–££ ## Footnote Provera is the only brand available but is not licensed for HRT.
103
What is the dose of Norethisterone irrespective of oestrogen dose?
5mg ## Footnote This is used in oral therapy for progestogen-only formulations.
104
What is the licensed dose of micronised progesterone for low/moderate-dose oestrogen?
200mg ## Footnote This dosage is typically taken for 10–12 days of a cycle.
105
What is the intra-uterine progestogen and its dosage?
Levonorgestrel 52mcg, 20mcg/24h ## Footnote The intrauterine system (IUS) is licensed for 4 years but endorsed for 5 years.
106
True or False: Norethisterone is licensed for endometrial protection.
False ## Footnote Norethisterone is endorsed by BMS but not licensed for this indication.
107
Fill in the blank: The dose of micronised progesterone for high-dose oestrogen is _______.
300mg (off-licence) ## Footnote BMS advises a daily dose for high-dose oestrogen.
108

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