I want to start HRT please - PowerPoint PPT Presentation

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Title:

I want to start HRT please

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Menstrual hx; check for IMB, PCB and Smear hx. Flushing or sweating ... HRT Androgen implants for loss of libido. No uterus. Oestrogen only ... – PowerPoint PPT presentation

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Title: I want to start HRT please


1
I want to start HRT please
  • Samadhi Reid
  • NPT VTS

2
History taking
  • Age (52 year old)
  • Why does she think she wants HRT?
  • What are her expectation?
  • Symptoms
  • Hysterectomy or not?
  • Menstrual hx check for IMB, PCB and Smear hx
  • Flushing or sweating
  • Urinary symptoms and loss of libido
  • (Tiredness, anxiety, irritability, poor sleep
    etc.)

3
History taking cont..
  • PMH
  • Breast Ca (do you examine your breasts?)
  • DVT
  • risk factors for CVD (inc smoking)
  • FH of above
  • DH
  • Previous experience of HRT
  • Anti epileptics
  • If on thyroxine, check TFT as dose may need to
    be ?
  • Contraception

4
Management
  • Check BP, Weight/ BMI
  • Explain what menopause/ peri-menopausal period is
  • Reassurance short lived symptoms
  • Complementary medicines - ? Red clover ? Soy
  • Clonidine - placebo
  • Simple measures - cotton wear, fans, avoiding
    triggers, exercise, relaxation techniques

5
HRT
  • Contraindications
  • Ca breast/ endometrial
  • Thromboembolic disease (inc AF)
  • Liver disease (raised LFT)
  • Indications
  • Early menopause - cont until 50 yrs
  • Hysterectomy - 14 have early menopause
  • Relief of symptoms of oestrogen deficiency

6
Choice of HRT
  • Tablets, patches, implants,
  • vaginal pessary/ gels/ creams/ rings
  • Topical preparations
  • For vaginal dryness and atrophic vaginitis
  • No progesterone is needed, but limit use to
    3-6/12 if intact uterus
  • HRT Androgen implants for loss of libido

7
  • No uterus
  • Oestrogen only
  • Add progesterone, if there is a hx of
    endometriosis
  • Intact uterus
  • Peri menopausal or first 12/12 since last period
  • Withdrawal bleed essential
  • Progesterone for the last 2/52
  • Check FSH/LH if on cyclical HRT (start of pack)/
    pill (end of pill free week) or
  • Stop HRT for 6/52 and check levels

8
  • After the first 12/12 of menopause
  • Can have a continuous combined preparation or
    Tibolone (Livial)
  • Side Effects
  • Oestrogen HRT - fluid retention, breast symptoms,
    nausea, headaches
  • Progesterone HRT - headache, bloating, weight
    gain, depression

9
Follow up
  • Review in 3/12
  • Review SE, Check BP and weight
  • Increase dose if still symptomatic
  • Erratic bleeding common in the first 3/12
  • CC preparations - spotting for 12/12 common, Ix
    if gt 12/12
  • Review 6 - 12 monthly after

10
Stopping HRT
  • Ideally lt 5yrs
  • Warn re withdrawal flushes
  • Stop in cold weather, halve the dose for 1/12
  • Need to discuss pros and cons of HRT

11
Risk and Benefits of HRTOxford General Practice
Library Womens health Oxford Press
12
Thank you!
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