QuestionSBA
QuestionChoice
Sequential therapy is suitable for women with a uterus. These women require endometrial protection in the form of a progestogen (either oral or via a Mirena coil). This woman does not have a uterus, so she does not require a progestogen.
49864
c
Evorel Sequi (sequential transdermal oestrogen-only hormone replacement therapy) and oral utrogestan for 14 days per month
QuestionChoice
Testosterone gel is not first-line therapy for treating symptoms of menopause, and this woman does not require a progestogen as she does not have a uterus.
49866
e
Testogel (transdermal testosterone gel) and oral utrogestan
QuestionChoice
Whilst continuous transdermal oestrogen-only hormone replacement therapy is the correct option, this would be trialled alone before thinking about adding in other options such as testosterone gel.
49865
d
Evorel conti (continuous transdermal oestrogen-only hormone replacement therapy) and Testogel (transdermal testosterone gel)
QuestionChoice
Women who have had a hysterectomy should be offered continuous oestrogen-only hormone replacement therapy. Sequential therapy is offered to women with a uterus who are still having menstrual periods, or are within a year of their last menstrual period. Topical vaginal oestrogen pessaries, however, would be a sensible addition to the correct regime.
49863
b
Evorel Sequi (sequential transdermal oestrogen-only hormone replacement therapy) and topical vaginal oestrogen pessaries
QuestionChoice
This woman has symptoms of menopause - hot flushes, night sweats, reduced concentration and vulvovaginal symptoms. She would therefore benefit from a trial of hormone replacement therapy. Since she has had her uterus removed, is it is most appropriate to prescribe her a continuous oestrogen-only regime.
49862
a
Evorel Conti (continuous transdermal oestrogen-only hormone replacement therapy)
QuestionComment
low yield af my boy godam
24760
QuestionComment
Not really tbh...woman without a uterus requires oestrogen only and these are just brand names of HRT...
25344
User
subscriber
Relapse Retrograde
User
subscriber
Anterior Hallux
QuestionComment
Evorel conti is not oestrogen only it has progesterone so all of these options are wrong...?
25926
User
subscriber
Space Occupying Lesion 
QuestionComment
oestrogen pessary is necessary due to the dyspareunia surely? 
29132
User
subscriber
Abrasion Nightshift
Concept
Chapter
# Summary 
  
 
Hormone Replacement Therapy (HRT) is a treatment strategy used to alleviate menopausal symptoms by replacing diminishing hormones. It typically involves small doses of oestrogen and progestogen (if the woman has a uterus) to reduce endometrial cancer risk. HRT may be administered systemically or vaginally and can help manage symptoms such as flushing, insomnia, headaches, vaginal atrophy, and dryness. However, it may also have side effects including breast tenderness, leg cramps, bloating, nausea, and headaches. Key investigations involve assessing the history and physical examination of the patient to decide the need for HRT. Management strategies include careful dose regulation and monitoring for side effects.
  
 
# Definition 
  
 
Hormone replacement therapy (HRT) is a treatment to relieve symptoms of menopause by replacing hormones that decrease as a woman approaches the menopause. It typically involves small doses of oestrogen combined with a progestogen if a woman has a uterus to reduce the risk of endometrial cancer.
  
  
 
# Indications 
  
 
  - Symptomatic relief of vasomotor symptoms such as flushing, insomnia, headaches, vaginal atrophy and dryness
  - Decreases the risk of osteoporosis and colorectal cancer
  - In premature ovarian insufficiency, HRT should be continued until the age of 50. This is to help prevent the development of osteoporosis
  
 
# Contraindications
  
 
  - Undiagnosed vaginal bleeding
  - Pregnancy
  - Breastfeeding
  - Oestrogen receptor-positive breast cancer
  - Acute liver disease
  - Uncontrolled hypertension
  - History of breast cancer or venous thromboembolism (VTE)
  - Recent stroke, myocardial infarction or angina


# Types


HRT can be given systemically, either via oral tablets, transdermal patches or gels, or can be given vaginally for urogenital atrophy, in the form of tablets, creams, pessaries or vaginal rings. Transdermal is the preferred route if the woman is at risk of VTE.


Hormones that can be given as part of HRT are:


  - **Oestrogens:** oestradiol, estrone and conjugated oestrogen are generally used.
  - **Progestogens:** Medroxyprogesterone, norethisterone, levonorgestrel and drospirenone are typically used. A levonorgestrel-releasing intrauterine system (e.g. Mirena coil) may be used as part of the progestogen component of HRT, so the woman may just take oral oestrogen and have endometrial protection via the intrauterine system
  - **Tibolone:** this is a synthetic compound containing oestrogen, progestogen and androgens.


All women require a combination of oestrogen and progesterone as part of their HRT, unless they have had a hysterectomy, in which case oestrogen-only is enough. This is due to risk of endometrial cancer if oestrogen is given alone. 

HRT can be given continuously (for postmenopausal women not having periods) or cyclically (for perimenopausal women still having some periods). Cyclical can include:

- Monthly: Oestrogen every day of the month + progesterone for the last 14 days 
- Every three months: Oestrogen every day for 3 months + progesterone for the last 14 days


# Side Effects


  - Oestrogen: breast tenderness, leg cramps, bloating, nausea, headaches
  - Progestogen: premenstrual syndrome-like symptoms, mood swings, breast tenderness, backache, depression, pelvic pain, fluid retention, weight gain
  - Cholestatic jaundice
  - Increased risk of breast cancer, endometrial cancer, VTE, stroke and ischaemic heart disease

  
# NICE Guidelines

[CLick here for NICE guidelines on HRT](https://cks.nice.org.uk/topics/menopause/prescribing-information/hormone-replacement-therapy-hrt/)

# References


[Primary Care Women's Health Forum](https://pcwhf.co.uk/resources/hrt-types-doses-and-regimens/#)

[Hickey & Davison 2012, The BMJ](https://www.bmj.com/content/344/bmj.e763.long)

[NHS Website](https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/types-of-hormone-replacement-therapy-hrt/)
1003
2365
Hormone replacement therapy
Topic
26
Gynaecology
10009
A 48-year-old woman attends her general practitioner troubled with waking up at night drenched in sweat. She also finds it difficult to concentrate on her work as a statistics professor. She has not had sex with her husband since her hysterectomy as she struggled with low libido postoperatively and now finds it too painful to attempt intercourse.

Her past medical history is significant for a hysterectomy with ovarian preservation age 44 for a large fibroid. She also has Ehlers-Danlos syndrome, which manifests as joint hypermobility with frequent dislocations.

Which of the following medication regimes is most appropriate?
a