F&C OSCES

Year 4

Mar 2016

HRT counselling + consent

WIPE + ICE
HRT involves taking hormones such as
oestrogen and progesterone to replace the
decline in the bodys levels around the time
of menopause. This can help with related
symptoms
HIST
-

Confirm menopause
Discuss symptoms
o Vasomotor hot flush, night
sweats
o Urogenital vaginal dryness,
pain with sex, UTIs
o CV palpitations
o Sleep + mood
Age 51y +-5y
Uterus intact? Y O + P because only O can cause womb cancer, not
intact O only

Rx osteoporosis, breast/ovarian/womb cancer, CHD, stroke, high BP, liver

disease
EXAMINATION BP, Height+Weight, Other exam
HEALTH PROMOTION- smoking + alcohol, diet +exercise, smear?, breast exam
+ screen
INVESTIGATIONS not required over 45, amemenorrhea for at least 12m
INDICATIONS treat most of symp with good risk:benefit ratio, early
menopause, under 60 who are at risk of osteoporotic fracture

BENEFITS
-

Vasomotor symptoms
Urogential symptoms
Reduction in
osteoporosis + CHD risk
Less palpitations
Better sleep and mood

RISKS
-

Breast cancer
VTE can be prevented
by transdermal route
CHD
SE bloating, oedema,
headaches, indigestion,
depression, erratic
bleeding

F&C OSCES

Year 4

Mar 2016

Which HRT? It is up to you what works best for you. The benefits usually
outweigh the risks. We start on the lowest effective dose to minimise SE.
Oral or transdermal Oestrogen transdermal fewer risks
Micronised progesterone 200mcg/d 2w, 2w off if youre still having periods.
100mcg/d if no periods

Sequential combined
-

LMP was <1y previous

Oestrogen then progesterone on day 14, regular bleeding at end of cycle

Continuous combined HRT-

LMP >1y since

OR LMP >2y if premature menopause