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HRT Quiz

HRT Quiz. Dr Sylvia Bond 16/9/09. Below what age is menopause premature?. How long is contraception advised after LMP?. Is PMH cancer of cervix a contraindication to HRT?. Name 3 absolute contraindications. Name 2 conditions HRT reduces the long term risk of.

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HRT Quiz

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  1. HRT Quiz Dr Sylvia Bond 16/9/09

  2. Below what age is menopause premature?

  3. How long is contraception advised after LMP?

  4. Is PMH cancer of cervix a contraindication to HRT?

  5. Name 3 absolute contraindications

  6. Name 2 conditions HRT reduces the long term risk of

  7. Name 1 non-hormonal alternative to treat hot flushes

  8. What FSH level would indicate menopause?

  9. When is CCT HRT indicated? ( Continuous combined therapy)

  10. What is the equivalent dose of HRT from Premarin 0.625mg tablets a. Oestrodiol tabletsB. Oestrodiol patches

  11. Name a type of HRT for the followingwomen with menopausal symptoms • 1 point type and 1 point brand name • Cyclical( sequential) • CCT ( Continuous Combined Therapy) • Unopposed Oestrogen • Topical Oestrogen • Mirena ( IUS) + unopposed oestrogen

  12. 49yrs, menorrhagia and needs contraception

  13. 51yrs , LMP 6/12 ago, IDDM

  14. 58yrs, c/o loss of libido

  15. Weight gain on premique cycle, 52yrs

  16. 52yrs, pmh of TAH,flushes despite premarin o.625mg

  17. 55yrs, stopped HRT 1 year still has flushes. No bleed since HRT

  18. 77yrs recurrent uti and urethritis

  19. Answers to quiz

  20. Below what age is menopause premature?

  21. Below what age is menopause premature? • 45years • Normal range of menopause 45-55 years • Menopause is last menstrual period • Peri-menopause may last 10 years+ with symptoms

  22. How long is contraception advised after LMP?

  23. How long is contraception advised after LMP? • 1 year if over 50 years • 2 years if under 50 years

  24. Is PMH cancer of cervix a contraindication to HRT?

  25. Is PMH cancer of cervix a contraindication to HRT? • No • PMH cancer of ovary is also not contraindicated as not Oestrogen sensitive.

  26. Name 3 absolute contraindications

  27. Name 3 absolute contraindications Pregnancy Undiagnosed abnormal bleeding Breast or endometrial cancer Severe liver disease PMH Thrombosis Migraine with aura

  28. Name 2 conditions HRT reduces the long term risk of

  29. Name 2 conditions HRT reduces the long term risk of • Osteoporosis • Bowel cancer • ? Alzheimer’s disease

  30. Name 1 non-hormonal alternative to treat hot flushes

  31. Name 1 non-hormonal alternative to treat hot flushes • Dixarit ( Clonidine) • Black Cohosh • Red Clover • Kava Kava • Angus castus • Magnesium/Zinc • Phytoestrogens ( Soya /Yam) • Evening Primrose oil • SSRIs

  32. What FSH level would indicate menopause?

  33. What FSH level would indicate menopause? • 32 iu May need to repeat to confirm if basing advice on contraception on result, e.g. When amenorrhoea with IUS and deciding when safe to remove.

  34. When is CCT HRT indicated? ( Continuous combined therapy)

  35. When is CCT HRT indicated? ( Continuous combined therapy) • 12 months after LMP or over 54 years If using cyclical ( sequential) HRT offer swap at 54 years on review or repeat prescription and monthly withdrawal bleeds should stop.

  36. What is the equivalent dose of HRT from Premarin 0.625mg tablets A. Oestrodiol tablets = 1 mg B. Oestrodiol patches = 50mcg

  37. Name a type of HRT for the followingwomen with menopausal symptoms • 1 point type and 1 point brand name • Cyclical( sequential) • CCT ( Continuous Combined Therapy) • Unopposed Oestrogen • Topical Oestrogen • Mirena ( IUS) + unopposed oestrogen

  38. 51yrs , LMP 6/12 ago, IDDM

  39. 51yrs , LMP 6/12 ago, IDDM • Cyclical HRT Still perimenopausal • Premique cycle MPA good for lipids and CVD risk

  40. 49yrs, menorrhagia and needs contraception

  41. 49yrs, menorrhagia and needs contraception • IUS + Unopposed Oestrogen • Mirena + Premarin 0.625mg/ Oestrodiol 1mg • May consider HRT + barrier methods

  42. 58yrs, c/o loss of libido

  43. 58yrs, c/o loss of libido • Tibolone ( Livial ) • CCT

  44. Weight gain on premique cycle, 52yrs

  45. Weight gain on premique cycle, 52yrs • Alternative Cyclical HRT • Femoston 1/10mg

  46. 52yrs, pmh of TAH,flushes despite premarin o.625mg

  47. 52yrs, pmh of TAH,flushes despite premarin o.625mg • Unopposed Oestrogen • Double dose to 1.25mg • Or try Oestrodiol 2mg or patch/gel • Or add non hormonal remedy

  48. 55yrs, stopped HRT 1 year still has flushes. No bleed since HRT

  49. 55yrs, stopped HRT 1 year still has flushes. No bleed since HRT • CCT, lowest dose possible • Kliovance ( 1 mg Oestrodiol+ P) • Premqiue low dose ( 0.325mg premarin+ P)

  50. 77yrs recurrent uti and urethritis

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