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8 Cards in this Set
- Front
- Back
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What are the treatment options? |
Estrogen
- Oral - Transdermal - Vaginal Estrogen and progesterone – sequential /continuous combined Tibilone Plant estrogens Non hormonal – Gabapentin, venlafaxin |
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What are the issues with hormone therapy? |
VTE
Stroke Gallbladder disease Metabolic M.I. Breast cancer Endometrial cancer Ovarian cancer |
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How does oestrogen affect atheroma? |
- A stable atheroma plaque consists of anextracellular matrix and a fibrous collagen cap - Macrophages release MMPthat digest collagen, thinning the fibrouscap anddestabilizes the plaque
- Oral estrogen increases MMP and CRPlevels - Oral estrogen thus dangerous in olderwomen withatheroma - Youngerwomen onlysuffer the consequences of the thrombotic state induced by estrogen - Transdermalestrogen do not induce these changes |
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Which patients benefit from transdermal oestrogen? |
Patients at increased risk for VTE suchas obese, osteoarthritis sufferers, varicose veins or family history
NB -Transdermal still contra-indicated inprevious VTE or prothrombotic mutation sufferers |
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What considerations are there with gallbladder disease and hormone therapy? |
Oral estrogens affect gallbladderfunction and risk for cholecystectomy increases with Hormone Therapy
Risk not increased with transdermal oestrogen |
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What are the metabolic effects of hormone therapy? |
Greater fat gain with oral oestrogen than transdermal
Transdermal route of choice for womenwith a family history of VTE and for obese women Oral HT reduces risk for new-onset DM Transdermal estrogen and micronized progesterone givesignificant reduction in new-onset DM Tgl and thrombotic factors, which frequentlyare elevated in DM are not increased further with transdermal HT Hpthas only been reported with oral therapy |
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What relation does hormone therapy have with myocardial infarction? |
Cardioprotection with transdermal oestrogen
No change with oral oestrogen DM – more MI’s, higher mortality and morerecurrences |
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What considerations are there with breast cancer and HT? |
Breast cancer increaed with progesterone Oestrogen+ micronized progesterone not associated with breast cancer risk Oestrogen + dydrogesterone associated withincrease in lobular cancer but not duct cancer |
