HRT in afya

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''Use for ....''
Vasomotor Sx - flushing, insomnia, headaches
Premature Menopause - continue till 50yrs

For reversal of vaginal atrophy and prevent osteoporosis - use other agents

''When starting check ....''
BP
Blood - cholesterol, TFT
Weight (so know if goes up)
V/E - ?big fibroid etc
Smear
Mammogram
Check FH breast or ovarian ca

''Advise''
menopause matters
Health Food shop - oestrogenic foods
Risks - breast, ovarian, endometrial - look at gpNotebook
Ca, Vit D, Exersize

''Use''
Elleste duet or solo (can go onto cont combined after 18/12 post-men)
If moody - change to MPA (Premique cycle)
If bloating - change to Dydrogesterone (Femostan)
If migraine can try patch for oestrogen (elleste solo) with MPA tabs (day 15-28) for progest. (patch gives lower dose)
Tibolone - useful for Sx though expensive

''SE''
nausea
fluid retention
weight gain

''Complications''
Inc breast ca (inc further with Progest)
Inc endometrial (helped by progest, but ?not eliminated unless given continuously ??)
inc VTE ( inc further with progest)
inc stroke
inc IHD if taken >10yrs post menopause

''Breast ca''
In WHI - inc relative risk of 1.26 at 5yrs
relates to duration of use and risk dec when HRT stopped - baseline by 5yr
higher in combined preps rather than oestrog only

Other benefit - dec colorectal ca

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