Hormone Replacement Therapy.
Introduction: (Good morning Miss Tracy, I am Dr. Munagapati Senior house officer in the department of Obstetrics and Gynaecology. I would like to have a little chat with you regarding HRT, Hormone replacement therapy.)
Age? When was the last period? Menstrual irregularities?
We you on any contraception?
Any (vasomotor disturbances like) hot flushes, sweating and palpitations? Fractures? (prone to osteoporosis)
Any (vaginal dryness) vaginal and urinary infections, dyspareunia, bleeding, stress incontinence and prolapse? (also atrophy of breast, genitalia and skin.)
Psychosocial problems like irritability & depression.
Smoking, Hysterectomy and oophorectomy?
H/o DM, Heart disease, thyroid and psychiatric problems?
There are a few contraindications to HRT.
Were you diagnosed as having breast carcinoma or undiagnosed PV bleeding? (also breast feeding) and h/o clots in the legs (DVT or PE)?
There are a few SE like weight gain, cholestasis and vomiting.
Hot flushes and vaginal dryness respond to HRT. HRT postpones menopausal bone loss and protects against cardiovascular disease and ovarian carcinoma.
Women with uterus should receive oestrogen and progesterone preparations. This pill is similar to OCP but in very very low dose. If you notice any bleeding consult your GP. (endometrial biopsy).
Types of HRT: Oral, creams, pessaries, rings, transdermal patches and oestradiol implants.
When is HRT particularly desirable: - Premenopausal bilateral ooporectomy, hysterectomy, increased risk of osteoporosis eg: inactive or smokers, Ischaemic heart disease or risk factors like DM and hypercholesterolaemia and Rheumatoid arthritis.
Rule out thyroid and psychiatric problems before starting HRT as they present similarly.
Counseling helps psychosocial problems, contraception should be continued for a year after the last period (PoP, IUCD and barrier methods are suitable.)
Refer: HRT.