Hormone Replacement Therapy

Question 1

On average, how long do these symptoms last for?

Answer 1

4 years

Question 2

What are the indications for Hormone Replacement Therapy?

Answer 2

• Vasomotor symptoms such as flushing, insomnia and headaches
• Low sexual desire
• Low Mood
• Premature menopause​

Question 3

For hysterectomy before menopause or early menopause, how long should HRT be continued?

Answer 3

To when women would naturally go through the menopause.

~50 years old.

Question 4

For symptomatic relief, how long should HRT be continued?

Answer 4

~5 years

(Remember that most menopausal symptoms lasted for only 4 years)

Question 5

For osteoporosis, how long should HRT be continued?

Answer 5

5 years

The minimum period for which benefits have been shown.

Question 6

Vasomotor symptoms affect how many women going to menopause?

Answer 6

80%

Question 7

What are the 3 types of oral HRT and who are they used in?

Answer 7

1. Oestrogen only - w/o womb. (Hysterectomy)
2. Cyclical HRT - Perimenopausal - helps to limit erratic bleeding.
3. Continuous combined HRT - use when 1 year later than menopause otherwise erratic bleeding.

Question 8

How else can HRT be delivered apart from orally?

Answer 8

• Transdemeral patch or topical
• Oral Oestrogen - with Progestogen by Mirena coil

Question 9

When stopping HRT can it be tapered or stopped abruptly?

Answer 9

Tapering is better over the short term.

Long terms outcomes are the same.

Question 10

Generally speaking, between what age should HRT be stopped and why?

Answer 10

60-65 years.

Risks start to outweight the benefits.

(If used >60 years - use low doses)

Question 11

When should patients be reviewed?

Answer 11

3 months THEN

Annually

Question 12

What should you do as part of your review?

Answer 12

1. Discuss S/E.
2. Ask about vaginal bleeding.
3. BMI
4. BP
5. Review FH
6. Review Medical history
7. Calculate 10 year CVD risk.

Question 13

Oral HRT increases the risk of devleoping what conditions?

Answer 13

• Ovarian cancer
• Breast cancer
• Ischaemic stroke
• VTE

Question 14

Transdermal HRT DOES NOT increase the risk of what conditions? (that oral HRT does)

Answer 14

• VTE
• Ischaemic stroke

Question 15

What conditions is HRT contraindicated in?

Answer 15

• Pregnancy.
• Undiagnosed abnormal vaginal bleeding.
• Active or recent blood clot or myocardial infarction (heart attack)
• Suspected or active breast or endometrial (womb) cancer.
• Active liver disease with abnormal liver function tests.
• Porphyria cutanea tarda.

Question 16

What is a good resource to discuss the risks of HRT with patients?

Answer 16

The Table at the back of the BNF.