HRT

Question 1

What non hormonal treatments can be used initially for menopausal symptoms ?

Answer 1

• Lifestyle changes : improving the diet, exercise, weight loss, smoking cessation, reducing alcohol, reducing caffeine and reducing stress
• CBT
• Clonidine
• SSRI antidepressants (e.g. fluoxetine)
• Venlafaxine (SNRI)
• Gabapentin

Question 2

What is clonidine and why is it used to help menopausal symptoms ?

Answer 2

• Alpha-2-adrenergic and imidazoline receptor agonist
• Helps vasomotor Sx and hot flushes

Question 3

Give 4 SE of clonidine

Answer 3

Dry mouth
Headache
Dizziness
Fatigue

Question 4

Give 8 contraindications to HRT

Answer 4

• Undiagnosed abnormal bleeding
• Endometrial hyperplasia or cancer
• Breast cancer
• Uncontrolled hypertension
• Venous thromboembolism
• Liver disease
• Active angina or myocardial infarction
• Pregnancy

Question 5

What are the 3 steps to commencing HRT?

Answer 5

• 1. Local or systemic Sx ? -> systemic go to step 2
• 2. Uterus ? -> no uterus give continuous oestrogen only HRT. Has uterus = combined HRT and go to step 3.
• 3. Period in last 12 months ? -> perimenopausal give cyclical combined HRT. Postmenopausal continuous combined.

Question 6

What is the best way of delivering oestrogen in HRT ?

Answer 6

• Patches : reduced rusk of VTE

Question 7

What is the best way of providing progesterone in HRT?

Answer 7

• Mirena coil

Question 8

What are the oestrogenic SE of HRT

Answer 8

Nausea and bloating
Breast swelling
Breast tenderness
Headaches
Leg cramps

Question 9

What are the progestogenic SE of HRT

Answer 9

Mood swings
Bloating
Fluid retention
Weight gain
Acne and greasy skin

Question 10

when can you switch from cyclical to continuous HRT ?

Answer 10

• After at least 12 mnths of treatment in women over 50, and 24 mnths in women under 50 .

Question 11

HRT if perimenopausal but suffers from migraines with aura

Answer 11

Topical cyclical combined oestrogen

Question 12

Counselling regarding oral progesterone (norethisterone) for example kin addition to the oestrogen patch

Answer 12

Increased risk of breast cancer (also VTE and CVD risk)