Explaining HRT

Question 1

What are the indications for HRT?

Answer 1

• Treatment of menopausal symptoms (when benefit outweighs risk)
• Treatment of early menopause
• Osteoporotic fracture prophylaxis in women <60 years (when non-oestrogen containing treatments are unsuitable)

Question 2

What are the contraindications to HRT?

Answer 2

Current conditions:

• Undiagnosed PV bleeding
• Pregnancy/breastfeeding
• Oestrogen-dependent cancer
• Acute liver disease
• Uncontrolled HTN

Historical conditions:

• Hx of breast cancer
• Hx of VTE
• Recent stroke/MI/angina

Question 3

What are the short-term benefits of HRT?

Answer 3

Relief of symptoms such as:

• Vasomotor symptoms
• Psychological symptoms (anxiety, low mood)
• Reduced libido
• Urogenital atrophy (use vaginal HRT if symptoms are primarily urogenital)

Question 4

What are the long-term benefits of HRT?

Answer 4

• Reduction in osteoporosis (and related fractures)

- Reduced risk of colorectal cancer (with combined HRT)

Question 5

What are the risks of HRT?

Answer 5

• VTE (*no risk with transdermal therapy)
• Stroke
• Breast cancer (small increase in risk, higher with combined HRT due to progestogens)
• Ovarian cancer (small increase if used >5 years)
• Endometrial cancer (if woman with uterus is taking oestrogen-only HRT)
• Coronary heart disease (if start >10 years after menopause)

Question 6

What are the side effects of HRT?

Answer 6

Oestrogen:

• Breast tenderness
• Leg cramps
• Nausea/bloating

Progesterone:
- PMS

Bleeding: PV bleeding occurs towards the end of progesterone phase of cyclical HRT

Question 7

What type of HRT is most appropriate for a woman with no uterus?

Answer 7

Oestrogen-only HRT (usually transdermal)

Question 8

What type of HRT is most appropriate for a perimenopausal woman with a uterus?

Answer 8

Cyclical HRT

Oestrogen given every day, and progesterone given for 12 days of each 28 day cycle (induces a bleed)

Question 9

What type of HRT is most appropriate for a postmenopausal woman with a uterus?

Answer 9

*No periods for >1 year or cyclical HRT for >1 year

Continuous combined HRT

Question 10

How would you explain to patients what menopause and HRT are?

Answer 10

Menopause:

• The time when menstrual periods cease and a woman is no longer able to get pregnant
• Occurs because the ovaries run out of follicles, and this results in reduced production of oestrogen by the ovaries
• Oestrogen plays a major role in regulating the female reproductive system, but also has other effects on the body (mood, libido)
• Symptoms usually last ~4 years, but can last up to 12

HRT:
- HRT replaces the oestrogen and/or progesterone

Question 11

What contraception is available for women on HRT?

Answer 11

• Barrier methods
• POP (in addition to HRT)
• Mirena coil (can be used as the progesterone component of HRT)

Question 12

What alternatives to HRT for mood-related symptoms?

Answer 12

• CBT

- Anti-depressants

Question 13

What alternatives to HRT for vasomotor symptoms?

Answer 13

• SSRIs
• SNRIs
• Clonidine

Question 14

What alternatives to HRT for vaginal dryness?

Answer 14

Lubricants/moisturisers

Question 15

What alternatives to HRT for irregular periods?

Answer 15

Mirena coil